Role-Emerging Clinical Placements in a Community-Based HIV Organization - Opportunities for Interprofessional Collaboration: A Case Report.

Purpose: We describe the development, implementation, and outcomes of role-emerging (RE) clinical placements at Positive Living Niagara (PLN), a community-based HIV organization (CBHIVO), for two second-year, entry-level Master of Science (Physiotherapy) (MSc[PT]) students from McMaster University. Client Description: A national, not-for-profit organization, Realize, conducted outreach to identify CBHIVOs interested in developing physiotherapy (PT) student placements. Intervention: PLN responded to the outreach and worked with McMaster's MSc(PT) programme and Realize to establish two part-time RE PT student placements. The placement description and expectations were developed collaboratively by PLN, Realize, and the MSc(PT) programme. All PT students participating in their third 6-week clinical placement were eligible to apply. A registered occupational therapist and physiotherapist and PLN's programme services manager participated in a shared model to supervise the students' clinical and administrative activities. Measures and Outcome: These first RE PT placements in a Canadian CBHIVO were completed between November and December 2016. The evaluation of the student and placement included a learning contract and the Canadian Physiotherapy Assessment of Clinical Performance. Over 6 weeks, the students collaborated with people living with HIV (PLWHIV) who were members of PLN to identify a role for physiotherapists at PLN and led two health promotion workshops for PLN's members and staff. Implications: The RE PT placement identified future opportunities for physiotherapists at PLN. The experience also influenced one student's decision to apply after graduation for a newly created PT position that included working with PLWHIV.

Objectif : présenter la création, la mise en œuvre et les résultats de stages cliniques en milieux émergents (MÉ) au sein de Positive Living Niagara (PLN), un organisme communautaire voué au VIH (OCVIH) où ont séjourné deux étudiants à la maîtrise en physiothérapie de l'université McMaster. Description du client : un organisme à but non lucratif national, Realize, a demandé à des OCVIH s'ils aimeraient accueillir des stages en physiothérapie. Intervention : PLN a répondu et, conjointement avec le programme de maîtrise en physiothérapie de McMaster, a mis sur pied deux stages en physiothérapie à temps partiel en MÉ. PLN, Realize et le programme de maîtrise ont rédigé ensemble la description du stage et les attentes. Tous les étudiants en physiothérapie qui participaient à leur troisième stage clinique de six semaines étaient admissibles. Un ergothérapeute agréé, un physiothérapeute et le chef des services relatifs aux programmes de PLN ont participé à un modèle de supervision partagé des activités cliniques et administratives des étudiants. Mesures et résultats : Ces premiers stages de physiothérapie en MÉ tenus dans un OCVIH canadien ont eu lieu entre novembre et décembre 2016. L'évaluation de l'étudiant et du stage incluait un contrat d'apprentissage et l'évaluation du rendement clinique de la physiothérapie au Canada. Sur une période de six semaines, les étudiants ont collaboré avec des personnes vivant avec le VIH (PVVIH) membres de PLN pour déterminer le rôle des physiothérapeutes à PLN et ont dirigé deux ateliers de promotion de la santé pour les membres et le personnel de PLN. Conséquences : le stage en physiothérapie en MÉ a permis de relever de futures possibilités pour les physiothérapeutes à PLN. L'expérience a également incité un étudiant à postuler, après l'obtention de son diplôme, à un nouveau poste de physiothérapeute auprès de PVVIH.

Dementia as a Disability and Human Rights Issue.

In their article "Toward a Community-Based Dementia Care Strategy: How Do We Get There from Here?" Morton-Chang et al. draw attention to the urgent need for a community-based dementia care strategy in Canada. Drawing from national and international experience, including an illustrative case study of policy in Ontario, they identify three key strategic pillars to guide strategic action: 1. Engage persons living with dementia (PLWD) to any extent possible in decisions around their own care. 2. Acknowledge and support informal caregivers in their pivotal roles supporting PLWD and consequently the formal care. 3. Enable "ground-up" change through policies and funding mechanisms designed to ensure early intervention across a continuum of care. In this paper, we aim to broaden the lens for dementia and strategic action by framing dementia in terms of disability and human rights. We contend that a human rights approach is critical to addressing the vulnerability of people with dementia and caregivers and achieving the principal goals of dementia care, as they are largely represented in the strategic pillars proposed. These pillars direct action towards key areas of change within the existing health system but may not in and of themselves create the transformative change needed across systems and levels. Through the lens of disability and human rights, we reflect upon the complexity of dementia and move from the individual to the social sphere - shifting the focus from "care" that is oriented to "maintenance" in the community, towards "enablement," "empowerment" and social change, as it involves the reconceptualization of dementia that has begun to take shape at local, national and international levels. This brings us to the central argument of this paper, that dementia is as much a human rights issue and a social problem as it is a health issue, necessitating widespread social/systems change and strategic action that "challenges and changes the defining beliefs of a system, resource and authority flows and routines in such a way as to protect human rights and ultimately enable the resilience of the individual and the broader system" (Ecosystems for Systems Change n.d.). Towards this aim, we will apply the concepts of disability and human rights to the pillars posited by the authors and suggest that each can be made stronger by shifting our focus from care to enablement and social change.

Errorless compliance training: building a cooperative relationship between parents with brain injury and their oppositional children.

Errorless compliance training, a noncoercive intervention for improving child compliance, was evaluated in a multiple baseline across-subjects design with 12 oppositional children (ages 2-7 years) and their brain-injured parents, who suffered from cognitive deficits, impulsivity, and/or emotional instability. Generalized and durable increases were observed in child compliance after treatment. Pre/post improvements were also noted on a measure of parent self-esteem. Errorless compliance training may be well suited to intervention with parents with cognitive and behavioral impairments that decrease their potential to benefit from traditional parenting approaches.