PURPOSE:To assess hypertension-related knowledge, self-management behaviors, and post-stroke needs among African American (AA) stroke survivors in rural Alabama. DESIGN:Cross-sectional, mixed-methods study. METHODS:Using convenience sampling, we recruited 25 AA stroke survivors aged 50 years or older from three rural counties in Alabama. Quantitative data were collected using the Hypertension Knowledge-Level Scale (HK-LS), hypertension Self-Care Activity Level Effects (H-SCALE), and the Southampton Stroke Self-Management Questionnaire. Fourteen participants completed semi-structured interviews. Descriptive statistics and thematic analysis were used to analyze the data. RESULTS:Most participants had low hypertension knowledge (56%) and poor adherence with medication (76%), the DASH diet (84%), physical activity (56%), and smoking cessation (72%). Qualitative analysis of participant interviews identified key barriers to hypertension management and post-stroke recovery, including limited hypertension knowledge, poor adherence, gaps in continuity of care, and limited social support. CLINICAL RELEVANCE:Rehabilitation nurses play a critical role in improving hypertension management and post-stroke recovery through culturally tailored education, reinforcement of self-management behaviors, and improved care coordination. Strengthening patient education and access to community-based resources may reduce recurrent stroke risk and improve outcomes. CONCLUSIONS:AA stroke survivors in rural settings face significant challenges in hypertension management and recovery. Targeted, culturally responsive, and community-engaged interventions are needed to improve self-management and long-term outcomes.
BACKGROUND:Millions of stroke family caregivers struggle to provide home care. As an experienced nurse and family caregiver, I have learned that there are general approaches/specific interventions that can assist carers and impact overall health, making families more competent and confident in providing effective home care. PURPOSE:Practice expertise and two "real" stories informed the family caregivers' Homecoming ABCs post stroke, a nurse-guided home management approach. they are shared and then intertwined with the Association of Rehabilitation Nurses (ARN) Competency Model for Professional Rehabilitation Nursing. APPROACH:The ARN Competency Model provides a lens to view and appraise situations, organize and act, and examine and judge outcomes. Homecoming ABCs woven throughout this model are health management methods that rehabilitation nurses can share with families in preparation for home discharge, or for continued home care. OUTCOMES AND CLINICAL RELEVANCE:Homecoming ABCs linked to the Competency Model reflect current practices and advance the specialty of rehabilitation nursing. Homecoming ABCs' nurse-guided approach suggested for family caregivers has the potential to enhance the quality of care experienced and reduce the risk for institutionalization for persons with stroke. CONCLUSION:Homecoming ABCs, along with the ARN Competency Model, provide an organized framework to promote best practices, as rehabilitation nurses prepare stroke caregivers for family members' discharge or continued care and management in home settings.
PURPOSE:To examine the agreement between unpaid caregivers' and rehabilitation nurses' evaluation of caregiver preparedness for discharge following a stroke. DESIGN:Observational design focusing on agreement between dyads. Dyads consisted of one caregiver and one corresponding rehabilitation nurse. METHODS:To assess agreement between dyads, the unpaid caregivers of poststroke patients and the rehabilitation nurses providing direct care to those patients, each independently completed the Preparedness Assessment for the Transition Home after Stroke (PATH-s) within 72 hours before patient discharge from an inpatient rehabilitation facility. Descriptive statistics and paired t tests were used to compare the total PATH-s scores. RESULTS:We analyzed data provided from 20 caregiver-nurse dyads. The mean PATH-s scores were slightly higher for caregivers (M=75.1, SD=11.4) than for nurses (M=73.2, SD=8.1); however, this difference was not statistically significant (t=0.67, P=0.51), and the effect size was small (Cohen d=0.15). CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING:Alignment between caregivers and rehabilitation nurses supports a shared understanding of discharge readiness . CONCLUSION:Overall agreement in perceived preparedness existed between caregivers and rehabilitation nurses regarding the transition home after stroke, suggesting that current discharge education practices may support alignment of expectations, though this finding does not confirm objective caregiver readiness or guarantee an uneventful discharge.
PURPOSE:To identify subgroups of older adults with hip fractures who are more likely to experience delayed discharge from acute orthopedic hospitalization to postacute rehabilitation and to examine the impact of such delays on adverse events and short-term outcomes. DESIGN:Retrospective cohort study conducted between 2018 and 2022 at a large tertiary hospital in north-central Israel. METHODS:The study included 474 adults aged ≥65 years hospitalized for hip fracture surgery and eligible for postacute rehabilitation (inpatient or home-based). Analyses evaluated predictors of delayed discharge from acute orthopedic hospitalization to postacute rehabilitation. We examined adverse events occurring after rehabilitation approval and before acute hospitalization discharge (infections, falls, and in-hospital mortality), early postdischarge outcomes (re-hospitalization and re-operation), and hospitalization costs . FINDINGS:Delayed discharge occurred in 61.4% of patients, with a mean delay of 3.5 days. In unadjusted analyses, delayed discharge was associated with higher rates of infections, falls, and mortality. In multivariable models adjusting for age and rehabilitation pathway, delayed discharge remained independently associated with healthcare-acquired infections (OR=3.09, 95% CI: 1.62-5.90, p<.001), but not with mortality. Referral to inpatient rehabilitation was also independently associated with infection risk (OR=2.21, 95% CI: 1.10-4.45, p=.026). CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING:Early identification of patients at risk for delayed transition to postacute rehabilitation may support proactive discharge planning, infection prevention strategies, and coordinated care across settings. CONCLUSIONS:Delayed transition from acute orthopedic hospitalization to postacute rehabilitation is independently associated with increased risk of healthcare-acquired infection and higher hospitalization costs. Reducing avoidable acute care days through improved coordination may enhance patient safety and system efficiency.
PURPOSE:This review synthesized the prevalence and factors associated with depressive symptoms among adult stroke survivors during the subacute and chronic phases. DESIGN:A scoping review. METHODS:Research articles in English published up to November 2024 were identified through PubMed and CINAHL searches, following Arksey & O'Malley's methodological framework. RESULTS:Fourteen studies were included from 609 screened. Various instruments were used to assess depressive symptoms, with prevalence estimates varying from 20% to 84.8%. Several clinical and psychosocial factors were associated with higher levels of depressive symptoms, including comorbid conditions, greater functional dependence, stroke severity, and perceived stigma. In contrast, post-stroke employment, optimism, and social support were associated with lower levels of depressive symptoms. Caregiver well-being was also closely linked to depressive symptoms among adult stroke survivors. CONCLUSIONS:Our findings highlight variation in prevalence and factors associated with depressive symptoms among adult stroke survivors during the subacute and chronic stages. Effective management should consider patients' clinical and psychosocial conditions as well as caregiver well-being. CLINICAL RELEVANCE:Brief standardized tools may support routine and repeated screening for depressive symptoms in nursing practice during ongoing rehabilitation and follow-up care. Screening for caregiver distress may also be important in stroke care.
PURPOSE:To estimate the association between morning and evening care and the duration of physical activity in patients with stroke. DESIGN:Multicenter cross-sectional study. METHODS:Physical activity of patients with stroke from five rehabilitation hospitals was measured using an accelerometer. Four datasets relative to activity time periods (7:00-20:00, 9:00-20:00, 7:00-18:00, and 9:00-18:00) were compared, and measurement error was assessed using the absolute percentage error (APE) relative to the 7:00-20:00 reference dataset. RESULTS:The final analysis included 245 patients (median age 71 y). Median sedentary behavior, light intensity physical activity (LPA), and moderate to vigorous physical activity (MVPA) during the 7:00-20:00 reference period were 644.7, 130.0, and 3.9 minutes per day, respectively. Based on the reference period of 07:00-20:00, the APE for LPA and MVPA was highest during 07:00-18:00 (LPA: 21.6; MVPA: 24.2), followed by 09:00-20:00 (LPA: 11.5; MVPA: 11.2) and 09:00-18:00 (LPA: 9.9; MVPA: 10.5). CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING:Rehabilitation nurses should be aware that nursing care and self-care are key opportunities for patients to engage in physical activity. CONCLUSIONS:Morning and evening care periods represent relevant physical activity times for survivors of stroke in rehabilitation hospitals.
PURPOSE:To evaluate the impact of phase III cardiac rehabilitation (CR) protocol on the physical fitness of individuals with cardiac disease in a community-based setting. DESIGN:A descriptive-correlational longitudinal study conducted at a community center in Portugal from November 2022 to January 2023. METHODS:Participants underwent two evaluation points, 10 weeks apart, during which they completed 20 supervised rehabilitation sessions. Physical fitness was assessed using validated instruments for the Portuguese population. Data collection was performed by rehabilitation nurses, and data were analyzed using SPSS version 28. RESULTS:The sample included 30 participants, mostly male (63.3%), with a mean age of 66.1 years. The majority were overweight (56.7%), and 43.3% had an elevated cardiovascular risk based on abdominal circumference. Statistically significant improvements were observed in abdominal circumference, lower limb strength, handgrip strength, and cardiorespiratory capacity. A nonsignificant but positive trend was also observed in body mass index. CLINICAL RELEVANCE:This study highlights the importance of community-based Phase III CR exercises as a strategy to improve functional outcomes and reduce cardiovascular risk. These interventions require structured supervision to ensure safety and effectiveness. CONCLUSIONS:The Phase III CR protocol led to meaningful improvements in physical fitness and anthropometric indicators among cardiac patients, supporting the continued expansion of structured rehabilitation services in community settings.
PURPOSE:This pilot study assessed the feasibility and usability of a Dashboard for Individual Clinician Enhancement (DICE) and explored its preliminary impact on nurses in a rehabilitation setting. DESIGN:The study included a focus group and quantitative measures of feasibility and usability. An exploratory randomized control trial (RCT) examined preliminary effects of DICE access on outcome measures. METHODS:In Phase I, nurses provided feedback on DICE design, and suggestions were incorporated into DICE V2.0. Phase II measured usability, viewing frequency, and perceived value, and included an exploratory RCT to examine potential effects on key performance indicators (KPIs) and the Psychological Empowerment scale (PES). RESULTS:Nurses rated DICE usability as "good" and accessed the dashboard an average of 2.2 times per month. Participants reported positive perceptions, describing the DICE as empowering, accessible, and helpful for increasing awareness of their contributions to patient care and quality improvement. Exploratory analyses of impact on KPIs and the PES were inconclusive due to insufficient statistical power. RELEVANCE TO CLINICAL PRACTICE:Preliminary findings suggest that DICE can help nurses to feel more informed about their performance, which could support empowerment in clinical practice. CONCLUSIONS:The study demonstrated DICE usability, feasibility, and positive reception by rehabilitation nurses.
PURPOSE:This study aimed to clarify the perception of the specific nursing role among nurses and the interprofessional team in two rehabilitation units of a Swiss University hospital. DESIGN AND METHODS:As part of an implementation project, we employed a multi-method design, including qualitative and quantitative approaches, to conduct a comprehensive contextual analysis in preparation for introducing an innovation in two rehabilitation units of the Geneva University Hospital. We performed 11 focus groups among nurses, nurse managers, other health care professionals, patients, and family members (N=50), analyzed using a six-stage thematic analysis approach. A structured questionnaire was additionally completed by 35 nurses. RESULTS:The nursing role in rehabilitation was recognized but only partially deployed. Identified barriers included unclear role definitions, lack of leadership, organizational constraints and limited interprofessional understanding. Nurses prioritized patient autonomy and holistic care, while interprofessional teams primarily perceived nurses in delegated roles. Quantitative results highlighted the importance of prioritizing the nursing role but revealed challenges in interprofessional collaboration, particularly regarding feasibility and competence. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING:Clarifying and reinforcing the contributions of rehabilitation nurses is essential to enhancing leadership, interprofessional collaboration, and patient outcomes. Recommended strategies include reflective practice, interprofessional training, and promoting nursing-specific competencies early in education (undergraduate/postgraduate training). CONCLUSION:Clarifying the specific nursing role in rehabilitation and participating in interprofessional training are key to improving collaboration and strengthening leadership. Future efforts should focus on integrating role clarification and leadership into nursing education to optimize teamwork and patient outcomes.
BACKGROUND:Pulmonary rehabilitation (PR) is a key nonpharmacological intervention that significantly improves prognosis and health outcomes in patients experiencing acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Despite its proven benefits, PR adherence among this population remains low, with multiple factors influencing participation and completion. OBJECTIVE:This mixed-methods systematic review aims to analyze and synthesize current evidence on the barriers and facilitators affecting PR adherence in patients with AECOPD. DESIGN:A systematic search was conducted in MEDLINE, PubMed, and Web of Science to identify studies examining PR adherence in patients with AECOPD. Studies published in English from 2014 to 2024 that involved adult patients with AECOPD participating in PR programs were included if they reported on adherence to PR and its influencing factors. Excluded were review articles, case reports, editorials, conference abstracts, and studies without accessible full text. Articles were extracted and analyzed using the convergent integrated approach. RESULTS:Eight studies met the inclusion criteria, including four quantitative studies, three qualitative studies, and one mixed-methods study. The methodological quality of the included studies ranged from moderate to high. Thematic analysis revealed the barriers and facilitators of PR adherence: (1) personal motivation and education, (2) physical and psychological health, (3) family and social support, and (4) transportation and economic challenges. CONCLUSION:Multiple and interrelated factors affect PR adherence in patients with AECOPD. The present findings indicate that future intervention research should test the effectiveness of developing individualized PR plans based on disease severity, addressing psychological barriers, and implementing motivation-enhancing interventions. Likewise, intervention studies are needed to verify that involving family members in the rehabilitation process and expanding the role of health care professionals in providing proactive, continuous support improve long-term adherence and patient outcomes.
PURPOSE:We aimed to investigate the relationships between supportive care needs, caregiver burden, and mental well-being of family caregivers providing care to patients with cancer. DESIGN:We conducted a cross-sectional correlational study. METHODS:We collected data from 217 family caregivers of patients with cancer during their relatives' treatment in oncology clinics, outpatient oncology clinics, and outpatient chemotherapy units of two hospitals between February and May 2024. We utilized the Supportive Care Needs Survey-Partners and Caregivers, the Zarit Caregiver Burden Scale, and the WHO-5 Well-Being Index. The Supportive Care Needs Survey includes four sub-dimensions: psychological and emotional needs, health care and information needs, work and social needs, and communication and family needs. We conducted Pearson correlations and mediation analyses to examine relationships among supportive care needs, caregiver burden, and mental well-being. RESULTS:We found a moderate negative relationship between well-being and caregiver burden (r=-.494, p<.01), and between well-being and supportive care needs (r=-.390, p<.01). We found a strong positive correlation between caregiver burden and supportive care needs (r=.616, p<.01). Mediation analysis indicated that higher supportive care needs were associated with greater caregiver burden, which was associated with lower mental well-being. CLINICAL RELEVANCE:Nurses are essential for identifying and addressing caregivers' supportive care needs. CONCLUSIONS:Our findings indicate that supportive care needs are associated with poorer mental well-being, andassociated with caregiver burden. Addressing caregivers' needs may help reduce their burden and, consequently, improve their mental well-being.
PURPOSE:Major dysvascular lower limb amputations often lead to psychosocial challenges postdischarge. This review aimed to synthesize evidence on the psychosocial perspectives during the postdischarge rehabilitation phase. DESIGN:Systematic meta-aggregation. METHODS:Full-text peer-reviewed articles were retrieved from PubMed, Embase, APA PsycInfo, Scopus, and CINAHL Ultimate up to August 11, 2023. Data were synthesized using the Joanna Briggs Institute meta-aggregation approach. Confidence in findings was assessed with GRADE-CERQual. FINDINGS:From 30 studies, 289 findings were synthesized into 12 key findings. According to findings, physical limitations, environmental barriers, social interactions, and personal expectations shaped activity, identity, independence, sexuality, and emotional adjustment. Prostheses, social support, and coping strategies facilitated engagement, while stigma, grief, fear, and financial strain posed challenges. Confidence levels were 7="high," 4= "moderate," 0="low," and 1="very low." CLINICAL RELEVANCE:Rehabilitation and counseling programs for persons with major dysvascular lower limb amputations should integrate psychosocial assessment and individualized goals. Nurses can support patients by facilitating peer support, addressing emotional distress, and managing expectations around prosthetic use to promote independence, mobility, and social participation. CONCLUSIONS:Postdischarge psychosocial experiences for persons with major dysvascular lower limb amputations are multifaceted. Holistic, tailored approaches supporting autonomy, mobility, and emotional health are essential. Future research should consider cultural and health care system differences.
PURPOSE:This meta-analysis investigated the effects of yoga-based interventions on caregiver quality of life and psychosocial variables. DESIGN:This study was conducted as a systematic review and meta-analysis. METHODS:A comprehensive literature search was conducted through September 2024 across Web of Science, CENTRAL, PubMed, and MEDLINE, identifying 926 records. After duplicate removal, 658 studies were screened by title and abstract, and 35 articles underwent full-text assessment. After exclusions due to reporting issues, insufficient data, or irrelevant outcomes, 12 studies were ultimately included in the meta-analysis. RESULTS:This meta-analysis demonstrated that yoga-based interventions were associated with a significant reduction in caregivers' anxiety [standardised mean difference (SMD)=-0.99, p=.003], depression (SMD=-0.69, p=.002), and stress levels (SMD=-0.35, p=.028). In addition, yoga-based interventions led to a significant improvement in psychological quality of life (SMD=0.82, p<.001) and overall quality of life (SMD=0.88, p=.007). In contrast, yoga-based interventions did not show a statistically significant effect on caregiver burden, physical quality of life, social relationships, or financial status (p>.05). CLINICAL RELEVANCE:Nurses may recommend yoga-based interventions to caregivers as a way to support their mental health, psychosocial well-being, and quality of life. CONCLUSIONS:Yoga-based interventions were effective in improving the quality of life and psychosocial variables among caregivers.
Background:This study explored patients' experience with a specialized rehabilitation course after aortic dissection surgery.Method:A qualitative study was conducted using content analysis inspired by Graneheim and Lundman. Participants were recruited by a physiotherapist at the end of or shortly after the rehabilitation course at the hospital to partake in an interview. The interviews were held either over the phone or in a private room at the hospital.Results:Through eight patient interviews (three women and five men aged 45-73 years), an overarching theme was identified: Finding peace in a new version of oneself, which deals with having to find oneself in a new role with a different body that must and can do less, at the same time with a feeling of gratitude for being alive. In addition, three subthemes arose from the time of operation and throughout the course of rehabilitation: (1) Having survived the operation-first the miracle! And what now? (2) The rehabilitation course provides security and provides well-being. (3) Becoming a whole person again.Conclusion:This study provides important insights of patients' perspectives of how structured cardiac rehabilitation after aortic dissection supports patients finding peace in a new version of themselves.
PURPOSE:This study aimed to assess the validity and reliability of the Turkish version of the Assessing Family Caregiver Communication in Chronic Illness (FCCT-CI) Scale. DESIGN:This study examined the psychometric properties of the FCCT-CI. METHODS:Data were collected between December 2023 and March 2024 from family caregivers of care recipients receiving home care services at a hospital in Central Anatolia, Türkiye. The study involved linguistic validation through translation and expert review. Construct validity was tested through confirmatory factor analysis, criterion validity through correlations with the Family APGAR, Bakas Caregiving Outcomes, and Family Climate Scales, and reliability through internal consistency. RESULTS:A total of 223 family caregivers were included in the study. The content validity index of the scale was 0.91. Confirmatory factor analysis supported a two-factor structure. Scale indicated acceptable convergent validity, whereas discriminant validity between the two subdimensions was not fully supported. Strong positive correlations were found between the FCCT-CI and both the Family APGAR Scale (conversation: r = 0.949; conformity: r = 0.824) and the Bakas Caregiving Outcomes Scale (conversation: r = 0.917; conformity: r = 0.786). For the Family Climate Scale, relationality showed strong positive correlations with conversation (r = 0.966) and conformity (r = 0.856), whereas intergenerational authority showed strong negative correlations with conversation (r = -0.862) and conformity (r = -0.754). Cognitive alignment also showed strong positive correlations with conversation (r = 0.930) and conformity (r = 0.838). The FCCT-CI demonstrated excellent internal consistency, with α = 0.992 for conversation and α = .804 for conformity. CLINICAL RELEVANCE:The FCCT-CI scale, including its Turkish version, can help nurses identify and address family communication dynamics to improve chronic illness care. CONCLUSIONS:The study provides initial evidence supporting the reliability and validity of the Turkish FCCT-CI for assessing FCCT-CI settings.
PURPOSE:Spinal cord injury is a significant cause of morbidity and mortality. This study aims to assess the caregiving competence and readiness of first-time caregivers for individuals with SCI. DESIGN:A cross-sectional and correlational study. METHODS:The study was conducted with 122 first-time caregivers of persons diagnosed with paraplegia or tetraplegia, hospitalized in a rehabilitation hospital in Ankara, Türkiye. Data were collected using the Descriptive Characteristics Form, the Caregiving Preparedness Scale, and the Caregiving Competence Scale. Analyses included descriptive statistics, correlation, and regression methods. RESULTS:Among the participants, 77% were female, and 41.8% had at least one chronic disease. Furthermore, 73.8% had received training from health care professionals on caregiving. The most challenging aspect of caregiving was transfers (45.1%). A strong positive correlation was found between caregiving competence and caregiving preparedness (r=.836, p<.001). Higher education and prior training were associated with greater competence and preparedness. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING:Findings underscore the importance of structured, individualized caregiver education. Rehabilitation nurses play a pivotal role in improving caregiver skills and reducing care burden. CONCLUSIONS:Targeted training programs during inpatient rehabilitation can significantly enhance caregiver competence and readiness, contributing to better outcomes for both caregivers and individuals with SCI.
BACKGROUND:Swallowing dysfunction is a common consequence of neurological disorders such as stroke, and may lead to malnutrition, aspiration, and reduced quality of life. Nurses are key members of the interdisciplinary team involved in the early detection and management of these issues. PURPOSE:This review explores the role of nurses in swallowing rehabilitation across the acute, recovery, and chronic phases, emphasizing interdisciplinary collaboration and the integration of emerging technologies. METHODS:A literature search was conducted using PubMed, focusing on studies involving swallowing rehabilitation in neurological patients, particularly those highlighting nursing interventions. RESULTS:In the acute phase, nurses perform bedside screening to identify dysphagia early and coordinate timely care with other team members. During recovery, they support swallowing exercises, monitor patient progress, and provide education to patients and caregivers. In the chronic phase, nurses oversee long-term care, support nutritional management, and train family members. Technologies such as virtual reality and artificial intelligence enhance individualized rehabilitation strategies. CONCLUSIONS:Swallowing rehabilitation requires phase-specific nursing interventions and close interdisciplinary teamwork. Strengthening the role of nurses in assessment, implementation, and patient education contributes to better patient outcomes and ensures continuity of care throughout all recovery phases.
A person who experiences a spinal cord injury (SCI) is often faced with significant alterations to nearly every aspect of their day-to-day life. Providing patients with SCI and their families all the key education during an inpatient rehabilitation stay is challenging for nurses due to short inpatient stays. Rehabilitation nurses and other clinicians must prioritize teaching the information and skills most essential for a safe discharge. After transitioning back into the community, people with SCI will have significant ongoing needs for trustworthy health information that will help them restore, maintain, and promote optimal health and function. This article provides background information and selected trustworthy resources, developed by health professionals and persons with SCI, that nurses can share with their clients. We also provide an online resource that can be shared with persons with SCI and their families that covers educational sources, health information, individual support, and online peer groups and mentoring.
BACKGROUND:Following a traumatic brain injury (TBI), 70% or more of patients display disruptive behaviors including verbal or physical aggression, wandering, nonadherence or care refusal, social withdrawal, and socially inappropriate behavior. These behaviors often worsen over the first few years after a TBI and place a significant strain on caring relationships. PURPOSE:Our brain injury program aimed to refine our inpatient rehabilitation programming approach, using the evidence base and provider expertise, to address disruptive behaviors among patients with TBI. METHODS:We formed an interdisciplinary committee, conducted one-on-one interviews and surveys, and participated in staff meetings. We based interventions on the premise that our TBI patients in the early stages of recovery required consistent environmental and interactional changes maintained by all members of the interdisciplinary team. We illustrate this approach with a case example. FINDINGS AND CONCLUSIONS:Our approach led to increased evidence-based behavior tracking, new health care assistant and nurse training, and improved team communication. Training was well received. Self-reported knowledge increased for all learners [ t (119)=-7.36, p <.001]. We saw increased event reporting on challenging behaviors, suggesting improved awareness of the need and opportunity for intervention. The Oversight Committee also received positive feedback about improved collaboration across disciplines.
