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Showing papers on "Referral published in 1982"


Journal ArticleDOI
TL;DR: Christenson and Ysseldyke as mentioned in this paper argue that an increase in the number of students served is a logical consequence of increased funding, and that increasing numbers of students are experiencing home and family problems as well as withinstudent deficits, dysfunctions, and disabilities, and are in need of special education services.
Abstract: Sandra Christenson is Research Assistant and James Ysseldyke is Director, both, Institute for Research on Learning Disabilities, University of Minnesota, Minneapolis, MN 55455. Between October, 1976,1 and December, 1980, the number of students served in special education increased by nearly 600,000 from 3,586,804 to 4,185,076. This is an increase of nearly 17% in the number of students served. Recently, educators have expressed concern about, and debated the reasons for, this significant increase. At least four kinds of arguments are heard. The first argument is that Public Law 94-142 was intended to provide services for increased numbers of previously unserved students (Ballard & Zettel, 1977), and that under mandates for child find and delivery of services to individuals between 3 and 21 years of age, schools are finally beginning to serve all this nation’s handicapped students. A second explanation is an economic one. In P.L. 94-142 it was argued that &dquo;Developments in the training of teachers and in diagnostic and instructional procedures and methods have advanced to the point that, given appropriate funding, State and local education agencies can and will provide effective special education and related services to meet the needs of handicapped students&dquo; (p. 776). Proponents of this explanation argue that an increase in the numbers of students served is a logical consequence of increased funding. A third explanation is one stressing that increasing numbers of students are experiencing home and family problems as well as withinstudent deficits, dysfunctions, and disabilities, and are in need of special education services. In 1979 the National Education Association

168 citations


Journal ArticleDOI
TL;DR: The management of encopresis requires an approach which combines the role of the physician as a diagnostician, a demystifier and educator, a pharmacotherapist, a counselor, a strong child advocate and co-conspirator, and a triage officer for further referral when needed.

107 citations



Journal ArticleDOI
TL;DR: It is suggested that the initial period after diagnosis of diabetes in a child should be considered a period of crisis, requiring special muitidisciplinary services to reduce future psychosocial maladjustments and improve compliance.
Abstract: A group of 223 insulin-dependent diabetic patients, aged 7–24 yr, who had been under the regular care of our clinic up to 15 yr, were rated by two independent judges on a two-level scale of adjustment and maladjustment. The patients were divided into two groups. Group A (N = 107) comprised those who had been under care from diagnosis of the disease and had been subjected to the special crisis intervention program offered to every family upon referral of a newly diagnosed patient. Group B (N = 116) comprised patients who were diagnosed and treated initially in a clinic that had no crisis intervention program. Significant differences between the two groups were found in respect to three of the four aspects studied, i.e., compliance, familial relationships, and sociability, with group A showing a better adjustment than group B. There was no significant difference in the fourth aspect studied, i.e., school achievement and work performance. It was found that it took three times the effort, i.e., the time invested in counseling and psychotherapeutic measures, to bring group B to a good level of adjustment than it did to achieve similar results with group A. It is suggested that the initial period after diagnosis of diabetes in a child should be considered a period of crisis, requiring special muitidisciplinary services to reduce future psychosocial maladjustments and improve compliance.

77 citations



Journal ArticleDOI
TL;DR: In this article, the authors identified institutional constraints and external pressures perceived by public school teachers as influential in making referrals, such as LEA procedures or the teacher's perception of the professional competence of referral recipients, and availability of services.
Abstract: Institutional constraints and external pressures perceived by public school teachers as influential in making referrals were identified in this research. Organizational factors, such as LEA procedures or the teacher's perception of the professional competence of referral recipients, and availability of services were cited as institutional constraints on referrals. Outside agency influences, federal or state requirements, and concerns of parents were cited as external pressures that influence referrals. The implications of these findings are discussed with regard to teacher concerns and professional practice.

64 citations


Journal ArticleDOI
TL;DR: A high index of suspicion of physical disease in the psychiatric population is advocated, and an aggressive multidisciplinary diagnostic and therapeutic approach is recommended.
Abstract: We report a study of 102 consecutive admissions to the acute medical care unit of a large psychiatric hospital. The study was designed to investigate the epidemiology and the barriers to diagnosis and treatment of medical illness among female psychiatric inpatients. The majority of the patients were transferred to the unit because of nonspecific changes in physical condition or for behavioral differences. More than 70% of the patients were unable to communicate adequately with the physician. Ninety-two percent of the sample were found to have at least one with an average of three previously undiagnosed physical diseases not predicted by their symptoms on referral. We advocate a high index of suspicion of physical disease in the psychiatric population, and recommend an aggressive multidisciplinary diagnostic and therapeutic approach.

64 citations


Journal ArticleDOI
TL;DR: In this paper, the authors identify the factors that two types of referring physicians, general/family practitioners and general surgeons, consider when deciding whether or not to refer the patient, and where to refer a patient.
Abstract: The results of a study to identify the factors that two types of referring physicians, general/family practitioners and general surgeons, consider when deciding whether or not to refer the patient, and where to refer the patient are presented and discussed. The factors for each type of decision were identified initially through interviews with physicians in active practice in Wisconsin and rank ordered according to their relative importance in making the referral decisions. These factors were then used in two alternative normative decision-making models to predict physician referral behavior. Factors related to the kind and quality of medical care the patient would receive appear to be most important in the decisions, with a high level of agreement between and among general/family practitioners and general surgeons as to the relative importance of the factors. Although the normative decision-making models correctly predicted a relatively high percentage of the referral decisions, not all of the factors were found to be important in explaining the behavior of physicians, and were not always consistent with the factors that were reported to be important.

61 citations


Journal ArticleDOI
TL;DR: The meaning of these concepts in medicine and in occupational therapy is compared to clarify the differences in orientation between the two disciplines and the development of a taxonomy of levels of performance in occupation is suggested.
Abstract: Professional practice is based on knowledge of order, disorder, and change. The meaning of these concepts in medicine and in occupational therapy is compared to clarify the differences in orientation between the two disciplines. The negative influence of the biomedical model on occupational therapy theory and practice is illustrated. The development of a taxonomy of levels of performance in occupation to serve as a basis for referral to occupational therapy and for theory building is suggested.

61 citations


Journal ArticleDOI
TL;DR: A "Family Room" that is private yet close to the NICU and by training the staff in more supportive approaches toward these families, this work has been able to deal with the problem of the dying newborn in a manner that has been beneficial to both families and staff.
Abstract: • Despite impressive improvements in outcome for infants cared for in neonatal intensive care units (NICUs), large tertiary-care referral units still admit a substantial number of infants who will not survive or, because of a predictably very poor outcome, should not be offered modern life-support techniques. Dealing with these infants can be extremely taxing on both the family and the staff. We have recently adapted the concepts first described in adult hospice care to the care of the dying neonate and his family. By providing a "Family Room" that is private yet close to the NICU and by training the staff in more supportive approaches toward these families, we have been able to deal with the problem of the dying newborn in a manner that has been beneficial to both families and staff. (Am J Dis Child1982;136:421-424)

59 citations



Journal Article
TL;DR: The quality of the consultation reports, as determined by the referring physician's opinion, increased directly with the amount of referral information originally sent to the consultant.
Abstract: A study of 141 consecutive referrals from family physicians in four clinic sites was undertaken to obtain descriptive characteristics of the referral-consultation process and to identify factors associated with effective outcomes. Consultation reports were returned to referring physicians in 88 percent, 75 percent, and 43 percent of referrals from consultants in community practice, university faculty practice, and university outpatient clinics, respectively. The quality of the consultation reports, as determined by the referring physician's opinion, increased directly with the amount of referral information originally sent to the consultant. The referral-consultation process appears to be functioning well in this site. The data suggest that this process might function even better if referring physicians would personally contact and send letters to consultants.

Journal Article
TL;DR: No differences in general practice consultation rates, in the subjective ratings of psychological distress, in control orientation or life satisfaction were found between the two groups, but the level of patient satisfaction was high.
Abstract: A controlled trial study is described in which 50 consecutive potential referrals for psychological treatment from one general practice were randomly allocated either to behavioural treatment or no-treatment conditions. Treatment-group patients received treatment from a clinical psychologist working within the practice; the control-group patients continued to be managed by their general practitioner. The patients' use of NHS resources was assessed during the treatment period (or its equivalent for the control group) and at a follow-up comparison point, when the patients' subjective ratings of their progress were also obtained. Between referral and the end of treatment the treated group received significantly less psychotropic medication than the control group. This difference was not, however, maintained at the longer-term follow-up. No differences in general practice consultation rates, in the subjective ratings of psychological distress, in control orientation or life satisfaction were found between the two groups, but the level of patient satisfaction was high. Implications for the design of future studies and for psychological health care delivery systems are discussed.

Journal ArticleDOI
TL;DR: An analysis of the timing of referral and the total number in care at various stages of the study period confirmed an increased rate of psychosis following childbirth, and rates for other diagnoses showed no such clear relationship.
Abstract: The Southampton case register and maternity records were used to identify all Southampton women who had babies in 1976 and 1977 and who had been in psychiatric care in the 2 years before and after the birth date. 127 such women were identified out of a total of 5200 having babies. An analysis of the timing of referral and the total number in care at various stages of the study period confirmed an increased rate of psychosis following childbirth. Rates for other diagnoses showed no such clear relationship. Obstetric and social factors were not related to postpartum morbidity. These results are discussed.

Journal ArticleDOI
TL;DR: This well-detailed article approaches the task of managing common childhood behavioral problems through a feasible and practical implementation of the American Academy of Pediatrics’ recommendations on well-child care.

01 Nov 1982
TL;DR: The major purpose of the Minnesota institute was to study the assessment of LD children.

Journal ArticleDOI
TL;DR: In this paper, a computer simulation program was developed for the purpose of studying the processes diagnostic personnel in the schools engage in when making psycho-educational decisions about students, and the program collected demographic data on 159 participants and assessed their knowledge base in assessment.
Abstract: A computer simulation program was developed for the purpose of studying the processes diagnostic personnel in the schools engage in when making psychoeducational decisions about students. Initially, the program collected demographic data on 159 participants and assessed their knowledge base in assessment. Bogus referral information for one of sixteen “cases” was then provided and subjects were instructed that they were to make eligibility and classification decisions for the child. They were told that scores and other information (e.g., observations) were available to them on a variety of tests from among seven domains. Although the referral data indicated the student might be evidencing academic or behavior problems, all assessment data indicated a normal or average performance. Fiftytwo percent of the subjects (i.e., 83) declared the “average” child eligible for special education services; their classification decisions were further analyzed. Decisions about the 16 different children were found to be mo...

Journal ArticleDOI
TL;DR: The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures.
Abstract: One-hundred and twenty-five families in the Medicaid Early Periodic Screening, Diagnosis and Treatment Program were assigned to one of five treatments to encourage parents to obtain health care service following the dental screening of their children: (a) a control procedure, in which parents were given a dentist's name; (b) a multiple contact procedure, in which parents received a postcard and two telephone call reminders; (c) a problem-solve procedure, in which a social worker aide conducted a brief session with the parent; (d) an incentive procedure, in which parents selected among four gifts that were contingent on seeking care; (e) an incentive + problem-solve procedure, in which the latter two treatments were combined. The multiple contact, incentive, and incentive + problem-solve techniques were significantly more effective in initiating dental visits than the control procedures. Families assigned to the intensive strategies were most likely to complete treatment. A cost-efficiency analysis showed the multiple contact technique to be a low-cost and highly effective procedure.

Journal ArticleDOI
10 Apr 1982-BMJ
TL;DR: It is feasible for junior staff in an accident department to decide whether patients with self-poisoning need admission or may be discharged with or without subsequent referral for psychiatric or social work help.
Abstract: The outcome in 115 consecutive patients with mild self-poisoning seen by junior medical staff and discharged from the accident department was compared with that of 98 similar patients admitted to the medical wards. Psychiatrists saw only four patients in the accident department and 25 admissions. In making their assessments the junior medical staff considered psychosocial factors as well as the patients9 physical condition. Most patients recommended for further care, and discharged from the accident department, subsequently received it. Repetition rates were similar in the two groups and there had been no suicides when patients were followed up at one year. It is feasible for junior staff in an accident department to decide whether patients with self-poisoning need admission or may be discharged with or without subsequent referral for psychiatric or social work help.

Journal ArticleDOI
TL;DR: An epidemiologic study of 308 consultations revealed substantial differences in referral rates related to the demographic, clinical, and programmatic characteristics of patients and services.

Journal ArticleDOI
TL;DR: Chronic headaches are relatively common in children and adolescents, and very few of these children go on to develop significant intracranial pathology, and the majority will remit spontaneously.

Journal ArticleDOI
TL;DR: The ability of a medical self-care program to have an impact on the utilization and cost of in-clinic and referral visits in a prepaid group practice was studied by following the medical encounter records of 900 HMO members in 217 families during a 12-month period.
Abstract: The ability of a medical self-care program to have an impact on the utilization and cost of in-clinic and referral visits in a prepaid group practice was studied by following the medical encounter records of 900 HMO members in 217 families during a 12-month period. A control group selected by randomization after acceptance of an initial invitation to participate was employed. In spite of the program's impressive effect on both self-care knowledge and per-visit costs, the study could not demonstrate any significant program effect either on the frequency or on the total costs of clinic visits.

Book ChapterDOI
01 Jan 1982
TL;DR: Attention to the issue of teams and teamwork in modern medicine becomes important because teams, or more accurately, the talk of teams, has been dominant in health care for at least thirty years.
Abstract: It should be apparent to anyone who thinks about the issue even for a moment that health care today is no simple matter involving single clinicians and individual patients. Care is provided more often by multiple personnel in complex institutions utilizing several layers of support, consultation, and referral. Yet bioethical discourse still seems focused largely on increasingly Active one-on-one ideal cases and the somewhat stale concern for individual patient and provider “rights”. If bioethical discussion is to remain vital, it must shift its focus away from individual relationships to complex, interactive contemporary realities and the incompletely explored philosophical problems of “authority” and “responsibility” closely related to them. That shift in focus is one major goal of this volume, and for this reason directing attention to the issue of teams and teamwork in modern medicine becomes important. Teams, or more accurately, the talk of teams, has been dominant in health care for at least thirty years. This phenomenon merits both careful historical exploration and serious philosophical attention.

Journal Article
TL;DR: The socio-demographic and clinical characteristics of one hundred consecutive referrals from emergency O.P.D. of a teaching general hospital were studied and the diagnosis of neurosis was given in half of the patients and one third of all patients were labelled as suffering from hysterical neurosis.
Abstract: The socio-demographic and clinical characteristics of one hundred consecutive referrals from emergency O.P.D. of a teaching general hospital were studied. The referral rate was 5.4%. The source, reason and purpose of the referrals were studied. Half of the patients had presented with somatic symptoms. Altered sensorium, suicidal attempt and excitements together constituted one third of all emergency referrals. The diagnosis of neurosis was given in half of the patients and one third of all patients were labelled as suffering from hysterical neurosis. The nature of the presenting complaints and psychiatric diagnoses were comparable to that of the other studies.

Journal ArticleDOI
TL;DR: In a time of conservative politics and economic retrenchment, social workers may find practice in public agencies increasingly fraught with problems as discussed by the authors, and many may consider private practice, and factors related to success and the relationship between psychotherapy and social work as practiced privately are explored.
Abstract: In a time of conservative politics and economic retrenchment, social workers may find practice in public agencies increasingly fraught with problems. Many may consider private practice. Some of the principal findings of a nationwide survey of private practitioners are reported here, and factors related to success and the relationship between psychotherapy and social work as practiced privately are also explored.


Journal ArticleDOI
16 Oct 1982-BMJ
TL;DR: An analysis of the referral routes of Southampton Eye Hospital of 191 patients who had been diagnosed as having chronic open-angle glaucoma showed that 121 patients (63.4%) were diagnosed as a result of the patient seeking advice for ocular symptoms or because they had a family history of glAUcoma.
Abstract: An analysis of the referral routes of Southampton Eye Hospital of 191 patients who had been diagnosed as having chronic open-angle glaucoma showed that 121 patients (634%) were diagnosed as a result of the patient seeking advice for ocular symptoms (118) or because they had a family history of glaucoma (3) Advice had been sought from general practitioners (48), ophthalmic medical practitioners (19), and ophthalmic opticians (46) The remaining eight patients had gone directly to the casualty department Seventy patients had been identified by chance, the majority of ophthalmic medical practitioners (26) or ophthalmic opticians (32)

Journal ArticleDOI
TL;DR: According to as mentioned in this paper, approximately eighty-five percent of the children receiving services in special programs for the learning disabled (LD), educably mentally retarded (EMR), and behavior disordered (BD) in the public schools are boys.
Abstract: Special education programs for the mildly handicapped l^grner in the United States are male dominated. Approximately eighty-five percent of the children receiving services in special programs for the learning disabled (LD), educably mentally retarded (EMR), and behavior disordered (BD) in the public schools are boys. The reasons for this imbalance are unclear, and explanations tend to be general in nature and inconsistent with one another. Biological differences between males and females as they relate to learning have not been clearly established. The fact that girls walk, talk, and, as a group, \"mature\" at an earlier age than boys is not sufficient evidence to account for the fact that so many more boys than girls receive special education services. Indeed, boys, in general, outdistance girls in overall academic achievement over time. Aggressiveness, noted more often in the behavior of boys than girls, is also often given as a reason for school problems. Whether aggressiveness is viewed

Journal ArticleDOI
TL;DR: The rate for diagnosis of dementia increased with age, whereas the rates for diagnoses of depression and alcohol/drug abuse decreased with age.
Abstract: Over 2300 patients referred to a geriatric outreach program were evaluated for the relationships between diagnosis and (1) referral reason, (2) referral source, and (3) age. Referral reason was only a clue to the eventual diagnosis. Patients referred for depression received a diagnosis of depression in only 46 per cent of such referrals, and patients referred for forgetfulness or confusion received a diagnosis of dementia in only 37 per cent of these referrals. Families were most likely to refer demented patients, and health agencies to refer depressed patients. Apartment managers and housing authority representatives were least likely to refer depressed patients and most likely to refer paranoid patients. The rate for diagnosis of dementia increased with age, whereas the rates for diagnoses of depression and alcohol/drug abuse decreased with age.

Journal ArticleDOI
TL;DR: Although in this setting NPs frequently did not adhere to C/R criteria for hypertension, this did not affect acceptable BP control and the relationship between adherence and blood-pressure (BP) control.
Abstract: The degree to which nurse-practitioners (NPs) and physicians (MDs) follow the mutually agreed-upon rules for their practice and the effects of any deviations are unknown. This study assessed whether NPs adhered to consultation/referral (C/R) criteria in NP standing orders for hypertension, whether MDs adhered to the task-delegation intent expressed in standing orders, and the relationship between adherence and blood-pressure (BP) control. A sample of 161 patients from a practice of five MDs and four NPs in a rural primary care clinic was studied over 16 months. Patient characteristics associated with provider non-adherence were identified by discriminant analysis. NPs failed to obtain consultation or referral for 22 of 66 patients (33 per cent) with conditions requiring C/R. MDs retained 17 of the 43 patients (40 per cent) without C/R conditions. NP non-adherence was associated with care by a single NP, presence of few non-hypertension problems, and need for dietary alteration (p less than .05). MD non-ad...