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Monday, September 04, 2006

The Assessment Team

The assessment team:

C is like many adults with age related disabilities. She does not have a caseworker or rehabilitation counselor as she is not eligible for services related to work preparation. C would benefit from the assistance of an occupational therapist if insurance would cover the expense. An assistive technology specialist and supportive life-skills personnel would further enhance C's ability to remain functionally independent.

The main problem

· C's physical limitations are threatening her ability to live independently.
· C is having difficulty maintaining a quality of life due to the loss of physical functioning.
· C lacks reliable transportation and is experiencing increased social isolation.

Goals

Goal #1: C will maintain independent living.

Objective: Adapt C's home environment to miminize the risk of injury. Specific attention will be given to C's concern over falling.
Areas of concern include:
· The bathroom
· The kitchen
· Other

Objective: Adapt C's home to maximize the use of existing physical functioning. Specific areas include:
· Door handles
· Light fixtures/lamps
· Locks
· Faucets
· Appliances
· Entry/Exits
· Other

Goal #2: C will maintain/improve her current ability to engage in meaningful hobbies and activities

Objective: Assist C in reading, writing, sewing, and gardening independently and without risk of pain or injury.




Goal #3: To allow C to shop, attend medical appointments, socializing, church and other business.

Objective: Assist C in locating reliable accessible transportation at least 2 times per week.


Method: Using a standardized Activity Analysis (act.ana.PDF) it is possible to identify activities in need of intervention given C's current level of functioning. The use of an activity analysis tool will provide baseline data to compare C's level of progress, future needs, and potential decline in functioning. First a low technology alternative will be explored and then a higher level technological intervention. It is assumed the least expensive alternative will be employed.

Measuring capacity and performance of functional activities will target
1. Mobility
2. Self-care
3. Social functioning/Quality of life
A modification scale may be administered in addition to the activity analysis to determine the needed level of adaptation.

Mobility
· Walking/standing
· Opening and closing doors
· In and out of car
· In and out of bed
· Stand/sit in shower/tub
· Ability to lift/carry objects
· Method of locomotion in and out of home
· Speed of movement
· Endurance

Self Care
· Food preparation
· Grooming and hygiene
· Laundry
· Bookkeeping
· Cleaning house
· Shopping/Appointments

Social Functioning/Quality of Life
· Social Interaction
· Problem solving
· Household chores
· Self protection
· Self-information
· Community functions
· Hobbies and other interests

Other considerations:
According to research by Technology and Disability (1997), acceptance of assistive devices by the elderly is related to device appearance and stigma as well as the perceived enhancement of individual functioning. In order to maximize potential use and acceptance, the use of "normalized" devices will be considered as possible.

General Fall Risk Factors (CsiA, 1998)

Age-related:
1. Sensory systems:
reduced visual acuity
reduced contrast sensitivity
reduced depth perception
reduced dark adaptation
reduced vestibular functioning
reduced cutaneous sensation
2. Musculoskeletal system:
reduced muscle strength
increased muscle fatigue
reduced flexibility
reduced range of motion
3. Nervous system:
slowing of reflex/response

Changes in balance:
1. Lateral instability
2. Variability in control of gait
3. Fear of falling

Environmental Risk Factors:
1. Doors/latching/swinging doors
2. Floors:
slippery surfaces
edges and obstacles
transitions between tile and carpet
thick/loose carpets
3. Lighting:
brightness
uniformity
glare
low-lit areas
4. Seating: lack of armrest/handrails

Interventions:
1. Floor coverings
non-skid wax on floors
non-skid strips in bathtub
avoid area rugs, tape edges of carpet/runners etctera
avoid transitions or clearly indicate variatios
eliminate trip hazards
2. Lighting
non-glare, uniform and bright
use night lights throughout house
3. Handrails and grab-bars
high visible
install in bathrooms, stairs, other high-risk areas
install for correct positioning (see Proper Handrail Design Parameters)
use vertial poles near chairs, bed, toilet, bath, other high risk areas (see Sturdy Grip example)
4. Toilets and bathtub:
raise height of toilet base and add armrests (see Toilevator example)
install low-wall bathtub (see Access Bathtub example)
5. Stairs/transitions in/out of house
remove visual distractions
remove all obstacles
ensure adequate lighting
clearly mark transition with high contrast/tactile paint or tape

What is a Therapeutic Community?

What is a therapeutic community?
Therapeutic communities provide long-term residential treatment for substance abuse in a secure, drug-free environment. The first therapeutic community, Synanon, was formed in 1958 (by an early member of Alcoholics Anonymous) to provide a safe environment in which users of alcohol and other substances could work together to help themselves and each other recover from their addictions and rebuild their lives. Since then, therapeutic communities have become the best-known and most common type of long-term residential program for substance-use recovery (Hubbard et al., 1989).

The primary goal of treatment in a therapeutic community is not simply to treat the addiction but to help a person in recovery achieve personal growth by learning new behaviors, coping skills, and attitudes that will help him or her to pursue a drug-free lifestyle. (De Leon and Rosenthal, 1989.) Social and vocational skills are also taught. Fellow residents and counselors (who are themselves usually former residents who have successfully recovered) help persons in recovery by serving as role models and setting a good example of how to handle stress without resorting to substance abuse. Peer pressure is also an important aspect of therapeutic community-based treatment.

What does therapeutic community-based treatment involve?
In a therapeutic community, treatment includes both individual and group counseling. Persons in recovery are counseled (sometimes in a confrontational manner) by their peers to (APA, 2000):

· overcome denial and accept their substance abuse problem
· understand the role of substance use in their lives
· identify unhealthy behaviors and ways of coping
· learn healthy ways to handle stress and depression
· develop attitudes and beliefs that are incompatible with continued substance use.
Therapy community programs often involve three key stages of treatment (Kooyman, 1993):
· induction (preparing persons in recovery for admission to the program)
· primary treatment (helping residents to recover and become stronger)
· reentry preparation (preparing residents for independent, substance-free living and reintegration
into society)

What is it like to live in a therapeutic community?
The therapeutic community environment is highly structured, with rules and schedules. Both penalties and rewards are used to encourage recovery and personal growth (Kerr, 1986). Newcomers to therapeutic communities are given very few privileges to start with; they are considered “low on the totem pole” and are given the least desirable work chores. As residents demonstrate that they can remain drug-free and follow community rules, they earn increasing privileges, status, and opportunities for leadership (APA, 2000).

Residents in a therapeutic community are considered “members,” not patients, and are expected from the beginning to take responsibility for themselves and to participate actively in all aspects of the community, including counseling of fellow members, community decision-making, and chores. Honesty, trust, and self-help are stressed. Members play an active role in all decisions affecting them, including admission and discharge of fellow residents, assignment of domestic tasks, and penalties for rule-breaking (Kennard, 1998).

How effective are therapeutic communities for drug addition recovery?
In order for therapeutic community-based treatment to be effective, the person in recovery must remain in treatment for an appropriate length of time. Unfortunately, only 15% to 25% of patients who are voluntarily admitted to a therapeutic community program remain in the program for a sufficient period of time (see below) (APA, 2000).

Therapeutic community-based programs may be more effective than outpatient programs in helping persons in recovery. Research suggests that one year after treatment, patients who have completed therapeutic programs are less likely to have started using drugs again than those that have undergone outpatient treatment (De Leon, 1984).

Three to five years after program completion, persons in recovery who have participated in a therapeutic community show less criminal activity and increased full-time employment (O’Brien and Biase, 1992).

Who is best suited for therapeutic community-based treatment?
Therapeutic community-based treatment may be most appropriate for people who are seeking a highly structured setting to begin their recovery. People who seek support and strong encouragement of peers who have “been there” and know what it takes to recover will do well in this treatment setting. This form of treatment may be especially appropriate for people for whom other forms of treatment have not been effective (APA, 2000).

There are two basic types of therapeutic communities for adults. The short-term type of therapeutic community, where treatment lasts an average of three to six months, is appropriate for persons in recovery who have a stable social and family environment, and focuses mainly on developing a drug-free lifestyle. For persons in recovery who do not have strong family and social support, the longer-term type of therapeutic community may be more appropriate. In this type of therapeutic community, treatment lasts an average of six to nine months; goals include both attainment of a drug-free state and development of practical living skills and social skills (Singer, 1992).

Therapeutic community-based treatment may not be appropriate for all persons in recovery. Studies have shown that people with low self-esteem, poor self-definition, and a tendency to criticize themselves heavily and overemphasize negative features are more likely to drop out of therapeutic community programs before treatment is complete (O’Brien & Biase, 1992). The confrontational style of counseling that sometimes occurs in the therapeutic community setting may be too intense for those that are highly sensitive to criticism (Singer, 1992).

What about therapeutic communities for adolescents?
Juvenile persons in recovery can also benefit from therapeutic-community based treatment. There are special adolescent therapeutic communities that have been modified to be appropriate for youths; these programs include the following features (Mullen, Arbiter, and Glider, 1991):
· shorter treatment periods
· less confrontational style
· increased supervision
· more recreational activities
· greater family involvement
· emphasis on education, including actual schoolwork
· increased staff-to-youth ratio
· separation of boys and girls (except for occasional program activities)

How long does therapeutic community-based treatment last?
Studies have shown that patients who remain in treatment for at least three months show improvement, but the greatest recovery benefits are achieved when treatment lasts from 6 to 12 months (APA, 2000), which is a typical length of stay. Treatment can last for as long as 18 to 24 months.

How much does therapeutic community-based treatment cost?
Treatment in a therapeutic community tends to be highly cost-effective. Treatment costs are lower than in clinical treatment settings, because former residents (rather than licensed professionals) serve as counselors and because residents work cooperatively to operate and maintain the residence. Costs for treatment in a therapeutic community vary depend on facility, but are approximately $55 to $60 per day for standard adult care. Treatment costs are slightly higher for adolescents, pregnant women, and other special populations (Wolf Jones, 2000). Government assistance is often available for those with limited incomes.

References

American Psychiatric Association (2000). Practice Guideline For The Treatment Of Patients With Substance Use Disorders Alcohol, Cocaine, Opioids. III: General Treatment Principles and Alternatives. (On-line: http://www.psych.org/psych/htdocs/clin_res/pg_substance_3.html)

De Leon G. (1984). The Therapeutic Community: Study of Effectiveness. NIDA Treatment Research Monograph Series, DHHS Publication (ADM) 85-1286. Rockville, Md, National Institute on Drug Abuse, 1984.

De Leon G, Rosenthal MS (1989). Treatment in residential therapeutic communities, in Treatments of Psychiatric Disorders: A Task Force Report of the American Psychiatric Association, Vol 2. Washington, DC, APA.

Hubbard, R. L., Marsden, M. E., Rachal, J. V., Harwood, H. J., Cavanaugh, E. R., & Ginzburg, H. M. (1989). Drug Abuse Treatment: A National Study of Effectiveness. Chapel Hill, N.C. and London: The University of North Carolina Press.

Kennard, D. (1998). Introduction to Therapeutic Communities. London: Jessica Kingsley Publishers.

Kerr, D. H. (1986). The therapeutic community: A codified concept for training and upgrading staffmembers working in a residential setting. In: De Leon & Ziegenfuss (eds.), Therapeutic Communities for Addiction, pp. 55-63. Springfield, IL: Charles C. Thomas.

Kooyman, Martien (1993). The Therapeutic Community for Addicts. Amsterdam: Swets & Zeitlinger.

Mullen, R., Arbiter, N., & Glider, P. (1991). A comprehensive therapeutic community approach for chronic substance-abusing juvenile offenders: The Amity model. In T.L. Armstrong (Ed.), Intensive interventions with high-risk youths: Promising approaches in juvenile probation and parole. Monsey, NY: Criminal Justice Press, a Division of Willow Tree Press, Inc.

O’Brien, W.B. & Biase, D.V. (1992). Therapeutic community: A coming of age. In: Lowinson, J.H., Ruiz, P., Millman, R.B., Langrod, J.G. (Eds.), Substance Abuse: A Comprehensive Textbook (2nd ed.). Baltimore: Williams and Wilkins.

Singer, A. (1992). Effective treatment for drug-involved offenders: A review and synthesis for judges and other court personnel. Newton, MA: Education Development Center, Inc.

Wolf Jones, L. R. (Executive Director, Therapeutic Communities of America). Personal communication, 11/13/2000.

Collaborative Learning with Internet Groupware - Review

Introduction:
Groupware refers to software designed to support or augment group communication or "shared interactive environments" (Wells, 1996). Originally introduced by Douglas Engelbart in 1968, Groupware has been widely used in business and the military for several years. It is now entering the academic arena as educators seek to enhance distance education coursework via on-line interactive/collaborative communications (Schrum and Lamb, 1998).
In general, collaborative learning has been documented to improve academic achievement, behavior and attendance; increase self-confidence, motivation, and liking of school and classmates (Office of Educational Research, 1992); increase academic test scores, raise self-esteem, increase positive social skills (Stahl, 1994); and encourage critical thinking (Newman, 1996; Gokhade, 1995; Nunamaker et. al, 1996).
Internet based collaborative learning, often coined "telecollaboration", can be classified into three genre with associated activity structures (Dawson, K., and Harris, J., in press). The first genre; "Interpersonal exchange", includes diverse activities such as telementoring or impersonations whereas "Information Collection and Analysis" may include a tele-fieldtrip or electronic publishing. The third genre; "Problem solving", is integral to working in groups but also includes information searches, peer feedback, simulations, and other "authentic" activities.


Internet based collaborative learning expands "community" and the learning environment (Ryder and Wilson, 1996); increases interactivity among geographically distant learners, experts, and resources (Schurm and Lamb, 1998); encourages diversity; maximizes user value on time spent gathering information and interacting with peers (Barua, Chellappa, and Whinston, 1996). It also facilitates lifelong learning skills by way of anytime/anywhere learning (Caviedes, 1998); enhances available resources via virtual libraries, publishing, presentations, communications, prints, etcetera (Caviedes, 1998), or even provides methods of instruction unavailable through other means (Bourne, Brodersen, Campbell, Dawant, and Shiavi; 1997).

GroupWare Classification:
GroupWare is classified according to: time/place, restrictiveness/ permissiveness, information sharing versus information exchange, and function.
Time/Place: GroupWare can be synchronous (real time), asynchronous (delayed/across time), or most commonly, a combination of both synchronous and asynchronous components.


















Tool
Category
Function


Whiteboard
Synchronous or Asynchronous
Shared Drawing


Interactive Slide Show &/or Web Tour
Synchronous
Presentation &/or Shared Web Browsing

Stored Slide Show
Asynchronous
Presentation

Email, Bulletin Board, Listserve
Asynchronous
Messaging systems

Chat Synchronous Text-based real time
Communication

Broadcasting/ Streaming Video
Synchronous or Asynchronous
Direct Messaging


Calendar
Asynchronous
Posting

Virtual Library Asynchronous Document

Restrictiveness/Permissiveness: Restrictive Groupware constrains or directs the behavior of the user by prescribing or restricting alternative courses of action. Permissive Groupware allows the user to do any action at any time.
Information sharing versus Exchange: Another method of classifying Groupware is according to the level of interaction. Information sharing allows users to observe and manipulate objects in a shared workspace whereas information exchange provides a medium for transference of information. Function: Educational groupware components include page and student tracking, test maker and automatic grading system features. Minimally, educational Groupware should consist of the following:
· The ability to input courseware from familiar applications
· Web based data entry
· Elimination of proprietary authoring tools or uploading of programs
· Automated test set up wizard
· Discussion groups, chat, and bulletin boards
· Email to instructor and others taking the course
· Pre-recorded streaming multimedia
· White boards, application sharing, and conferencing.
· Downloadable reference materials, bibliographies, articles, papers,
· Hyperlinks to Web sites

· Courseware search facility
· Ability to set performance criteria, control pace and testing thresholds
· Assignment creation and issuance
· Student progress tracking
· Self-correcting tests with instructor comments (Microsoft, 1999).


Levels of GroupWare Collaboration:
Groupware collaboration is divided into three levels of group effort: Individual, Coordinated, and Concerted (Nunemaker, Briggs, Mittleman and Vogel; 1996). At the individual level, work effort requires no coordination but is simply the sum of individual results. The coordinated work level requires coordination between independent individual efforts; the concerted work level requires "continuous concerted effort" (Nunemaker, Briggs, Mittleman, and Vogel; 1996).
Levels of Groupware collaboration are responsible for variations between laboratory and field findings due to the synergistic impact of collaboration in individual, organizational, and environmental process. Early laboratory findings differed significantly from "real life" applications mainly because "real groups do not perform tasks in a void, but within an organizational context which drives objectives, attitudes, and behaviors in group meetings" (Nunemaker et. al., 1996). A synergistic effect is achieved when different views of group members creates a

"greater understanding of the problem…or when the group solution is better than if produced by any member individually" (Stenberg, 1995).
The concept of synergistic knowledge acquisition has led to the development of "knowledge management" which centers on the creation of knowledge, securing/combining of knowledge, and the distribution/retrieval of knowledge (Seung, Jayl, Prasad, and Granger; 1997). Widely accepted in the business arena, the same concept is being applied to distance education and distributed learning environments.

Internet Collaboration…It's Different!
Laboratory results indicate variations between the use of Groupware versus none use of Groupware. However, more variations exist between "face to face" collaboration versus "distant" or Internet based collaboration made possible via the Internet (Nunemaker et. al, 1996; Stenberg, 1995). Synergistic effects occur in traditional "face to face" group encounters as well as distant encounters. However, research indicates increased synergistic effects in distance based communications. This is due to the fact "low status members have a tendency to automatically agree (with)…high status members during face to face encounters whereas the anonymity provided by distance correspondence minimizes this problem as the low-status members are unable to copy high status members " (Stenberg, 1995). Additionally, "total amount of input is higher…due to the parallel communication,

that allows the group to "talk" at once and consequently makes it possible for larger groups to be productive" (Stenberg, 1995). This increased productivity once again results in increased synergistic impact for the group. Group members often report this synergistic impact increases stimulation and results in higher overall satisfaction scores in addition to increased access to collective information (Stenberg, 1995).
Although access to collective information is increased, individual "absorption" of information and corrective communication is demonstrated to be "slower than conventional techniques. "Conformance pressure" …commonly referred to as "groupthink"… may also become problematic. Nonetheless, laboratory studies show "teams using anonymous GSS contributed more ideas when they were allowed to enter both positive and negative comments" (Nunamaker et. al., 1996).
The nature of some applications may contribute to other problems rarely encountered in face to face collaborative efforts. For example, the anonymous nature of some components may encourage "flaming" or other unbecoming behaviors. Conflict management can be difficult in a distant environment, the perceived loss of social interaction may hinder some members from full participation, and dominating members may draw undue attention to themselves therefore distracting others from the task at hand. Information overload may result in incomplete task analysis and the technology itself may become a drawback

(Nunamaker et al., 1996; Stenberg, 1995). Adoption and acceptance is fundamental to the success of an initiative as "many groupware systems simply cannot be successful unless a critical mass of users chooses to use the system" (Usabilityfirst.com, 1999). An example is the use of a chat room…it is useless if you are the only student logged in. According to Usabilityfirst, "Two of the most common reasons for failing to achieve critical mass are interoperability and the lack of appropriate individual benefit (Usabiltyfirst.com, 1999). Due to these and other potential problems, mediation is extremely important for the use of groupware applications in distance education. According to Nunamaker et. al; "…technology does not replace leadership"…or as another researcher so succinctly stated: "It's the humans, stupid" (Newman, 1996).

Leadership Issues:
Several elements have been identified as essential to the success of a collaborative learning initiative; (Stahl, 1994; Gay, 1997; Campbell and Bourne, 1997) the following criteria are critical:
· Specific student learning outcome objectives
· Student "buy in" regarding objectives and outcome
· Clear and complete task directions
· Heterogeneous groups
· Equal opportunity for success

· Positive Interdependence
· Positive social interaction behaviors and attitudes
· Access to "must learn" information
· Opportunities to complete required information processing tasks
· Sufficient time spent learning
· Individual accountability
· Public recognition for group academic success
· Post-group reflection on within group behavior
· Flexibility
· Evaluation of the learner and learning environment
· Required contribution and participation
· Non-authoritarian style and responses
· Attention to social and emotional aspects
Instructors must maintain a facilitative approach to learning; "The instructors role is not to transmit information, but to serve as facilitator for learning" (Gokhade, 1995). Instructors must be responsive to learner differences and group "personality". According to Gay, "it is important to incorporate as many approaches as possible into your design to accommodate a range of student learning styles" as well as emphasize active listening between students and instructor interaction (Gay, 1997). Research indicates students who preferred a

visual learning style reported enhanced work whereas students who preferred a verbal learning style found significantly less enhancement from the use of groupware (Becker and Dwyer, 1998).
Responsiveness involves more than just learning style; a study of collaborative learning at Western Illinois University found a "humor played a vital role in reducing anxiety" in addition to shared responsibility for problem solving (Gokhade, 1995). Another study demonstrating the importance of interpersonal relations in groupware discovered storage of information accounted for only 25% of all work surface activities while expression of ideas and mediation of interaction comprised 50% and 25% respectively. Gesturing "played a prominent role in all work surface actions", accounting for 35% of all activity (Greenberg and Gutwin, 1998). Clearly, mediation of interpersonal relations is a significant factor in the success of groupware applications.
Management issues also impact the success of collaborative learning with groupware; security, student/instructor support and training, and evaluation (Gay, 1997). "If the group is headed toward a clearly defined goal…(they) can achieve the goal more productively. If the group is unclear about its goal, the lack of direction will become immediately obvious…" (Nunamaker et. al., 1996).




Structure, Use and Interface Issues:
Groupware applications are highly dependent upon structural related issues with the most recent applications striving toward a "socially natural" setting. According to Saul Greenberg and Carl Gutwin from the University of Calgry (Greenberg and Gutwin, 1998); socially natural groupware consists of:
· Tight coupling: used in intense collaboration but highly restrictive. Tight coupling does not allow the user to move independent of other users.
· Loose coupling: used in less formal collaboration and less restrictive. Loose coupling allows the user to move independently of other users while maintaining "workspace awareness".
· Casual interaction: in daily life people maintain a "general sense of who is around and what others are up to as they work and mingle in the same physical environment…(but) casual interaction in distributed environments is difficult" (Greenberg and Gutwin, 1998). Casual interaction in socially natural groupware mimics the natural setting by allowing "peephole" functions which alert group members availability and actions (Greenberge and Gutwin, 1998).
· Seamless transactions: In the "real world, people move themselves and their artifacts continually and effortlessly between different styles of collaborations; across time, across individual and group activity, across


place, across formality, etc (Greenberg and Gutwin, 1998). Seamless transaction in socially natural groupware supplies:
· A place for individual and group work
· A place for formal and informal face to face meetings
· A place to leave reminders, note, and work artifacts
· A places that supplies opportunities for casual interaction
Socially natural groupware supports the six criteria for designing communal work surfaces (Tang, 1989) including;
1. Methods of conveying and supporting gestural communication
2. Minimization of overhead encountered when storing information
3. Methods of conveying the process of creating artifacts to express ideas
4. Allowing seamless intermixing of work surface actions and functions
5. Provision of a common work surface view with simultaneous access and sense of close proximity.
6. Facilitation of participants natural abilities to coordinate personal collaborations

Groupware and Workspace Awareness:
The new generation of socially natural groupware is highly involved in integrating the social, environmental and other cues mentioned above. Workspace


awareness research has identified several kinds of awareness integral to groupwork including (Gutwin, 1996):
· Workspace awareness: "up-to-the minute" awareness of other's location, activities, and intentions relative to the task and space.
· Organizational awareness: knowledge of positioning…how the group activity fits within larger groups.
· Situational awareness: understanding of the state of a dynamic system.
· Structural awareness: knowledge of roles, expectations, responsibilities,
The issue of awareness is a recurring theme in distance/distributed education literature as it is directly related to the level of perceived comfort associated with the course and therefore, productivity. Research indicates positive results in performance and perception if design and other factors are accounted for. In fact, studies indicate: 97% of students reported "more access to the instructor than in conventional course delivery", 80% indicated "conventional courses were more boring…", and 67% reported "more communication with fellow students…" (Andriole, 1998).

Evaluation:
Groupware is measured in relation to several criteria including efficiency and effectiveness, cost, learner and faculty satisfaction, behavior and results.
Functionality is evaluated in terms of :

· Usability: the ease of learning, using, and modifying the capabilities of the product to accomplish the tasks that are common to most users...both instructor and student.
· Capability: the functionality of the product in accordance to the needs/desires of the target audience.
· Performance: the speed or capacity in performing the product's function.
· Interoperability: the ability of the product to transfer information to and from other information systems including file exchange, platform, etc..
· Manageability: the ability to configure, use, and control functions.
Kirkpatrick (1994) proposed the use of four levels of evaluation including:

1. Learner reaction (end of course evaluation sheet)
2. Learning (learner performance at the end of the course)
3. Behavior (ability to use what is learned in real-life situations)
4. Results (impact on learner/learners organization/etc.)
Three determinants of user value include level of information access (the ability to access relevant information), interaction richness (the extent to which users are able to overcome the barriers of space, time and media/document formats in an interaction with others), and information /interaction cost including the time and effort needed to use and learn supportive technology/software (Barua, Chellappa, and Whinston; 1996).


These criteria lend themselves to a "process evaluation" to determine what "influences facilitate and impede student perceived progress toward student course goals, how are these influences related, and what is their relative importance?" (Campbell, 1997). The process evaluation approach stresses the importance of learning strategy and implementation over that of delivery method but hesitates to use grades and examinations as primary modes of evaluation; "Evaluation of examinations and grades may be to limited. Instead we need to identify specific and meaningful learning outcomes using different models…meaning mastery of higher order learning (Campbell, 1997). Qualitative research is frequently used in the evaluation of groupware applications in the academic arena, however,
quantitative analysis is needed as well.
Qualitative research has traditionally focused on observations, interviews, and analysis of learner posting/feedback whereas quantitative research (widely used in the business arena) has focused on the "no significant difference" phenomena or cost analysis of comparable outcomes (Campbell, 1997). Both qualitative and quantitative evaluation methods have drawn criticism.
Qualitative evaluation focused on learner outcomes assumes all work is exclusively the product of the learner. Critics maintain security issues have not been adequately standardized to ensure testing and outcome measures are actually evaluating student knowledge (Campbell, 1997; Moonen, no date).


The "no significant difference" phenomena as well as the cost analysis approach are both considered questionable quantitative measures for the evaluation of groupware applications with further research indicated. The "no significant difference" phenomena has drawn criticism as a "weak evaluation" unable to "detect the differences… experiments can be designed using a power analysis to estimate the number of learners required to find statistical significance". Indeed, several studies have demonstrated significant improvements (Campbell, 1997).
Quantitative evaluation using cost analysis has also drawn criticism due to the difficulty determining direct and indirect cost, resource accessibility, and other factors (Moonen, no date). Until a standardized dollar value can be identified for both the direct and indirect investment and resource acquisition/access, cost
analysis will continue to draw "fire" as a meaningful evaluative measure.
To complicate matters, experts have not yet agreed upon an operational definition of "value", "efficacy", or even "benefit" in order to determine by what criteria programs will be evaluated. Generally speaking, "cost-effectiveness analysis is applied when the cost are expressed in monetary terms and the effects are measured in non-monetary terms" (Moonen, no date). These variations lend to the expectation of efficacy and effectiveness evaluations. The issue of evaluation is central to the discussion of evaluation and comprises one area in need of future research within the field of collaborative learning and distance education.

Resources
Andriole, Stephen J. (1998). Requirements -Driven ALN Course Design, Development, Delivery, and Evaluation. [On-line]. Available: http://www. Aln.org/alnweb/journal/issue2/andriole.htm

Balkcom, Stephen, (1992). Cooperative Learning. Office of Educational Research and Improvement. ED Digest 346999 June 1992.

Barua, Anitesh; Chellappa, Ramnath; and Whinston, Andrew B., (1996). Creating a Collaboratory in Cyberspace: Theoretical Foundation and an Implementation. Center for Information Systems Management. University of Texas at Austin. [On-line]. Available: http://www.cism.bus.utexas.edu/ram/papers/job/job.html

Becker, D'Arcy; Dwyer, Meg; (1998). The Impact of Student Verbal/Visual Learning Style Preference on Implementing Groupware in the Classroom. JALN Vol. 2 Issue 2-8/1998.

Bourne, J.R.; Brodersen, A.J.; Campbell, J.O.; Dawant, M.M.; and Shiavi, R.G.; (1997). A Model for On-line Learning Networks in Engineering Education. JALN. Vol. 1, Issue 1- 3/97. [On-line]. Available: http://www.aln.org/alnweb/journal/issue1/bourne.htm

Bourne, John R.; McMaster, Eric; Rieger, Jennifer; and Campbell, Olin;. (no date). Paradigms for On-line Learning: A Case Study in the Design and Implementation of an Asynchronous Learning Network (ALN) Course. Center for Innovation in Engineering Education. Vanderbilt University.

Campbell, Olin, J. (1997). Evaluating ALN: What Words, Who's Learning?. ALN Magazine Vol. 1, Issue 2-8/1997.

Caviedes, J., (1998). A Technological Perspective of Anytime, Anywhere Education. ALN Magazine Vol. 2, Issue 1-3/1998.

Dawnson, K. and Harris, J. (1999). Unpublished original material.

Gay, Greg. (1997). Using Research to Design Effective Distance Education. Ontario Institute for Studies in Education (OISE). University of Toronto.

Gokhade, Anuradha, (1995). Collaborative Learning Enhances Critical Thinking. Journal of Technology Education. Vol. 7, Number 1. Fall 1995.





Greenberg, Saul; and Gutwin, C. (1998). From Technically Possible to Socially Natural Groupware. Proceedings of the 9th NEC Research Symposium: The Human-centric Multimedia Community. 8-31-9-1. Naru Japan. [On-line]. Available:
http://www.krlnec-unet.ocn.ne.jp/english/tope.html

Gutwin, Carl. (1996). Workspace Awareness Research. [On-line]. Available: http://www.cpsc.ucalgary.ca/projects/grouplab/people/carl/research/awareness.html

Moonen, Jef, (no date). The Efficiency of Teletraining. Educational Science and Technology. University of Twente Enschede, The Netherlands.

Newman, D.R. (1996). How can WWW-based groupware better support critical thinking in CSCL? ERCIM workshop on CSCW and the Web. Sankt Augustin Germany, 2/7-9/96.

Nunamaker, Jay; Briggs, Robert; Mittleman, Daniel; and Vogel, Douglas. (1996). Lessons from a Dozen years of Group Support Systems Research: A Discussion of Lab and Field Findings. MIS Department: University of Arizona.

Ryder, Martin; Wilson, Brent. (1996). Affordances and Constraints of the Internet for Learning and Instruction. Association for Educational Communications Technology. [On-line]. Available: http://www. Cudenver.edu/~mryder/aect_96.html .

Seung, Jayl; Prasad, Granger. (1997). An Intelligent Agent-Based Framework for Knowledge Management on the Web: An Exploratory Study of a Virtual Team in Designing a Multimedia System. [On-line]. Available: http://hsb.baylor.edu/ransomewer/ais.ac.97/papers/back.htm

Schrum, Lynn and Lamb, Theodore. (no date). Groupware for Collaborative Learning: A Research Perspective on Process, Opportunities, and Obstacles. Journal of UCS. Vol. 2 No 10. [On-line]. Available: http://www.iicm.edu/jues_2-10/groupware_for_collaborative_learning/html/paper.html

Stahl, Robert. (1994). The Essential Elements of Cooperative Learning in the Classroom. ERIC Clearinghouse for Social Studies. ERIC Digest ED370881 March 1994.

Stenberg, Kettil (1995). The Effect of EMS on Group Work. Masters Thesis in Economics. School of Economics and Business Administration. Helsinki

Tang, J.C. (1991). Findings from observational studies of collaborative work. Computer Supported Cooperative Work and Groupware. International Journal Man Machine Studies, 34(2).

Usabilityfirst. (1999). Groupware Design Issues. [On-line]. Available: http://www.usabilityfirst.com/groupware/design-issues.html

Wells, David. (1996). Groupware and Collaborative Support. Defense Advanced Research Projects Agency: U.S. Army Research Laboratory. Object Service and Consulting Inc..

Staying Independent - A Course for Active Adults Intro

Course Overview:
This course will focus on promoting independent living skills for adults aged 55 and over. Physical and psychological changes related to various stages of an adults life will be explored with an emphasis on healthy living and planning for future needs. Topics include: available community resources, good living through technology, tackling transportation troubles, living with age related impairments, safety in and around the home, nutrition and exercise, and other topics of concern to student participants.

Important Announcements:
· Please feel free to discuss any special arrangements you may need due to disability.
· Breaks will be given on a regular basis however, do not hesitate to "remind" me if I forget. J
· Several guests have been invited to speak on their area of expertise. It is requested that you arrive on time to class.
· This is a new course. Your participation and feedback will be greatly appreciated.
· I look forward to getting to know all of you! WELCOME!!!

Statistics Terminology

Chapter 1

Statistics: a set of methods for organizing, summarizing and interpreting info.

Population: the set of all individuals of interest in a study.

Sample: a set of selected individuals representative of the population.

Parameter: a value (usually numeric) that describes a population.

Statistic: a value (usually numeric) that describes a sample.

Data: measures or observations.

Data Set: a collection of measurements or observations.

Datum: a single measurement or observation.

Score: a single measurement or observation.

Descriptive statistics: statistical procedures used to summarize, organize, and simplify data.

Inferential statistics: techniques that allow the study of samples in order to make generalizations about the population.

Sampling error: the discrepancy or amount of error that exists between a sample statistic and the corresponding population parameter.

Variable: a characteristic or condition that changes or has different values for different individuals.

Constant: a characteristic or condition that does not vary between individuals.

Correlational method: two variables are observed to see if there is a relationship.

Experimental method: one variable is manipulated while changes are observed in another variable. Seeks to establish cause/effect. Must use randomization and a control group.

Independent variable: the variable manipulated by the researcher.

Dependent variable: the variable observed for changes.

Control group: a condition of the independent variable that does not receive the experimental treatment.

Experimental group: receives the treatment.

Confounding variable: an uncontrolled variable that is unintentionally allowed to vary systematically with the independent variable.

Quasi Experimental: Like the experimental but lacking the control or manipulation.

Constructs: hypothetical concepts used in theories to organize observations in terms of underlying mechanisms.

Operational definition: defines a construct in specific operational or procedural measurements.

Hypothesis: a prediction about the outcome of an experiment…usually about how the manipulation of the independent variable will affect the dependent variable.

Scales of measurement: Nominal, Ordinal, Interval, Ratio

Nominal: labels observations by category only. Exp: Male/Female

Ordinal: a set of categories rank ordered. Exp: Best to worst employee.

Interval: rank ordered catergories that for intervals of the same size. Allows you to measure the difference in size or amount...magnitude.

Ratio: an interval scale with an absolute zero point.

Discrete variable: separate indivisible categories.

Continuous variable: infinite number of possible values between two observed values.

Real limit: the halfway point below and above two adajacent continuous value scores.

Frequency distribution: an organized tabulation of the number of individuals located in each category on the scale of measurement.

Histogram: vertical bars are drawn above each score so the height corresponds to the frequency and the width corresponds to the real limits of the score. Used for interval or ratio scales.

Bar Graph: vertical bar is drawn above each score or category so the height of the bar corresponds to the frequency and there is a space separating each bar. Used for nominal or ordinal scales.

Polygon: a single dot is drawn above each score so the dot is centered above the score and the height of the dot corresponds to the frequency. A continuous line is then drawn to connect the dots and down to the zero frequency at each end of the range of scores. Used with interval or ratio scores.

Relative frequencies: like a polygon except there are too many scores so this shows proportions on the vertical axis in a curve rather than a series of lines…shows distribution of scores rather than individual scores as the polygon.

Rank or percentile rank: the percentage of people with a score below that level.

Symmetrical distribution: equal on each side.

Skewed distribution: scores pile up on one end and taper at the other end.

Tail: the side where the scores taper off.

Positive skew: the tail points toward the positive (above zero) end of the x axis. (Right).

Negative skew: tail points toward the negative (left) end.

Central Tendency: a statistical measure that identifies a single score as representative of an entire distribution. The goal is to find a single score most representative of the group.

Mean: The average.

Weighted mean: Adding scores to determine the average.

Median: the score that divides a distribution in half. Equivalent to the 50th percentile.

Mode: the most common observation among a group of scores.

Open ended distribution: when one category is left open as with 75 and above…etcetera.

Variability: a quantitative measure of the degree to which scores in a distribution are spread or clustered.

Range: the distance between the largest and smallest score in the distribution…or the upper real limit of the largest x value and the lower real limit of the smallest x value.

Interquartile range: the distance between the first quartile and the third quartile.

Semi-interquartile range: one half the interquartile range.

Deviation: the distance from the mean. (deviation scores must always add to zero)

Population variance: the mean squared deviation. Variance is the mean of the squared deviation scores.

Standard deviation: is equal to the square root of the variance.

SS: sum of squares: the sum of the squared deviation scores.

DF: Degrees of freedom: see text.

z-score: the precise location of each x value within a distribution. Can be positive or negative...the value of the score indicates the distance from the mean by counting the number of standard deviations between x and u.

Standardized distribution: transformed scores that result in predetermined values for u and q regardless of their values for the raw score distribution. Used to make dissimilar distributions comparable.

Standard score: a transformed score that provides information about its location in a distribution. A z-score is an example of a standard score.

Probability: in a situation where several outcomes are possible, probability is the fraction or proportion of any particular outcome. Must have random sampling.

Random sampling: for a sample to be random, each individual in the population has an equal chance of being selected and if more than one individual is to be selected there must be a constant probability for each and every selection.

Normal distribution: is symmetrical: the mean, median, and mode are equal; fifty percent of the scores are below the mean and fifty percent are above; most of the scores pile up around the mean and extreme scores are rare.

Sampling error: the discrepancy or amount of error between a sample statistic and the corresponding population parameter.

Distribution of sample means: the collectionof sample means for all possible random samples of a particular size (n) that can be obtained from a population.

Sampling distribution: a distribution of statistics obtained by selecting all possible samples of a specific size from a population.

Hypothesis testing: an inferential procedure that uses sample data to evaluate the credibility of a hypothesis about a population.

Null hypothesis: predicts the independent variable (treatment) has no effect on the dependent variable.

Alternative hypothesis: predicts the independent variable (treatment) will have an effect on the dependent variable.

Type I error: rejecting the null hypothesis when the null is actually true.

Type II error: the investigator fails to reject a null hypothesis that is really false.

Alpha level or level of significance: a probability value that defines the unlikely sample outcomes when the null hypothesis is true. Defines the probability of a type I error.

Critical region: extreme sample values that are unlikely to be obtained if the null hypothesis is true.

One-tailed test: a directional hypothesis: the statistical hypotheses specify an increase or a decrease in the population mean score.

Power: the probability a test will correctly reject a false null hypothesis.
Factors affecting power include; alpha level, one-tailed versus two tailed, and sample size.

The general elements of hypothesis testing:
1. State the null hypothesis.
2. Use the sample data to calculate a sample statistics that corresponds to the hypothesized population parameter.
3. Evaluate findings by measuring standard error, sampling error, variability of the scores etcetera.
4. Test the statistics using a z-score or other means.
5. Test the alpha level/level of significance.

t-test: use instead of a z-test when the population standard deviation is not known. Uses standard error.

Degrees of freedom: the number of scores in a sample that are free to vary.

Independent measures research design: an experiment that uses a separate sample for each treatment condition or each population.

Repeated measure study: a single sample of subjects is used to compare two or more different treatment conditions. Each individual is measured in one treatment and then again in the second treatment.

Matched subject study: each individual in one sample is matched with a subject in the other sample.

Estimation: the inferential process of using sample data to estimate population parameters

Point estimate: use of a single number as the estimate of an unknown quantity.

Interval estimate: use of a range of values as an estimate of an unknown quantity. When it is accompanied with a specific level of confidence or probability it is called a confidence interval.

ANOVA: a hypothetical procedure used to evaluate mean differences between two or more treatments or populations. Major advantage is that it can compare two or more.

IN ANOVA a Factor is an independent variable.
Single factor design: a research study with only one independent variable.
Factorial design: a study with more than one independent variable.

Error term: in an ANOVA the denominator of the F-ratio. The error term provides a measure of the variance due to chance. When the treatment effect is zero (the null hypothesis is true) the error term measures the same sources of variance as the numerator of the F-ratio so the value of the f-ratio is expected to be nearly equal to 1.00

Levels of the factor: the individual treatment conditions that make up a factor.

K= the number of treatment conditions / the number of levels of the factor in ANOVA

Experimentwise alpha level: the overall probability of a type I error accumlated over a series of separate hypothesis tests.

Variance between treatments.
1. Treatment effect: the different treatment conditions produce different effects and cause the individuals scores to be higher or lower in one condition than another.

2. Experimental error: anytime behavior is measured there may be error introduced. It may cause scores to be different in one individual across conditions.

Variance due to chance; the error term.
1. Individual differences: within each treatment the scores come from different individuals.
2. Experimental error: the uncontrolled and unsystematic error could always be the source of differences.

ANOVA notations
K= the number of treatment conditions

A n= the number of scores in each treatment

N= the total number of scores in the entire study.

G= the sum of all the scores in the study. The value of G corresponds to the summation of x for all N scores and specifies the grand total for the experiment.

T= the sum of the scores in each treatment condition (treatment total).

SS= the sum of the squares for each treatment (SS)
åX2= the sum of the squared scores for the entire study.

P= personal total. Used to measure individual differences in the analysis.

F-ration: requires between treatments variance and error variance.

Main effect: the mean differences among the levels of one factor.

Interaction: the effect of one factor contingent upon the level of the second factor.

Between-treatment variance is caused by the treatment effect, individual differences, and experimental error.

Positive correlation: two variables tend to move in the same direction. As the x variable increases the y variable also increases and vv.

Negative correlation: two variables tend to go in opposite directions. As the x variable increases the y variable decreases.

Correlations are used to predict, test validity, reliability, and theory verification.

Pearson correlation: measures the degree and direction of linear relationship between two variables.

Spearman correlation: measures the degree and direction of relationships between two variables where both are measured on ordinal scales…that is, both x and y consist of ranks.

Point biserial correlation: used to measure the relationship between two variables when one is measured on an interval or ratio scale but the second has only two different values (dichotomous variables such as male/female).

PHI-Coefficient: when both variables (x and y) are dichotomous.

Regression: the technique for finding the best fitting straight line for a set of data.

Standard error of estimate: a measure of the standard distance between a regression line and the actual data points.

Ten Causes of Holiday Stress

Top 10 Causes of Holiday Stress
1) Having expectations that are too high
2) Taking on too many responsibilities
3) Trying to change or control other people
4) Wrestling with troubling memories
5) Feeling unpleasant emotions and physical reactions to the season
6) Failing to anticipate problems and delays
7) Blaming yourself or others when things go wrong
8) Using foods, drugs, or alcohol to cope
9) Expecting others to behave the way you want them to
10) Trying to do too much.

Holistic Health and Stress Adaptation Measures

Hormones related to the measurement of stress include the levels of norepinephrine, epinephrine, and cortisol which can be measured from the blood and urine levels after exposure to stress. Cortisol is the end product but before that it is possible to measure the metabolism of ACTH in the blood and urine. But, because the body maintains a level balance of ACTH, the level of 17-OCHS is often a better indication of stress as the level of 17-OCHS is more indicative of recent stress. The level of thyroxin is also an indicator of stress. The greater the level of thyroxin the greater the stress. It is also possible to measure other chemicals that indicate stress such as the amount of free fatty acids and cholesterol levels in the blood. Generally speaking, after exposure to a stressor, the adrenal medulla releases catecholmines, epinephrine (adrenaline), norepinephrine, and dopamine. ACTH reaches the adrenal cortex which then releases corticoids (primarily cortisol) and aldosterone. The thyroid releases thyroxin. Taken as a whole, this results in the well known “fight or flight” response.
Another common measurement of stress is skin resistance. When skin resistance is high then a person is relaxed, when skin resistance is low then a person is usually more tense and susceptible to “injury”.
Besides laboratory tests and biologically based examinations, psychological and sociological measurements of stress are often used to determine the level of stress and associated risk of disease or emotional risk. Examples of these include chronic stress inventory’s, daily stress inventory’s, and social integration scales.
All of these measurements are able to provide a “picture” of how much stress the individual is exposed to in relation to their ability to cope or adapt. This does not mean the amount or degree of stress is any higher or lower than the general populations, but rather indicates a continuum at which the individual may or may not adapt or appropriately respond.

Holistic Health - The Stress Response

The mind is the first to perceive a stressor and formulate the response to that perceived stress. An environmental stimuli is perceived and translated according to the individuals conditioning and background. This may result in a direct physcial response, or an emotional response. In either case, the hypothalamus is stimulated, which then stimulates the posterior hypthalamus which in return has a direct affect upon the pituitary gland throught the release of CRF and TRF hormones which in turn stimulate the pituitary gland to secrete ACTH, TTH, and ADH. According to the text, the hypothalmic secretions are linked to the limbic sytstem and the cortex, which forms the basis of the connection between emotions and psychosomatic disease. The ACTH then stimulates the adrenal gland (which is divided into the adrenal medulla and the adrenal cortex). The adrenal cortex is the segment responsible for increased blood glucose...once the ACTH stimultes the adrenal cortex, it secretes cortisol and aldosterone. The cortisol increases the availability of energy needed during the “fight or flight” response by increasing liver functioning which is responsible for the production of glucose through the availabe glycogen and amino acids available in the body while decreasing the amount of glucose used by the muscles and fatty tissues.

Holistic Health and Darwin

The holistic view of health and disease is largely influenced by Darwins evolutionary theory and natural selection and the “fight or flight” concept set forth by Walter Cannon which states that a stimuli... either real or perceived, can elicit a response that originally enabled an immediate survival response by readying the body to either fight or run away from danger. This immediate response ensured maximum resistance for short duration in order to resist or avoid danger. However, as mankind continued to evolve, the primitive dangers were replaced by social and perceived psychological stressors which often elicit the same physical response patterns but without the ability to expend the associated energy. Also, perceived psychological stressors may be found frequently in daily interactions...so frequently they become a learned coping response. Some degree of stress, physical, mental, and emotional, is necessary for optimum performance. For example, exercise is a form of positive stress which allows the organism to function more optimally. However, modern living exposes the human organism to an on-slaught of stressors without the corresponding ability to relieve the built up tension.
Now the quick response which previously ensured the survival of the species has become a potential source of illness. This is especially true when mental and emotional work become the mainstay of society. Now a measure of survival depends upon modern man being able to quickly respond to less physical danger but rather respond to emotional and social stimuli which represent a threat to livelihood. The body responds in the same manner to any perceived threat whether or not a physical response is warranted. So, under a perceived psychological, emotional, or social threat the person responds with the same physiological arousal as if confronted by immediate physical danger. That response is not appropriate and must be controlled therefore prolonging or even prohibiting the release of tension. This often becomes a common occurrence and may result in malfunction or chronic disease due to the bodies chronic state of stress as identified in the General Adaptation Syndrome.
The concept of psychosomatic is taken to mean the mind/body interaction especially as it relates to the excess emotional arousal which may lead to disease. The process of disease may be a response to the chronic or continued stress in and of itself, or it may allow a previously existing condition or pathogen to gain access to the body during a period of reduced resistance. In either case, there is a stimuli which is either real or perceived to be a threat. The perception of that threat may be conscious or sub-conscious and is often determined by the individuals background, training, and conditioning. In either aspect, the hypothalamus is aroused resulting in the “fight or flight” response previously noted with the corresponding muscular arousal, cardiovascular involvement, increased immune responsivity, decreased peristaltic activity, and overall physical arousal. During this process there are several points at which to intervene. Beginning with the individuals perception, it is possible to dramatically influence this response pattern by altering what the individual perceives to be threatening in the first place. If the stimuli is not regarded as a threat then the corresponding physiological chain of events are less likely to occur. Research has shown that some persons “over-react” or fail to appropriately react to stressors thereby increasing the potential risk for harm. For example, “excessive reactors” often fail to control their response to stress whereas “deficient reactors” fail to appropriately respond in a manner that allows them to rid themselves of stress. By teaching an individual the correct way to respond or by desensitizing them to stimuli, it may be possible to eliminate the stress by the person not perceiving it to be stress, or teaching them to handle the stress appropriately if it is considered stressful. Next, it may be possible to manipulate the environment in order to reduce the exposure to threatening or stressful stimuli. These may include relationships or the physical environment surrounding the individual. Once again, this can result in the elimination or reduction of the degree or quantity of the assault. The next intervention point may be that of the physical response once a person has been exposed to a stressor. Once again, since some persons over-react or fail to appropriately react to stress, the physical assault can become disproportional to the actual degree of stress. Also, due to the chronic nature of some stressors, the body...in its attempt to maintain a level of homeostasis... “resets” itself to a higher or more stressful state. By teaching the body itself to lower its own response to stress, it is possible to reduce the overall level of stress. This can be accomplished in many ways but the primary objective is to teach the body a new way of responding so that the physical arousal state is minimized once a stressor is perceived. This results in less chronic damage. A common example of this is the use of biofeedback and relaxation techniques to lower blood pressure or other physical manifestations of maladaptive stress response patterns...or what the book terms “incompetent coping”. Other physical interventions can include diet, exercise, sleep, etcetera. Whether these interventions focus on the psychological, social, environmental, or physical ... all are designed to minimize the frequency, duration, or intensity of the stress while allowing the person to gain greater coping techniques that withstand a higher degree of stimulation without perceiving it as threatening but rather as an opportunity for growth. Finally, by controlling the by-products...so to speak...of stress, it is possible to maximize the individual overall level of functioning to allow greater productivity, growth, health.
In summary, points of intervention include the following:
1. Social engineering: this may include life events such as environmental factors or social interaction.
2. Personality engineering: this may include cognitive based therapy, education, or other interventions designed to change perception, feelings, emotional instabilities, or defense mechanisms.
3. Physical arousal...both covert and overt. This may include exercise, releaxation techniques such as visualization, progressive muscle relaxation, meditation, Yoga, and biofeedback; or the use of medication.

Taxonomy of Holistic Health

A Systems View of Health and Disease by Howard Brody and David Sobel, provides a hierarchical arrangement of living systems...beginning with atoms, molecules, cells, organs, persons, family/group, organizations, societies, homosapiens, and finally the biosphere, where health is seen as the “ability of a system (for example, cell, organism, family, society) to respond adaptively to a wise variety of environmental challenges (for example physical, chemical, infectious, psychological, social).” This view of health was adapted from the work of Dubos. Health is considered a process not a static state of being whereas disease is a seen as a “failure to respond adaptively to environmental challenges resulting in a disruption the overall equilibrium of the system.” Because all the levels are interconnected, a breakdown or malfunction in one area has resulting effects upon the other systems. Generally western society has focused upon the lower levels of functioning, for instance the virus most immediately responsible for an illness. This fails to account for the process of resistance, health, or the resulting effect upon the other surrounding systems which may aide or interfere in the process of disease or health. Not only is it possible to more effectively manage disease once it occurs through multiply interventions directed at various levels in the hierarchy, it is often possible to prevent disease throughout these same routes. But, the systems view of health accounts for more than simply the prevention or cure of a disease, it also recognizes that a disease may not be prevented...in this case it is necessary to confine the disease process so that it does not affect other levels in the hierarchy. This recognizes the possibility of healthy living with a disease or illness, once again reaffirming the individuals control over the illness and promoting the opportunity for growth.
The level of the disease does not necessarily determine the level of the intervention although it should be noted that intervention at one level often produces great impact upon other levels. Take for example nutrition. The chemical reaction of better nutrition would be noted on the individual, the organs, and down to the atomic level. Likewise, nutritional intervention would likely entail educating the family and close relationships on proper food preparation and nutritional content. Even on a societal level it is possible to see restaurants and food packaging recognizing the need for some special diets by providing for these needs. Each exerts an influence upon the other. Health promotion acts as a mediate between the traditional western view of the treatment of disease and symptoms, and the more proactive and inclusive nature of the framework provided by the systems view of health and disease.

Eight Principles of Holistic Health

The eight basic principles of holistic health include the following:
1. Health requires the integration of mind, body, and spirit.
2. Positive wellness rather than the absence of symptoms is the main goal of health care.
3. Everyday living habits are the basis of health.
4. The individual must affirm personal responsibility for their own health.
5. Illness provides an opportunity for growth.
6. Environmental factors play a major role in individual health.
7. All modalities of healing...ancient or modern....deserve scientific exploration and should be used when appropriate.
8. The inner capacity for health is the foundation for achieving positive wellness.
Drawing on these basic concepts, several themes emerge. Beginning with the definition of health which is seen not as the ultimate goal within itself but rather a precondition necessary for the attainment of other goals, and not as an end product but rather a process or a condition, it is possible to observe various sociological and theoretical foundations underlying the revived interest in holistic health. For example, the concept of four types of persons:
1. Type one-well adjusted physically and emotionally.
2. Type two-well adjusted psychological but poor physical health. Can adjust due to good coping/adaptation abilities.
3. Type three-seemingly health but have poor adaptation/coping skills
4. Type four-poor health and poor adaptation/coping skills.
The role of health promotion become vital in the utilization of scarce resources and manpower, in order to achieve maximum productivity and health. It is possible to intervene on a psychosocial level with dramatic effects upon individual health.
Another example is the work of Renee’ Dubois who defines health a sense of balance or equilibrium that results from mans adaptation to his environment. Once again, health is not seen as a static state but a process by which an individual can grow or modify themselves, not only for the present but to prepare for the future. In this view, the state of health or disease is considered an expression of the success or failure of the organism in its effort to respond and adapt to environmental challenges.
The systems view of health is another framework from which to view the role of each individual within society and their ability to adapt/cope and grow. Whichever framework chosen, it is necessary to practice holistically in order to maintain health. This means the attitudes, behavior, and physical functioning necessary to ensure continued health or to treat disease. Current health status indicates lack of health is often based on behavioral patterns or activities. Examples can be found in epidemiological studies showing a decline in viral disease deaths but a rise in cardiovascular disease and other behavioral health risk. Also, tracking immigration and disease statistics demonstrates the rise of these same behavioral diseases once a given population takes on the predominant cultural risk factors. Given this type of data, it is concluded that a change in the patterns of disease/diseases of adaptation can result from behavioral interventions. Finally, the satisfaction level of the current practice of healthcare is not high. Despite modern medicines ability to intervene in the disease state, little has been done to prevent the occurrence of the disease in the first place. Also, medicine often fails to account for quality of life issues and the side effects of the treatment. As individuals take more responsibility for their own health, holistic health has increased.

Health Topics in Need of Development

Proposed Topics

Computerized Instructional Methods
· Computer Assisted Instruction (CAI)
· Computer Managed Instruction (CMI)
· Computer Mediated Education (CME)
Pro's and Con's/ Abilities and Limitations/ Considerations/Examples & Resources

Essential Technology Skills for School Health Teachers

Copyright Information for Educators

Critical Design Issues for Digital Information Delivery in Health Education
· Functionality
· Reliability, availability, and integrity
· Standardization, integration, consistency, and portability
· Five evaluation measures
· Accommodating diversity

An Educational Technology Primer for HSE

Pedagogical Foundations of Ed. Tech. In HSE

Accessibility in Electronic Health Communications

The Status of Health Ed. For Special Populations

Low Literacy and Health Education

Forgotten Children: The Health Needs of Incarcerated Youth

Integrating Health Education into ESOL/ABE/GED Instruction

Electronic Portfolios for Sunshine State Standards (only for Fl School Health Assoc)

Requirements for Effective Use of Technology

Personalizing Health Education through Technology

Challenges to Curriculum Design and Evaluation
· Non-linear versus linear
· Multi-media versus print
· Self-directed versus lead
· Active versus passive
· Facilitative versus Lecture Based

Disability Awareness in Recreational Therapy Program Plan Outline

INTRODUCTION:
DART will operate with the Department of Recreation, Parks, and Tourism at the University of Florida in conjunction with the Marion County School Board. Funding for the 5 year pilot project will consist of . This covers all expenses including materials, development of original resource, training, supplies, hardware/software, and personnel. Future funding will be shared between private/public partnership with the University of Florida Department of Recreation, Parks, and Tourism disseminating data, organizing, training personnel and programs in conjunction with private sponsorship. Furthermore, it is expected that increased technological abilities will offer potential for revenue generation by professional development training seminars and “sales” of computer advertising within the programming software itself.
The University of Florida is a recognized leader in education and research which
The Florida Department of Education is committed to the enactment of the Individuals with disabilities Education Act (IDEA) which guarantees a free public education to all disabled persons within the least restrictive environment possible. This has generated the concept of “inclusion” where disabled children are educated with their peers whenever possible.
Inclusion seeks to provide greater opportunity and the eradication of structural, social, and societal barriers which restrict nearly 20% of uninstitutionalized Americans from equal access to education, work, and leisure. The economic and social ramifications of isolation and limited opportunity for 48 million Americans can no longer be ignored. As the U.S. disabled population increases (due to age, disease, advances in medical technology, etc.) and the government simultaneously seeks to cut spending, it becomes economically unfeasible to continue the support of millions of disabled persons. Thus, the trend towards inclusion within the school system is the necessity of tomorrow.
Inclusion seeks to minimize the differences associated with a disability while maximizing the abilities of each individual. Unfortunately, lack of awareness, misconceptions, inadequate exposure, and training, or even fear may hinder the actual application of inclusion. In order to address these and other issues, a Disability Awareness through Recreation and Technology (DART) program is set forth.
DART will provide a comprehensive training, awareness, and experiential program for K-12 grade students. By utilizing technological resources in a “fun” and stimulating manner, improved awareness, increased interpersonal skills, and disability education will be demonstrated. Educators will be trained in the use of Disability Awareness Activities and information in order to further the process of inclusion.
Initially DART will target Marion County in the provision of services to approximately 26,000 students of public education for a 5 year pilot program. recognizes the economic, social, and individual benefit derived from inclusion. The Therapeutic Recreation emphasis is uniquely situated to provide an educational and fun response to the challenges faced by the non-disabled as well as the disabled population within the school system. By reaching the needs of all students inclusion becomes a reality.

STATEMENT OF NEED:

Statistics from the U.S. Census Bureau demonstrate the potential impact of this grant proposal.
· Florida serves 258,522 children under the Individuals with Disabilities Education Act (IDEA).

· Over 48 million Americans are disabled: Nearly one out of every Five non-institutionalized persons!

· According to the EEOC, $169 BILLION dollars were spent on transfer payments (Social Security Disability Insurance, Workman’s Compensation etc.)

· According to the same EEOC report, at least 8 Million disabled workers could Immediately return to work given an enabling environment. This would result in decreased social service expenditures and increased economic growth due to the newly gained economic vitality of disabled persons as they join the labor force.

· The Urban Institute reports that in 1994 children received more than $4 Billion dollars in SSI benefits. SSI expenditures represent less than 10% of combined federal, state, and local expenditures on children with disabilities. An estimate on combined cost would exceed $35 Billion dollars annually.

· The number of children receiving SSI has more than doubled since 1990. Adult caseloads have increased 30%.

· According to the Social Security Administration, Disability outlay in 1995 (excluding workman’s compensation and other transfer payments) was $41.6 Billion dollars. OASI benefits were $292.2 Billion dollars. Total outlay for 1995 exceeded $336 Billion dollars.

Despite the alarming nature of these statistics, Disability Awareness lends hope for a brighter tomorrow. Much as other Civil Rights movements, centered on gender, race, or religious status; the issue of disability has historically been overlooked or underestimated. Parallels among earlier Civil Rights movements and the current need for inclusion can be drawn. For example, the economic impact of discrimination and segregation became burdensome to society as a whole. Also, as with other Civil Rights movements, the disadvantaged group is aware of the issues, problems, and discrimination faced daily...it is necessary to educate and sensitize OTHERS in order to include all members of society. However, traditional services fostered dependence and isolation rather than independence and integration.
There is a unique feature which disability shares with no other movement: Disability is open to all. Unlike race or gender, disability can be acquired.
DART will be conducted as a model project designed to enhance the inclusion of disabled persons through the education of non-disabled persons. It is recognized and generally acknowledged that environment is the largest determining factor associated with the degree of handicap experienced by a disabled person. Given the vast amount of resources and funds directed at programs which inhibit the full potential of disabled person, the need for inclusion is urgent.
The medically diagnosed disability will still exist, but the degree of handicap or missed opportunity, experienced can be drastically minimized or even eradicated given an enabling environment. Project DART addresses this issue of environment though an outreach program targeted to the non-disabled as opposed to only the disabled population. There are few programs designed to meet the needs for education and training issues for the non-disabled person. These same persons will have a tremendous impact upon the success of any effort towards inclusion. This need is especially critical in the school system which is at the forefront of the inclusion effort in our society.
BACKGROUND:
Approximately 10-12% of all students are classified as “Special Education” in the United States. The education of special populations goes back to 16th century Spain where the education of the deaf was undertaken by Pedro Ponce de Leon. During the 18th century Sign Language was developed in France. Attempts to educate the blind and mentally retarded came about during the late 1700’s and early 1800’s. However, the United States did not open its doors to disabled children until 1869 when a school for the deaf opened in Boston. In 1896 the Chicago School for the Blind was established. Generally, disabled persons were kept at home or institutionalized. Educational opportunities remained rare and awareness of disabilities was grossly underestimated.
During the early 1900’s the government began screening for military personell. This screening process drew attemtion to physcial/cognitive/other conditions which the military deemed “unfit” for service. For the first time in American History a more accurate reflection of disability emerged. In 1929 the White House Conference on Children made special education a national priority. This was delayed due to the Great Depression and WWII and it was not until 1958 that Congress passed legislation designed to assist teacher training for the retarded. Ten years later the Education of the Handicapped Act was passed (amended in 1970), requiring the education of all disabled children. Finally, in 1975...only 20 years ago...did all states in the union provide education for all disabled students.
These traditional approaches to educate the disabled have historically consisted of segregated education and leisure, the effects of which carry far into adulthood. Only recently has the concept of inclusion or integration been adopted. Thus far the programs aimed at providing oppotunities for the disabled have fallen into the following categories:
· Segregation:
· Special Olympics
· Special Education
· Integration aimed only at the disabled:

· Independent Education Porgrams: focus upon mainstreaming children whenever possible but does little to address the quality of the social interaction by assuring an understading and supportive environment once the disabled child is placed into a tractional environment.
· “Techpress” which aims at the inclusion of disabled persons through technological education and education of the disabled.

· Protection from the disabled:

· Numerous programs aimed at the awareness and education of the disabled are available in order to Protect business and service providers from potential lawfuits or discrimination complaints, but very limited opportunities for education regarding inclusion are available. The ability to maximize the agency resources and potential effectivenees while providing meaningful opportunites for the disabled population still must be addressed.

Project DART fill this void. First, rather than viewing service provision as a “duty” with “cost” associated, the realistic and proactive financial “investment” is emphasized as having great potential “gains” for all citizens.
TARGET POPULATION:
DART initially will target school aged children grades K-12 in the Marion County Public School System. Disabled and non-disabled children will both be eligible for program participation as even disabled children are not aware of other disabling conditions. DART will also provide Instructor Education regarding curriculum and activities designed to Reinforce acquired learning.
Following the initial pilot project, DART will expand the educational compenent to school districts throughout Florida. Additionally, training seminars for professional, private, and public entities will be developed in order to elicit community support and awareness.
PROGRAM GOALS & OBJECTIVES:
1. To increase awareness and sensitivity to issues of Disability.
For each age appropriate category, various activities designed to enhance understanding and acceptance of issues surrounding disabiites will be personally experienced by each student.

In elementary school, the board game “In My Shoes” by DPI will be utilized. Additionally, each child will be allowed to touch, play, and use various assistive devices such as cruthes, eyeglasses, and wheelchairs in order to breakdown fear and barriers associated with unfamiliar objects. This will be under the supervision of carefully trained personall. Afterwards, a processing of the information and the experience of each child will be forthcoming.

For middle school children, interaction with various assisstive devices will be taken one step further as each child will “take on” a disability for one hour at a time. There will be an associated computer lab experience consiting of a video game portraying positive “can-do” disabled characters which provide a positive and fun approach.

High school students will experience a sophisticated replication of “acquiring a disability” through the use of Virtual Reality technology. The student will be allowed 10 to 15 minute sessions due to the extreme realism associated with the experience. Again, a processing of each students experience will be conducted thereafter. The associated computer lab experience for these students will consist of a software program which allows the students to interact with each other or other schools via computer. The program divides each group by selected criteria (age, disability,expertise, etc.) and allows input on a preselected decision making activity. Students will be instructed to implement, design, or carry-out a preassigned activity while providing for the designated disability.

2. To improve interpersonal skills and encourage the value of diversity.

DART will provide opportunity and availability for soical interaction with disabled “mentors”. An interaction, question and answer session, and internet “pen pal” correspondence will be utilized by each student during the course of training.

3. To educate student in respect to the need for inclusion of the disabled.

Specific age appropriate learning modules will be presented. Learning modules will be 10-30 minutes in duration and consist of verbal, written, media, and action oriented communication. Foundation Learning modules will be presented by initial DART personell. Supplemental Learning modules will be at the disposal of trained instructors and deigned for eas of implementation into all subject matter.

4. Teacher, Parent, and Community awareness and support for inclusion.

In order for inclusion to work, all members of society should be as activiely informed as possible. DART will send a copy of “DART-BOARD” (newsletter) to educators (to be distributed to teachers and parents) and community resources every 6 to 8 weeks. Highlights of DART activities, research, resources, infomration, and community sponsors will be included.

DART will also maintain a Homepage via the WWW accessible by computer 24 hours a day which list information, resources, and feedback from the community.

5. “Train the Trainer” Professional Development.

In order to obtain the maximum results, Volunteer Teachers from local schools, and related service providers from local not for profit organizations will be invited free of charge to participate in the full range of Disability Awareness through Recreation and Technology Programs. Each participant will be enrolled in a 4 to 6 hour course. Beginning with the education phase and followed by the Virtual Reality experience of an “acquired” disability. A firsthand introduction to the aspects of inclusion as it relates to Professional Development and Community growth will be emphasized.

PLAN OF ACTION & PROGRAM DESIGN:
DART will build a foundation with
Education
Awareness
Experience
To meet the needs of
Students
Educators
Community
Through
Recreation
Technology
Information

DART will continue to grow and generate funds through...
· Charging for Professional Development Seminars
· Corporate Sponsorship
· Ongoing Community Awareness
· Liason with related agencies.
· Sales of corporate advertising within the software and newsletter.
· Sales of Learning Modules.
· Learning Modules consist of various applications, exams, examples, etc. Designed to expose studetns to disability concepts after the foundation course by assimilating disability information and awareness into the general curriculum. Learning Modules will be sent in disk format for ease of duplication, savings of resources, and convenience of use. Each disk will have complete examles, tranparencies, and presentations. Learning Modules can be designed for use with any subject!
METHODOLOGY:
DART will provide local, state, and federal data and statistics through ecological and demographic data collection and dissemenation related to disability. A collection of referenced materials and resources will be made available via the Webpage for continuous updates. Also, unique localized information and data collection will be collected, analyzed and dissemenated for future use.
MANAGEMENT AND STAFFING PROJECTIONS:
During the five year pilot project phase, it is anticipated that DART personell will consist of the following positions:
Principal Investigator: The pricipal investigator will spend approximately 1/3 time on the project for 9 months of the year and 100% during the remainder of the year.

Project Coordinator: A full time project co-ordinator will be required to oversee the daily operations of the program. Duties will include assisting in personell issues, development of Learning Modules, supervision of Graduate assistents, and training.

Community Coordinator: A full time community co-ordinator will be required to act as community liason for related agencies and schools. Duties will include site selection and accomodation, information and “key-contact” support person, and production of “DARTBOARD” as well as the Homepage on the WWW.

Professional Development Specialist: A full-time specialist will be required to conduct Professional Development training and produce original resources. The integration of community and investigative needs will be combined to provide an adequate base of knowledge while meeting “real world” concerns.

Secretary: A full time secretary will provide written and verbal support through scheduling, sending out requested information, and all other office task.

Hardware Consultant: Training on related computers and Virtual Reality equipment will be necessary for a realistic experience and the maintenance of the equipment.

Software Consultant: A software firm will be hired to produce a quality software package consisting of “Can Do” video games and Learning Modules specifically for DART.

Graduate Assistants: Five 1/2 time graduate assistants will be needed to assist in the implementation of the actual program, training, professinal development, and information acquisition.

Student Employees: Five 1/2 time student employees will be needed to assist in guidance of children during activities, routine office task, and development of support resources.

ORGANIZATIONAL STRUCTURE:

Health and Wellness Activites - Community and Media Analysis

· Baseline Data Sheet and Personal Fitness/Health Goals
· 3 Day Dietary Analysis
· Study Guide Activities for Assigned Chapters
· Optional Bonus: View one of these 3 videos: Gattica, Outbreak, The Band Played On and discuss how these relate to covered topics.
· Library Scavenger Hunt

· Drug Culture Analysis: In the second half of this semester you will study the substance abuse and related phenomena. Although the U.S.A. has been fighting a 'war against drugs' for many years, people still abuse drugs. After viewing the video's and completing the corresponding readings, you are to write a list of every single time you see a drug of any type [including smoking, alcohol, etc.] in your daily life for 3 days. This means if you go into a store to buy gasoline and see a beer display you write it down! If you turn on the television and someone is drinking or smoking...write it down! Then give me your opinion as to how this impacts children and adults in their decision to use drugs. Have we become 'immune' to the concept of substance abuse? How does this impact someone who has made the decision not to use drugs? What do you think would help us 'win the war on drugs'?

· Sexually Transmitted Diseases: You will also study STD's and the concept of "safe sex". But is the message of "Safe Sex" really reaching the right people? Is it effective? After viewing the video's and completing the corresponding assigned readings, you are to critique the "messages" regarding sex that culture sends to our youth by:
· Analyzing the lyrics to at least 3 songs popular among young teenagers [radio is fine]. Do the lyrics mention or suggest sex? Is it 'Safe Sex'? Explain.
· Analyze at least one magazine that targets teenagers. How many advertisements, articles, or other information concerns sex either directly or indirectly?
· Visit a local teen 'hang-out" such as a skating rink, store targeting teens, etc. and explain if/how sex is portrayed.
· Watch at least two movies or television shows targeting teens. How is sex portrayed?
· In your opinion, how does this impact the transmission of STD's in the USA?
What can/should be done?

Release of Confidential Information - Confidentiality - Substance Abuse

Introduction:
Substance abuse is a major problem confronting this nation. The associated crime rate, broken families, and impact on the business sector have taken a toll on the “American Way of Life”. Due to the widespread impact upon society, various means of addressing the problem are utilized including punishment (prison, jail, and detention centers), rehabilitation (treatment facilities), and prevention (educational programs), as well as private hospitals and employee assistance programs. Despite acknowledgment of the problem, there is still a great deal of social cost associated with disclosure of a substance abuse problem or risk of a problem. For this reason stringent regulations have been established to ensure the individuals right to privacy.
Federal regulations protecting the confidentiality of drug and alcohol records were first issued in 1975, but due to the complexity, length, and general impracticability of the legislation, infractions are common. Added criteria associated with juveniles and potential criminal justice proceedings further complicate a misunderstood process. This can be particularly troublesome for health educators unfamiliar with the legal mandates surrounding drug education and prevention.
Statutory Authority:
In 1975, regulations were issued pursuant to two different statutes, although only one set of regulations exist. The Drug Abuse Office and Treatment Act of 1972 was amended to mandate confidentiality of patient records to be maintained in connection with the performance of any drug abuse prevention function. Similarly, the Comprehensive Alcohol Abuse and Alcohol Prevention Treatment and Rehabilitation Act of 1970 (also amended in 1974) governs records maintained in connection with the performance of any program or activity relating to alcoholism, alcohol abuse, education, training, treatment, rehabilitation, or research.
Regulatory Framework:
The Alcohol, Drug Abuse and Mental Health Administration subdivision of the Health and Human Services Public Health Service has general oversight and coordination responsibility but lacks direct enforcement ability. The National Institute of Alcohol Abuse and the National Institute of Drug Abuse more closely monitors compliance with regulations set by the HHS.
The regulations are organized into four parts: Scope of applicability, definitions, general rules regarding disclosures, and specific situations of disclosure. The regulations broadly apply to nearly every facility or program that provides drug or alcohol treatment, and extend authority to programs “directly or indirectly assisted by any department or agency of the US”. This is interpreted to mean any drug or alcohol prevention function directly assisted by government grant; regulated, licensed, or authorized by federal government; indirectly assisted by government contracts, or assisted by the Internal Revenue Service (IRS) through tax deductions or exempt status. This remains in effect even if drug and alcohol prevention/treatment is not the primary function.
General Rules:
Confidential information includes ALL information about clients in the possession of program personnel: attendance/absence records, physical whereabouts, and status as a patient...whether or not this is documented. Whereas in most hospital settings family members can call to request general information (room number, date of release, etcetera), this is strictly forbidden in regard to substance abuse. Disclosure that a person answers to a particular description, name, or has/has not attended a program, is subject to the prohibitions and conditions of the regulations. Any improper or unauthorized request for disclosure, records, or information must be met by a non-committal response.
The search for a truly non-committal response presents implicit disclosure problems. Considerable time has been spent attempting to draft a response that does not produce an implicit or negative disclosure. However, even if such a response could be drafted, determining when to use it also presents difficulties. If it is used only when a record contains drug/alcohol information, there is implicit disclosure of this fact by virtue of the response. If a non-committal response is used in reply to every request for records, the implication is equally possible that the patient MAY be receiving substance abuse services when in fact, they are not. To further complicate the issue, the identification of drug and alcohol clients through their files is also suspect...whether in a hospital setting, employee assistance program, prevention program, or criminal justice setting.
Basic rules are set forth regarding disclosure of records pertaining to minors, deceased or incompetent patients, informants, and identification cards. When disclosure is made in compliance to the regulations, it must be “limited to information necessary in the light of the need or purpose for the disclosure”: another essentially subjective statement often left to the broadest interpretation.


Disclosure with Consent:
The form of consent required is explicitly stated. Consent must be in writing and contain the following:
1. The name of the program making the disclosure.
2. The name or title of the person or organization to which disclosure is being made.
3. The name of the patient.
4. The purpose/need for disclosure.
5. The extent or nature of the information to be disclosed.
6. A statement that consent is subject to revocation at any time...except for that disclosure already provided (unless for a criminal justice release which cannot be revoked once given).
7. The date on which the consent form was signed.
8. The signature of the patient or authorized guardian.
9. The date, event, or condition upon which the consent will expire if not revoked before (This can be no longer than “reasonably necessary” to serve the given purpose).
The release must be written with the client rather than pre-typed. Disclosure is prohibited if the consent is “non-conforming” in any respect. Redisclosure of information released is prohibited. Each disclosure must be accompanied by a written statement substantially similar to:
“....This information has been disclosed to you from records whose confidentiality is protected by federal law. Federal regulation (42CFR Part 2) prohibits you from making any further disclosure without specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations.”
This includes the patients family, third party payers, and criminal justice system. This is difficult when the program is housed in a criminal justice setting or pertains to a minor in any respect.
A facility may deny relatives access even with written consent if disclosure is deemed harmful in any manner. Employers who obtain written consent from clients may receive information limited to the verification of the status of treatment. In all other situations not specifically provided for, a facility or program may make disclosure in compliance to a written consent if the consent is given voluntarily/without coercion and the request for disclosure will not cause harm to the client in general.
The requirements of such subjective determinations of benefit versus harm has been criticized as unpracticle and burdensome for the program/facility as well as overly paternalistic toward the clients who should have a “right” to control information about themselves. Questions arise in response to this “right”; including criminal activities reported during the course of counseling or program activities, the rights of parents versus minor children, the rights of pregnant women versus the unborn child who is also subject to the effects of drug abuse, the right of an employer to know if an employee referred to counseling is successfully completing treatment, and numerous other legal and ethical concerns.
As a general practice, substance abuse personnel learn to ask precise questions in order to avoid the occasional admission of guilt regarding an “unsolved” crime. In cases where admission of guilt is an issue, the privilege of confidentiality protects both client and personnel. Exceptions include breach of confidentiality based on the “Tarasoff Rule” which requires personnel to warn possibly endangered third parties with whom the provider has had no previous relationship, or in the case of child abuse which must always be reported. But, what about the unborn child? Some state and local authorities require maternal drug and alcohol usage to be reported to authorities as child abuse. These reports can result in criminal charges against the mother and/or placement of the children into protective custody with the loss of parental rights. Implications for health education programs can conflict with program goals. If maternal usage of the substance is labeled child abuse then a legal obligation to report the abuse exists. However, this may lead to an undesired outcome as the mother may chose to forego not only substance abuse services but also prenatal care in order to avoid criminal charges. The client may feel the standard is haphazardly applied due to the drug of choice (drugs such as cocaine are routinely tested for and often result in prosecution whereas hallucinogenic drugs can only be tested through cerebral spinal fluids requiring a complicated and invasive spinal tap which is rarely performed ), or that disclosure of information is a punitive approach in itself.
Federal regulations require facilities to inform pregnant women about their right to confidentiality AND required reporting procedures/possible court involvement. Information concerning the woman may not be disclosed without written consent. A woman does have the right to control the release of confidential records pertaining to her infant according to the Treatment Improvement Protocol #2 of the US Department of HHS, unless excused by law. Due to the sheer number of conflicting laws dealing with the subject, the issue is far from adequately resolved. In addition to regulations cited for general disclosure information, various other federal and state laws from the Child Welfare Act of 1980 to the Americans with Disabilities Act must also be considered.
Another area of difficulty is the rights of adolescents. In most instances parents have the right to consent for their children and the right to information regarding their children, but when dealing with substance abuse the adolescent must consent to the program, treatment, and release of information regarding themselves. Parents cannot sign for the child. Consent must be in writing and assurance of free will must again be considered. Debate is unresolved in regard to adolescents who seek treatment or services without parental knowledge or consent, and/or refuse parental disclosure. As with other issues such as abortion rights, it is felt the child’s safety may be jeopardized, however, rejection my be paramount to denying medical treatment.
Disclosure Without Consent:
Exceptions to the rule that a patient must consent to disclosure do exist. These include bona fide medical emergencies, child abuse, suicidal or homicidal threats, the content necessary for qualified personnel to conduct scientific research, financial audits, program evaluations, and court orders. That is not to say there is free/open access to records. For example, in regard to a court order, a supeona alone is not sufficient grounds to comply. Proper response requires acknowledgment of the supeona and attendance to a “Good Cause” hearing which serves to document that a good cause exists for the protection of life or serious bodily harm. This is specific to substance abuse only.
Summary:
There remains a great deal of work to be done to determine exact standards for the release of information with far- reaching social consequences and legal ramifications for clients and providers of substance abuse services. Issues of pre-natal child abuse received widespread attention in recent years but little is known about long term results of the stance taken. Employers attempting to eradicate substance abuse from the workplace implemented programs to address the issue but remain dissatisfied with the lack of knowledge available concerning progress/participation. Only for “reasonable cause” versus the factor of need, can an employer gain access to information. Meanwhile, the issue of adolescent participation is far from resolved. With high rates of teenage drug use and associated criminal activity, attention has focused on prevention programs for this group...but little consensus has been reached regarding the “how to’s” of disclosure. This is especially true if the minor denies parental disclosure or disagrees with parental consent. Finally, criteria used to determine the proper stance is subjective in nature, leading to discrepancy in the application of regulations.






References
Confidentiality of Alcohol and Drug Abuse Patient Records. 42 CFR Part 2 SS2.1-2. 67-1 (1979).
Federal Register. Vol. 52 No. 110. Rules and Regulations. Release of Confidential Information 42 CFR Part 2. 1987.