Mainstreaming gambling-related harm in Britain as a public health issue

Aim

In this paper we make the case for gambling–related harm treatment services in Britain to be mainstreamed within the remit of public health. Although the focus of this article is on the British situation many of these issues are generalisable to other jurisdictions.

The profile of problem gamblers

In Britain, 0.9 % of adults are problem gamblers, and it is more common in the young, socially deprived and the ethnic minorities.

Who provides and who should provide treatment services?

At present in Britain, almost all dedicated funding to address gambling-related harm is provided by voluntary contributions from the gambling industry and the level of service provision is far from adequate.

Mainstreaming gambling treatment

Problem gambling is associated with a range of health and social harms yet it often goes unnoticed for a variety of reasons. Early interventions can minimise or prevent the negative effects of problem gambling on various spheres of the gambler’s life, his/her family and wider society.

Conclusion

Consistent with plans to move the commissioning of drug-misuse treatment services within the remit of public health, it would seem entirely logical to commission gambling-related harm treatment services from the public health ‘purse’, and to request that gambling-related harm falls under the remit of the new Health and Well-Being Boards.     

Predictors of Initial Engagement in Child Anxiety Mental Health Specialty Services

Background

Child and family mental health services remain largely underutilized despite the relatively high rate of youth suffering from mental, emotional, and behavioral disorders. As such, it is important to address challenges and examine factors related to child mental health service use and engagement, especially when it comes to children in need of services for anxiety.

Objective

Informed by the behavioral model of health services use, the present study sought to examine predictors of service use and engagement for families seeking assistance for their anxious children. Initial levels of engagement in culturally tailored services were predicted from predisposing characteristics (e.g., child age, ethnicity), enabling resources (e.g., Spanish services, transportation), and need characteristics (e.g., child clinical severity).

Methods

Participants included Latino (n = 126) and Caucasian (n = 116) families who presented to a specialty clinic due to child emotional and behavior problems related to anxiety. Initial service utilization and engagement was assessed along the following levels toward services care: (1) initiated contact and completed a clinical intake, (2) completed a home screen, and (3) completed an on-site diagnostic assessment. All procedures were culturally tailored to the presenting needs of families.

Results

Predisposing characteristics, enabling resources and need characteristics emerged as significant predictors of child mental health service use, with some variations. Child age, ethnicity, referral source, and enabling resources predicted completion of a home screen. Proximity to services predicted completion of the on-site diagnostic assessment.

Conclusion

Knowledge of factors that predict engagement in child mental health services can help identify avenues to promote service utilization, especially among ethnic minority children and families. Our culturally tailored approach to serving families appears to be promising in bridging the cross-ethnic services gap and therefore has implications for practice.     

Rationing is a reality in rural physiotherapy: a qualitative exploration of service level decision-making

Background

Deciding what health services are provided is a key consideration in delivering appropriate and accessible health care for rural and remote populations. Despite residents of rural communities experiencing poorer health outcomes and exhibiting higher health need, workforce shortages and maldistribution mean that rural communities do not have access to the range of services available in metropolitan centres. Where demand exceeds available resources, decisions about resource allocation are required.

Methods

A qualitative approach enabled the researchers to explore participant perspectives about decisions informing rural physiotherapy service provision. Stakeholder perspectives were obtained through surveys and in-depth interviews. A system theory-case study heuristic provided a framework for exploration across sites within the investigation area: a large area of one Australian state with a mix of rural, regional and remote communities.

Results

Thirty-nine surveys were received from participants in eleven communities. Nineteen in-depth interviews were conducted with physiotherapist and key decision-makers. Increasing demand, organisational priorities, fiscal austerity measures and workforce challenges were identified as factors influencing both decision-making and service provision. Rationing of physiotherapy services was common to all sites of this study. Rationing of services, more commonly expressed as service prioritisation, was more evident in responses of public sector physiotherapy participants compared to private physiotherapists. However, private physiotherapists in rural areas reported capacity limits, including expertise, space and affordability that constrained service provision.

Conclusions

The imbalance between increasing service demands and limited physiotherapy capacity meant making choices was inevitable. Decreased community access to local physiotherapy services and increased workforce stress, a key determinant of retention, are two results of such choices or decisions. Decreased access was particularly evident for adults and children requiring neurological rehabilitation and for people requiring post-acute physiotherapy. It should not be presumed that rural private physiotherapy providers will cover service gaps that may emerge from changes to public sector service provision. Clinician preference combines with capacity limits and the imperative of financial viability to negate such assumptions. This study provides insight into rural physiotherapy service provision not usually evident and can be used to inform health service planning and decision-making and education of current and future rural physiotherapists.

     

Community pharmacy-based opiate substitution treatment and related health services: a study of 508 patients and 111 pharmacies

Background and aims

Community pharmacies have a central role in the provision of opiate substitution therapy (OST) for drug misusers, offering accessible, additional health services within recovery-oriented systems of care. However, little is known about the patients receiving OST, availability and uptake of related services and associated pharmacy characteristics. We aimed to describe OST in terms of patients, pharmacies and services within the UK’s largest health authority, NHS Greater Glasgow and Clyde, Scotland.

Methods

Patients completed semi-structured questionnaires and pharmacists provided summary statistics relating to OST provision.

Results

Responses from 508 patients receiving OST from 111 participating pharmacies revealed an established patient population, with 89 % (449/507) aged 30 years or above and 80 % (387/484) attending the same pharmacy for 1 year or more. Methadone was the main form of OST (96 % (487/508), with 97 % (491/504) receiving supervision. Within pharmacies, OST consumption was supervised in one of four main areas: consultation room, dispensing hatch, quiet/private area or over the counter. Location of supervision was considered suitably private by 96 % of patients. Positive staff attitudes, privacy and the provision of additional health services were key factors influencing choice of pharmacy. Additional health services were offered to 75 % of patients and included information provision (43 %), signposting to other health care providers (72 %) and a Scottish service offering free advice and medicines for minor ailments (74 %).

Conclusion

Patients and pharmacists have developed working relationships, enabling access to multiple services associated with health gain and harm reduction. Further development of enhanced services in community pharmacies is merited.

     

Setting priorities in preventative services

Aim

We investigate opinions regarding which preventative services should be given priority funding; the importance of primary, secondary and tertiary prevention; and bivariate associations between the respondents’ sociodemographics, health status and lifestyle and their preferences.

Subjects and methods

Computer-assisted personal interviews (CAPI) were conducted with participants from a regional quota sampling by sex, age and socioeconomic status (SES) in Germany. Participants were asked to indicate whether they would keep the status quo, expand or reduce health-care provision for eight primary, six secondary and four tertiary preventative services. Furthermore, they stated the importance of primary, secondary and tertiary prevention on a four-point Likert scale. Data were evaluated using contingency analysis and correspondence analyses.

Results

One hundred and three people completed the survey. The majority of participants opted for expanding non-medical primary preventative services like health education and counselling and for expanding secondary preventative services like cancer screening. For tertiary prevention, like rehabilitation, the desired service distribution depends on the specific preventative services. There were few differences in answers to the questions on the importance of the provision in primary, secondary and tertiary prevention. Bivariate associations between the respondents’ characteristics like age, SES, health status and lifestyle and their preferences could be observed.

Conclusion

Primary preventative services and disease detection should receive more funds. No consistent pattern could be detected for tertiary prevention. Respondents expressed some differences of opinion on the importance of types of prevention. The differences are related to knowledge, personal circumstances and interests of the respondents.     

Appraisal of health care: from patient value to societal benefit

Aim

This paper summarizes the deficiencies and weaknesses of the most frequently used methods for the allocation of health-care resources. New, more transparent and practical methods for optimizing the allocation of these resources are proposed.

Method

The examples of quality-adjusted life years (QALYs) and efficiency frontier (EF) are analyzed to describe weaknesses and problems in decisions regulating health-care provision. After conducting a literature search and discussions with an international group of professionals, three groups of professionals were formed to discuss the assessment and appraisal of health-care services and allocation of available resources.

Results

At least seven essential variables were identified that should be heeded when applying the concept of QALYs for decisions concerning health-care provision. The efficiency frontier (EF) concept can be used to set a ceiling price and perform a cost-benefit analysis of provision, but different stakeholders—a biostatistician (efficacy), an economist (costs), a clinician (effectiveness), and the patient (value)—could provide a fairer appraisal of health-care services. Efficacy and costs are often based on falsifiable data. Effectiveness and value depend on the success with which a particular clinical problem has been solved. These data cannot be falsified. The societal perspective is generated by an informal cost-benefit analysis including appraisals by the above-mentioned stakeholders and carried out by an authorized institution.

Conclusion

Our analysis suggests that study results expressed in QALYs or as EF cannot be compared unless the variables included in the calculation are specified. It would be far more objective and comprehensive if an authorized institution made an informal decision based on formal assessments of the effectiveness of health-care services evaluated by health-care providers, of the value assessed by consumers, of efficacy described by biostatisticians, and of costs calculated by economists.     

Relationships between antenatal and postnatal care and post-partum modern contraceptive use: evidence from population surveys in Kenya and Zambia

Background

It is often assumed, with little supportive, empirical evidence, that women who use maternal health care are more likely than those who do not to use modern contraceptives. This study aims to add to the existing literature on associations between the use of antenatal (ANC) and post-natal care (PNC) and post-partum modern contraceptives.

Methods

Data come from the most recent Demographic and Health Surveys (DHS) in Kenya (2008–09) and Zambia (2007). Study samples include women who had a live birth within five years before the survey (3,667 in Kenya and 3,587 in Zambia). Multivariate proportional hazard models were used to examine the associations between the intensity of ANC and PNC service use and a woman’s adoption of modern contraceptives after a recent live birth.

Results

Tests of exogeneity confirmed that the intensity of ANC and PNC service use and post-partum modern contraceptive practice were not influenced by common unobserved factors. Cox proportional hazard models showed significant associations between the service intensity of ANC and PNC and post-partum modern contraceptive use in both countries. This relationship is largely due to ANC services; no significant associations were observed between PNC service intensity and post-partum FP practice.

Conclusions

While the lack of associations between PNC and post-partum FP use may be due to the limited measure of PNC service intensity, the study highlights a window of opportunity to promote the use of modern contraceptives after childbirth through ANC service delivery. Depending on the availability of data, further research should take into account community- and facility-level factors that may influence modern contraceptive use in examining associations between ANC and PNC use and post-partum FP practice.     

Prescribing incentive schemes

Introduction

From 2000 to 2004, primary care organisations (PCOs) in England were legally required to operate a prescribing incentive scheme for their general practices. A statutory framework specified the types of target, maximum rewards and use of ‘good cause for failure’ provisions that schemes should include. Our objective was to explore whether schemes might be a useful approach to encourage ‘good quality’ prescribing.

Methods

We requested copies of the original schemes from all PCOs in England in 2001 and 2002. Data were extracted on the rewards offered, types of budgetary targets set and additional conditions specified.

Results

Many schemes had not been finalised, some PCOs had no scheme, and one scheme operated without rewards. Although schemes covered similar therapeutic areas, they varied considerably in their length, complexity, reward levels and reward structure. Over half the schemes contained no ‘good cause for failure’ provision.

Discussion/conclusion

PCOs are offering diverse incentives to general practices and some have interpreted the statutory framework imaginatively. Better use of the ‘good cause for failure’ provision may help to overcome inflationary pressures on prescribing, but further research is needed to clarify the role of financial incentives in influencing prescribing.     

Linking ecosystem services and human health: the Eco-Health Relationship Browser

Objectives

Ecosystems provide multiple services, many of which are linked to positive health outcomes. Review objectives were to identify the set of literature related to this research topic, and to design an interactive, web-based tool highlighting the weight of evidence, thus making the information more accessible.

Methods

A systematic review was conducted to create the Eco-Health Relationship Browser (http://www.epa.gov/research/healthscience/browser/introduction.html). The search was conducted in four stages utilizing Google Scholar, PubMed and Science Direct, targeted journals, and targeted keywords; search results were limited to peer-reviewed journal articles published in English from 1 January 1990 to 31 December 2012.

Results

The review identified 344 relevant articles; a subset of 169 articles was included in the Browser. Articles retrieved during the search focused on the buffering and health-promotional aspects of ecosystem services. Landscape and Urban Planning, Urban Forestry and Urban Greening, and Health and Place yielded the most articles relevant to this search.

Conclusions

Results from the systematic review were used to populate the Browser, which organizes the diverse literature and allows users to visualize the numerous connections between ecosystem services and human health.     

Practice activity trends among oral and maxillofacial surgeons in Australia

Background

The aim of this study was to describe practice activity trends among oral and maxillofacial surgeons in Australia over time.

Methods

All registered oral and maxillofacial surgeons in Australia were surveyed in 1990 and 2000 using mailed self-complete questionnaires.

Results

Data were available from 79 surgeons from 1990 (response rate = 73.8%) and 116 surgeons from 2000 (response rate = 65.1%). The rate of provision of services per visit changed over time with increased rates observed overall (from 1.43 ± 0.05 services per visit in 1990 to 1.66 ± 0.06 services per visit in 2000), reflecting increases in pathology and reconstructive surgery. No change over time was observed in the provision of services per year (4,521 ± 286 services per year in 1990 and 4,503 ± 367 services per year in 2000). Time devoted to work showed no significant change over time (1,682 ± 75 hours per year in 1990 and 1,681 ± 94 hours per year in 2000), while the number of visits per week declined (70 ± 4 visits per week in 1990 to 58 ± 4 visits per week in 2000).

Conclusions

The apparent stability in the volume of services provided per year reflected a counterbalancing of increased services provided per visit and a decrease in the number of visits supplied.     

Informal payments in the Greek health sector amid the financial crisis: old habits die last...

Background

Under-the-table informal payments are commonplace as reimbursements for health care services in Greece. As the country faces a severe financial crisis, the need to investigate the extent of such payments, their incidence and their impact on household income is pressing.

Methods

A survey of 2,741 persons from across the country was conducted between December 2011 and February 2012. The sample was defined via a multistage selection process using a quota for municipality of residence, sex and age. The maximum error margin was 2.41 % with a confidence interval of 95 %.

Results

The survey reports under-the-table payments for approximately 32.4 % of public hospital admissions. Private clinics, which display the bulk of out-of-pocket payments, naturally display the lowest under-the-table payments. The highest percentage of under-the-table payments in the private sector appears at visits to private practitioners and dentists (36 %). Informal payments are most frequently made upon request, prior to service provision, to facilitate access to care and to reduce waiting times, and at a much lower percentage, to post-service provision, and out of gratitude.

Conclusions

This survey reveals that, due to severe financial pressure, there is a growing unwillingness of citizens to pay informally and an increasing demand for these payments as a prerequisite for access to services or to redeem services provided. This “hidden” financial burden of at least 27 % impacts negatively on the living conditions of households and is not reported as purchasing ability or cost of living.

     

The mediating role of self-stigma and unmet needs on the recovery of people with schizophrenia living in the community

Purpose

For people with schizophrenia living in the community and receiving outpatient care, the issues of stigma and discrimination and dearth of recovery-oriented services remain barriers to recovery and community integration. The experience of self-stigma and unmet recovery needs can occur regardless of symptom status or disease process, reducing life satisfaction and disrupting overall well-being. The present study examined the mediating role of self-stigma and unmet needs in the relationship between psychiatric symptom severity and subjective quality of life.

Methods

Structural equation modeling and mediation analyses were conducted based on a community sample of 400 mental health consumers with schizophrenia spectrum disorders in Hong Kong.

Results

The model of self-stigma and unmet needs as mediators between symptom severity and subjective quality of life had good fit to the data (GFI = .93, CFI = .93, NNFI = .92, RMSEA = .06, χ²/df ratio = 2.62). A higher level of symptom severity was significantly associated with increased self-stigma (R ² = .24) and a greater number of unmet needs (R ² = .53). Self-stigma and unmet needs were in turn negatively related to subjective quality of life (R ² = .45).

Conclusions

It is essential that service providers and administrators make greater efforts to eliminate or reduce self-stigma and unmet recovery needs, which are associated with the betterment of the overall quality of life and long-term recovery. Both incorporating empowerment and advocacy-based interventions into recovery-oriented services and providing community-based, person-centered services to people based on personally defined needs are important directions for future recovery-oriented efforts.     

“We both just trusted and leaned on the Lord”: a qualitative study of religiousness and spirituality among African American breast cancer survivors and their caregivers

Purpose

Most breast cancer (BC) survivorship research focuses on the general population of survivors. Scant research investigates the potentially unique experiences of minorities, especially during and after the difficult transition from primary treatment to post-treatment. This qualitative study explored African American BC survivors’ and caregivers’ quality-of-life in the post-treatment period with a focus on social and spiritual well-being.

Methods

Participants included a convenience sample of African American women with stage I–III BC (N = 23) who completed treatment 6–24 months before enrollment. Primary caregivers (N = 22) included friends, spouses and other family members (21 complete dyads). Participants completed separate semi-structured telephone interviews. Template analysis was used to evaluate themes related to religiousness and spirituality, both across and within dyads.

Results

After treatment, religiousness and spirituality played a major role in both survivors’ and caregivers’ lives by: (1) providing global guidance, (2) guiding illness management efforts and (3) facilitating recovery. Participants described a spiritual connectedness with God and others in their social networks. Dyad members shared the goal of keeping a positive attitude and described positive growth from cancer. Few future concerns were expressed due to the belief that survivors were healed and “done” with cancer. Beyond practical and emotional support, provision of spiritual assistance was common.

Conclusions

Results highlight the principal, positive role of religiousness and spirituality for African American BC survivors and caregivers after treatment. Findings emphasize the need to assess the importance of religious and spiritual beliefs and practices, and if appropriate, to provide resources that promote spiritual well-being.     

Trends in social class inequalities in the use of health care services within the Spanish National Health System, 1993–2006

Objective

The aim of this study was to analyse the trends and socio-economic inequalities in the use of health care services in Spain between 1993 and 2006.

Methods

A study of trends was performed using data from six Spanish National Health Surveys (1993, 1995, 1997, 2001, 2003 and 2006). Sample sizes were 21,061; 6,396; 6,396; 21,066; 21,650 and 29,478, respectively. The following dependent variables were analysed: having visited a general practitioner (GP) or specialist in the previous 2 weeks, having visited a dentist within the previous 3 months and having visited a gynaecologist, having used the emergency services or having been hospitalised in the previous year. The main independent variable was social class, classified as manual or non-manual occupation. For each service, age-standardised proportions of use were calculated by survey year, sex and social class, and indices of relative (RII) and absolute (SII) inequality were computed. Trend tests were applied.

Results

An increase in the proportion of use was observed for all services, particularly emergency services. Individuals from manual classes were more likely to visit the GP and emergency services than those from non-manual classes. Conversely, those from non-manual classes were more likely to use specialised services. This trend was most notable for dentist visits. Social inequalities did not change significantly during the study period.

Conclusions

Despite the increase in the use of health care services, the relationship between social class and the use of these services has remained stable throughout the study period. Achieving equity in the use of specialised care services is still a challenge for universal health care systems.     

Quantifying the economic burden of malaria in Nigeria using the willingness to pay approach

Background

Osteoporosis creates brittle bones susceptible to fracture, with resulting high levels of morbidity and mortality. Poor access to bone densitometry services for the residents of North Wales led to the Welsh Assembly Government offering capital to purchase a dual-energy X-ray absorptiometry (DXA) scanner, used to diagnose osteoporosis, for the region. The commissioning question for the six Local Health Boards across North Wales was where to site the new scanner. This decision needed to reflect current inequalities in access to services and concerns over inappropriate prescribing relative to Welsh norms.

Methods

Epidemiological, corporate and comparative healthcare needs assessments were performed. In addition, two cross-sectional surveys were conducted to determine the views of general practices and users of bone densitometry services resident in North Wales. An option appraisal and sensitivity analysis of 13 costed options for DXA scanning was conducted.

Results

We estimated that only 31% of the people in North Wales who met national guidelines were receiving DXA scans. There was definite inequity of access to the current service provided by area of residence. There was also evidence of inequity of access by age and sex. The most suitable option identified in the option appraisal was a bone densitometry service based in the central location of Llandudno.

Conclusion

The assessment identified significant unmet need for DXA scanning. A recommendation was made to improve access through the introduction of a new bone densitometry service based at Llandudno. This would double scanning provision provided and reduce travel costs and time for many North Wales residents. This recommendation was adopted by a joint commissioning group established by the six Local Health Boards in North Wales at the end of 2004 – evidence based commissioning in practice.     

The Efficiency of Increasing the Capacity of Physiotherapy Screening Clinics or Traditional Medical Services to Address Unmet Demand in Orthopaedic Outpatients: A Practical Application of Discrete Event Simulation with Dynamic Queuing

Background

Hospital outpatient orthopaedic services traditionally rely on medical specialists to assess all new patients to determine appropriate care. This has resulted in significant delays in service provision. In response, Orthopaedic Physiotherapy Screening Clinics and Multidisciplinary Services (OPSC) have been introduced to assess and co-ordinate care for semi- and non-urgent patients.

Objectives

To compare the efficiency of delivering increased semi- and non-urgent orthopaedic outpatient services through: (1) additional OPSC services; (2) additional traditional orthopaedic medical services with added surgical resources (TOMS + Surg); or (3) additional TOMS without added surgical resources (TOMS ? Surg).

Methods

A cost-utility analysis using discrete event simulation (DES) with dynamic queuing (DQ) was used to predict the cost effectiveness, throughput, queuing times, and resource utilisation, associated with introducing additional OPSC or TOMS ± Surg versus usual care.

Results

The introduction of additional OPSC or TOMS (±surgery) would be considered cost effective in Australia. However, OPSC was the most cost-effective option. Increasing the capacity of current OPSC services is an efficient way to improve patient throughput and waiting times without exceeding current surgical resources. An OPSC capacity increase of ~100 patients per month appears cost effective (A$8546 per quality-adjusted life-year) and results in a high level of OPSC utilisation (98 %).

Conclusion

Increasing OPSC capacity to manage semi- and non-urgent patients would be cost effective, improve throughput, and reduce waiting times without exceeding current surgical resources. Unlike Markov cohort modelling, microsimulation, or DES without DQ, employing DES-DQ in situations where capacity constraints predominate provides valuable additional information beyond cost effectiveness to guide resource allocation decisions.

     

Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study

Background

Injection drug users (IDU) commonly seek manual assistance with illicit drug injections, a practice known to be associated with various health-related harms. We investigated the social structural factors that shape risks related to assisted injection and the harms that may result.

Methods

Twenty semi-structured qualitative interviews were conducted with IDU enrolled in the ACCESS or Vancouver Injection Drug Users Study (VIDUS) who reported requiring assistance injecting in the past six months. Audio-recorded interviews were transcribed verbatim and a thematic analysis was conducted.

Results

Barriers to self-injecting included a lack of knowledge of proper injecting technique, a loss of accessible veins, and drug withdrawal. The exchange of money or drugs for assistance with injecting was common. Harms experienced by IDU requiring assistance injecting included theft of the drug, missed injections, overdose, and risk of blood-borne disease transmission. Increased vulnerability to HIV/HCV infection within the context of intimate relationships was represented in participant narratives. IDU identified a lack of services available for those who require assistance injecting, with notable mention of restricted use of Vancouver's supervised injection facility.

Conclusions

This study documents numerous severe harms that arise from assisted injecting. Social structural factors that shape the risks related to assisted injection in the Vancouver context included intimate partner relations and social conventions requiring an exchange of goods for provision of injecting assistance. Health services for IDU who need help injecting should include targeted interventions, and supervised injection facilities should attempt to accommodate individuals who require assistance with injecting.     

Vitamin B12 as a potential compliance marker for fish intake

Objectives

The aim of the present study was to investigate whether the following four markers: vitamin B₁₂, selenium, vitamin D, and parvalbumin may be used as compliance markers for fish intake.

Methods

Blood samples from a randomized cross-over herring intervention study (n = 32) were analysed by HPLC and immunochemistry. The criteria were that plasma or serum concentrations of candidate compliance markers after the herring diet should increase significantly compared to starting concentrations. In addition, the reference meat diet should not yield an increase in plasma concentration of the candidate marker.

Results

Vitamin B₁₂ and selenium met the set criteria for indicating a correlation between the marker and fish intake with significant increases in serum concentrations at 8.9 % (p = 0.008) and 4.6 % (p = 0.02), respectively, after a 6-week herring intervention (5 meals a week). Parvalbumin and 25-hydroxy vitamin D₃ levels did not increase significantly after the herring interventions.

Conclusions

Vitamin B₁₂ may be suitable as a compliance marker for fish intake. Although selenium also met the criteria, the change in selenium serum concentrations was small compared to the change in vitamin B₁₂ levels.     

A Response to Intervention Model to Promote School Attendance and Decrease School Absenteeism

Background

Regular school attendance is foundational to children’s success but school absenteeism is a common, serious, and highly vexing problem. Researchers from various disciplines have produced a rich yet diverse literature for conceptualizing problematic absenteeism that has led to considerable confusion and lack of consensus about a pragmatic and coordinated assessment and intervention approach.

Objective

To lay the foundation and suggested parameters for a Response to Intervention (RtI) model to promote school attendance and address school absenteeism.

Methods

This is a theoretical paper guided by a systematic search of the empirical literature related to school attendance, chronic absenteeism, and the utilization of an RtI framework to address the needs of school-aged children and youth.

Results

The RtI and absenteeism literature over the past 25 years have both emphasized the need for early identification and intervention, progress monitoring, functional behavioral assessment, empirically supported procedures and protocols, and a team-based approach. An RtI framework promotes regular attendance for all students at Tier 1, targeted interventions for at-risk students at Tier 2, and intense and individualized interventions for students with chronic absenteeism at Tier 3.

Conclusions

An RtI framework such as the one presented here could serve as a blueprint for researchers as well as educational, mental health, and other professionals. To develop this model and further enhance its utility for all youth, researchers and practitioners should strive for consensus in defining key terms related to school attendance and absenteeism and focus more on prevention and early intervention efforts.