The Volunteers of America Greater Los Angeles (VOALA) Girls Inc. program is implementing and rigorously evaluating its Preventing Adolescent Pregnancy curriculum as part of a demonstration grant to identify effective teen pregnancy prevention programs sponsored by the U.S. Department of Health and Human Services Office of Adolescent Health (OAH). A total of 517 participants from Title I urban middle and high schools were randomly assigned to either Preventing Adolescent Pregnancy (treatment) or Economic Literacy (control) in two cohorts. Programming occurred after school weekly at middle and high schools. Low attendance and loss of sample (attrition) are common challenges in after-school programming, negatively affecting both the ability of a program to be successful and the integrity of a randomized controlled trial. The current article discusses challenges encountered with recruitment, incentives, and school factors during a first cohort of youth and innovative implementation changes during a second cohort that resulted in increased attendance rates and decreased attrition rates. Commentary is provided by the OAH Project Officer as well as lessons learned after 2 years of implementing the program.
The care coordination program described here evolved from 5 years of trial and learning related to how to best serve our high-cost, high-utilizing, chronically ill, urban core patient population. In addition to medical complexity, they have daily challenges characteristic of persons served by Safety-Net health systems. Many have unstable health insurance status. Others have insecure housing. A number of patients have a history of substance use and mental illness. Many have fractured social supports. Although some of the best-known care transition models have been successful in reducing rehospitalizations and cost among patients studied, these models were developed for a relatively high functioning patient population with social support. We describe a successful approach targeted at working with patients who require a more intense and lengthy care coordination intervention to self-manage and reduce the cost of caring for their medical conditions. Using a diverse team and a set of replicable processes, we have demonstrated statistically significant reduction in the use of hospital and emergency services. Our intervention leverages the strengths and resilience of patients, focuses on trust and self-management, and targets heterogeneous "high-utilizer" patients with medical and social complexity.
The study of pragmatic competence has gained increasing importance within second language assessment over the last three decades. However, its study in L2 language testing is still scarce. The aim of this paper is to research the extent to which pragmatic competence as defined by the Common European Framework of Reference for Languages (CEFR) has been accommodated in the task descriptions and rating scales of two of the most popular Oral Proficiency Interviews (OPIs) at a C1 level: Cambridge’s Certificate in Advanced English (CAE) and Trinity’s Integrated Skills in English (ISE) III. To carry out this research, OPI tests are first defined, highlighting their differences from L2 pragmatic tests. After pragmatic competence in the CEFR is examined, focusing on the updates in the new descriptors, CAE and ISE III formats, structure and task characteristics are compared, showing that, while the formats and some characteristics are found to differ, the structures and task types are comparable. Finally, we systematically analyse CEFR pragmatic competence in the task skills and rating scale descriptors of both OPIs. The findings show that the task descriptions incorporate mostly aspects of discourse and design competence. Additionally, we find that each OPI is seen to prioritise different aspects of pragmatic competence within their rating scale, with CAE focusing mostly on discourse competence and fluency, and ISE III on functional competence. Our study shows that the tests fail to fully accommodate all aspects of pragmatic competence in the task skills and rating scales, although the aspects they do incorporate follow the CEFR descriptors on pragmatic competence. It also reveals a mismatch between the task competences being tested and the rating scale. To conclude, some research lines are proposed.
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