Servicenow-CIS-ITSM health - Certified Implementation Specialist IT Service Management Updated: 2023

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Suicide Prevention in Schools and Colleges

The Suicide Prevention in Schools and Colleges initiative will implement suicide prevention and early intervention strategies for youth ages 10-25 across Pennsylvania. The grant will provide gatekeeper training, suicide risk management training, standardized screening, and training in empirically supported treatments. The project will raise awareness, increase identification of at risk youth, facilitate referrals to treatment and Strengthen treatment outcomes. The problem addressed by our proposal is that suicide risk is being under identified in Pennsylvania’s schools, community colleges and universities. There is no systematic training for professionals or standardized screening procedures to identify youth at risk. Therefore, too many young people are not identified and too many of those who are high risk are not being adequately screened, and not receiving treatment and support.

There are 500 school districts and 181 community colleges and universities in Pennsylvania. In the general state population, there are 2,570,000 individuals age 10-15 representing a wide range of cultures and demographic diversity. The majority is white, but there are also Black, Hispanic, Asian and American Indian students. We will focus on racial and ethnic, rural and urban cultural differences as well as the needs of the Veteran and the lesbian, gay, bisexual, and transgender populations. Building on the Student Assistance Program in Pennsylvania schools, we will provide gatekeeper training and state of the art screening tools to appropriate school personnel and the behavioral health systems that serve these schools.

Building on the work of past Campus Grants, we will organize a coalition of community college and university representatives to develop model suicide prevention plans and processes for higher education throughout the Commonwealth. Project goals and measurable objectives include: a) increasing the number of persons in schools, colleges, and universities, trained to identify and refer youth at risk for suicide, b) increasing the number of clinical service providers (including those working in schools, mental health, and substance abuse) trained to assess, manage and treat youth at risk for suicide, c) increasing awareness about youth suicide prevention, specifically including the promotion and utilization of the National Suicide Prevention Lifeline, d) comprehensively implementing applicable sections of the 2012 National Strategy for Suicide Prevention to reduce rates of suicidal ideation, suicide attempts and suicide deaths in their communities, and e) promoting state systems-level change to advance suicide prevention efforts in our public schools.

With gatekeeper training and awareness campaigns, we plan to reach 186,000 youth over five years. With screening in schools, colleges and primary care practices, we plan to reach approximately 26,000 indicated youth over five years. Thus, our total impact will be felt by nearly 212,000 youth across Pennsylvania.

Screening and Referral of Suicidal Youth in Primary Care

A major challenge in suicide prevention work is locating adolescents before they attempt suicide. Fortunately, over 70 percent of adolescents see a physician at least once a year making primary care a potentially important gatekeeper for adolescent health. We proposed to build a comprehensive identification, screening and triage system within primary care systems to identify adolescents at high risk for suicide. In Year 1, we organized a statewide suicide prevention task force consisting of a wide range of stakeholders from public and private sectors through a participatory action research framework. Bi-monthly meetings were held to identify policy barriers and solutions to better integrating suicide prevention and behavioral health services (mental health and substance abuse treatment systems) into primary care offices. Representatives from 11 diverse counties participated. In Year 1 our goals focused on creating educational resources, technical assistance, policy changes and funding support to help several of these counties implement the new system. Year 2 focused on this implementation.

The proposed program consisted of four components. First, pediatricians, family physicians and nurse practitioners (referred to as medical practitioners) received gatekeeper training in identifying adolescents at risk for suicide. Second, computer-based screening measures were introduced into the medical offices. Third, a system to provide family based, clinical assessment of the adolescent was geographically and administratively integrated into the primary care offices, as needed. Fourth, clinical training for treatment systems (medical and behavioral health) in how to engage and work with suicidal youth and their families was provided. Systemic change at the state and local levels enabled other counties to implement a similar system over the next five years. This project was a state effort (supported by the Departments of Public Welfare, Health and Education) in collaboration with suicide experts at the Children's Hospital of Philadelphia (CHOP), the University of Pennsylvania, Western Psychiatric Institute at the University of Pittsburgh and the Pennsylvania Academy of Pediatrics.

Behavioral Health Screen (BHS) in Emergency Departments

The BHS has been used for many years in several emergency departments. The longest operation is at Children’s Hospital of Philadelphia. Here, BHS is used for all adolescent presenting at the emergency department (ED). CHOP treats 27,000 teens a year and screening about 500 adolescent a month. BHS also operates at the Children’s Crisis Center, the Medicaid Managed Care psychiatric emergency room in the City. This facility treated about 2000 psychiatric pediatric emergency case each year.

Extension of BHS development into the emergency department setting occurred in 2006 with a Health Resources and Services Administration (HRSA) grant (R49CCR 321711-01). After the qualitative studies on acceptability and feasibility of standardized screening in the ED mentioned above, full implementation of the screening began in March 2007 and evaluation of the screen lasted for nine months. All non-critical patients between the ages of 14 and 18 years who presented for something other than a primary psychiatric concern were asked to complete the Behavioral Health Screening-Emergency Department (BHS-ED). In the end, 857 adolescent patients completed the screening tool. Of those screened, 4.3 percent self-reported moderate or severe depressed mood and 3.6 percent reported suicidal ideation in the past week. Results showed that screening increased the identification of youth with behavioral health problems (χ2 = 154.86, p < .001), increased the rate of behavioral health assessment (χ2 = 141.86, p < .001), and increased behavioral health referrals (χ2 = 76.86, p < .001). This screening process was fully incorporated into clinical care for adolescents, and when initiated by the nursing staff achieved a 40 percent penetration rate for eligible patients. Findings from this study can be found at Fein et al, 2010 in our reference list.

The great digitization breakthrough that has swept through much of the world has been slower to materialize in Germany, ISG Provider Lens™ report says

FRANKFURT, Germany–(BUSINESS WIRE)–$III #ISGProviderLens–German enterprises have been slow to embrace ServiceNow, yet stricter government regulations and the growing complexity of the overall IT landscape may provide the workflow automation platform with new momentum in the German market, according to a new research report published today by Information Services Group (ISG) (Nasdaq: III), a leading global technology research and advisory firm.

The 2023 ISG Provider Lens™ ServiceNow Ecosystem Partners report for Germany finds the crisis in Ukraine and a reluctance to part with legacy systems have contributed to Germany’s comparatively slow adoption of ServiceNow, despite the platform’s rapidly expanding functionalities. Given ServiceNow’s high licensing costs, clients who fear vendor lock-in are clinging to the preferred open-source model, the ISG report says.

“ServiceNow and its partners are gaining traction in the German market,” said Dr. Matthias Paletta, director, technology modernization, for ISG in Germany. “Yet their growth is not as steep as it is in other markets, notably the U.S.”

Although ServiceNow can be potentially more flexible than legacy systems, that increased flexibility also hinges on a company’s willingness to adopt a prefabricated solution, rather than going through the process of customizing it to match precise business requirements. Companies that continue to pursue “perfect” solutions do so at the expense of increased deployment speed, the ISG report says.

The Ukraine crisis, which led to higher energy costs and inflation, has proven that upheavals can occur rapidly and that periods of relative planning certainty are becoming shorter than ever, the ISG report says. ServiceNow’s Tokyo platform, which was released in the fourth quarter of 2022, strongly focuses on process efficiency and opportunities for rapid value creation. The speed at which it can react to changing circumstances is seen as a boon for many companies.

In addition, the growing prevalence of multicloud environments has significantly increased the overall complexity of the IT landscape and reinforced the need for tools that can help address it, as have Germany’s Supply Chain Act and the introduction of new ESG regulations, the ISG report says.

“Enterprises in Germany are looking for reliable, accredited professional services to take full advantage of ServiceNow’s broad functionalities,” said Jan Erik Aase, partner and global leader, ISG Provider Lens Research. “ServiceNow implementations can act as a catalyst for a new type of company management.”

The report also examines the improved analytics and RPA capabilities introduced in ServiceNow’s exact release of its Utah platform.

The 2023 ISG Provider Lens™ ServiceNow Ecosystem Partners report for Germany evaluates the capabilities of 29 providers across three quadrants: ServiceNow Consulting Services, ServiceNow Implementation and Integration Services, and ServiceNow Managed Service Providers.

The report names Accenture, agineo, Atos, Capgemini, Infosys and T-Systems/OS as Leaders in all three quadrants, while Deloitte, DXC Technology, HCLTech and nuvolax are named Leaders in two quadrants each. Cognizant, Fujitsu, KPMG, Kyndryl, NTT DATA, TCS and Tech Mahindra are named as Leaders in one quadrant each.

In addition, Computacenter and Fujitsu are named as Rising Stars — companies with a “promising portfolio” and “high future potential” by ISG’s definition — in one quadrant each.

A customized version of the report is available from T-Systems/OS.

The 2023 ISG Provider Lens™ ServiceNow Ecosystem Partners report for Germany is available to subscribers or for one-time purchase on this webpage.

About ISG Provider Lens™ Research

The ISG Provider Lens™ Quadrant research series is the only service provider evaluation of its kind to combine empirical, data-driven research and market analysis with the real-world experience and observations of ISG’s global advisory team. Enterprises will find a wealth of detailed data and market analysis to help guide their selection of appropriate sourcing partners, while ISG advisors use the reports to validate their own market knowledge and make recommendations to ISG’s enterprise clients. The research currently covers providers offering their services globally, across Europe, as well as in the U.S., Canada, Brazil, the U.K., France, Benelux, Germany, Switzerland, the Nordics, Australia and Singapore/Malaysia, with additional markets to be added in the future. For more information about ISG Provider Lens research, please visit this webpage.

A companion research series, the ISG Provider Lens Archetype reports, offer a first-of-its-kind evaluation of providers from the perspective of specific buyer types.

About ISG

ISG (Information Services Group) (Nasdaq: III) is a leading global technology research and advisory firm. A trusted business partner to more than 900 clients, including more than 75 of the world’s top 100 enterprises, ISG is committed to helping corporations, public sector organizations, and service and technology providers achieve operational excellence and faster growth. The firm specializes in digital transformation services, including automation, cloud and data analytics; sourcing advisory; managed governance and risk services; network carrier services; strategy and operations design; change management; market intelligence and technology research and analysis. Founded in 2006, and based in Stamford, Conn., ISG employs more than 1,600 digital-ready professionals operating in more than 20 countries—a global team known for its innovative thinking, market influence, deep industry and technology expertise, and world-class research and analytical capabilities based on the industry’s most comprehensive marketplace data. For more information, visit www.isg-one.com.

Contacts

Press Contacts:

Philipp Jaensch, ISG

+49 151 730 365 76

philipp.jaensch@isg-one.com

Matthias Longo, for ISG

+49 152 341 464 63

matthias@longo-pr.de

OPINION

By Dr Ian Clarke

I was channel hopping the other morning and landed on a South African TV station in which they were discussing the proposed national health insurance scheme (NHIS) for South Africa.

South Africa currently has a dual healthcare system, with expensive private facilities and a public system that is underfunded. The cost of care in private hospitals is high, so the premiums for medical insurance are also high (around 4-5 times what we pay in Uganda).

Despite the high premiums, the coverage of health insurance is much higher than in Uganda, with about 20% of the population covered (compared to under 2% here).

Although only 20% of the population use the private system, 80% of total health resources go to the private system. The principle of national health insurance (NHI) is that health expenditure should be spread across the whole population, making it equitable for everyone, but getting everyone to agree on the way forward is a challenge.

Like Uganda, the debate on NHI has been going on for several years, but they do not seem to be making much progress, despite a proposed 2026 launch date.

The debate on television was critical of government, with a professor from Wits University claiming that the problem was blatant corruption and that the political establishment were making promises but doing nothing to tackle the underlying issues. He claimed that even now the money in the public system was not reaching the intended beneficiaries.

It seems that in all African countries, we have aspirations and then we have reality and the two are rarely the same.

Many of our government ministries, such as health, are not working well, but when spoken of at a high political level, apparently, everything is fine. There is a gap between what we say and what we do, and the aspiration is taken as the reality. We do the same thing in everyday life: if a person is asked whether he is coming for an appointment he may say kanzije (let me come), but what he has stated is an intention and he may not arrive because of obstacles which prevent him from fulfilling his intention to attend the meeting. We should not confuse aspiration (or intention) with implementation. When politicians or news outlets announce a government programme, we should ask ourselves the question — is it being funded and implemented or it is an aspirational promise?

The professor was pointing out that promises of the benefits of the new NHI meant nothing until they first dealt with the underlying obstacles in the existing public system. It is the same scenario in Uganda — we will not make any progress with a more idealistic system until we fix what we have. People talk about NHI as if it is a magic bullet, but no one has even carried out a detailed actuarial analysis on the promises being made. I am not against NHI, but if we simply form another statutory body with draconian powers to make unrealistic rules and regulations for health providers, it could make the situation worse.

Although there is no simple fix for our health services, we can Strengthen them using our current resources.

NSSF has shown willingness to offer a scheme to its members, but this has not been explored. Prof. Francis Omaswa has demonstrated a community mobilisation approach in four districts, which has yielded better health outcomes.

One of his key findings was that the quality of the district leadership has a profound effect, but we are not mobilising or educating the district leaders.

There are other initiatives in the health sector which could Strengthen the system. A Ugandan tech company called CTI has developed a system that can track health indicators in the individual, in the community and for patients in hospital.

A tech start-up, Clinic Pessa, has developed a system for saving small amounts on a mobile money clinic account for payments to clinics, which can be topped up through loans, should the need arise.

Another area which can be improved is the collaboration between the public and private sectors, including increased support for the faith-based hospitals.

The Minister of Health thinks that NHIS will open another stream of cash from the private sector to fund improvements in the health sector, but the private sector is being so squeezed by the Uganda Revenue Authority that there is no more cash to be wrung out. Instead, what is likely to happen is that companies with existing private medical insurance will stop covering their employees and push the responsibility on to NHIS. Since no one has done the actuarial calculations of this shift, NHIS may not see a net inflow, but net outflows, making the system collapse.

Onyebuchi Ezigbo in Abuja

The Joint Health Sector Unions and Assembly of Healthcare Professional Associations (JOHESU/AHPA) yesterday  held a protest in Abuja, urging the federal government to pay its members the adjustment of Consolidated Health Salary Structure(CONHESS).

The workers, who staged an early morning protest at the Unity Fountain,  called on President Muhammadu Buhari to immediately approve and implement the Technical Committee Report on the adjustment of  CONHESS.

The unions also tasked the incoming government, National Assembly especially, Senators-elect and House of Representatives members-elect to ensure the appointment of seasoned administrators with cognate experience as ministers in charge of the health sector.

The National Vice Chairman of Joint Health Sector Unions (JOHESU), Dr. Obinna Ogbonna, while reading a letter addressed to the Senate President, Senator Ahmed Lawal, said the unions were compelled to embark on the protest rally to draw  the attention of the National Assembly to the unending vicious cycle of tyranny visited on  the respective affiliate of JOHESU in the health sector by the physicians- dominated Federal Ministry of Health.

Ogbonna further explained that the collective Bargaining Agreement between the federal government and the JOHESU established strongly that once there is an adjustment in any of the salary structure, the other structure should be adjusted commensurately.

He said the last three successive physician health ministers in the last 12 years had done nothing to address their grievances in this regard.

According  to Ogbonna, the ministers have deliberately truncated the adjustment of CONHESS on four occasions since January 2, 2014.

He said this alleged social injustice and discriminatory adjustment championed by the Federal Ministry of Health in favour of the physicians and to the great disadvantage of other health workers led to a trade dispute declared by JOHESU  in September, 2021.

“This dispute was, however, apprehended by the Chief Conciliator of the Federation and Minister of Labour, Senator Dr. Chris Ngige, at a conciliatory meeting held on 7 September, 2021 at the Conference Room of the Federal Ministry of Labour and Employment”.

“During the conciliatory meeting attended by the Minster of Health, Dr. Ehanire Osagie, and the then Minister of State for Health, Senator Olorunnibe Mamora, with other top federal government officials from ministries and inter-ministerial departments and agencies with the national leadership of  JOHESU, the meeting resolved that, all matters in dispute be referred back for negotiation at the Federal Ministry of Health.”

“Upon resumption of negotiation at the Federal Ministry of Health at a meeting held on 19” September, 2021, the FG and JOHESU team agreed to the setting up of a High Level Inter-Ministerial Committee to determine the justification for the adjustment of CONHESS, work out a detailed financial implication and make appropriate recommendations.

“The committee was chaired by the Chairman, National Salaries, Incomes and Wages Commission (NSIWC), and membership drawn  from Office of the Head of Service of the Federation, Federal Ministry of Health, Federal Ministry of Labour and Employment, Budget Office, National Salaries, Incomes and Wages Commission, Office of the Accountant General of the Federation, and JOHESU.

“The Technical Committee report had since been submitted to the Federal Ministry of Health for onward transmission to the Federal Executive Council. That the Ministry has refused to do since over a year.”

Speaking further, Ogbonna said the  bane in the spread of benefit packages is domineering as influence of Physicians in the Ministry Departments and Agencies (MDAs); from the Federal Ministry of Health to agencies like National Health Insurance Authority (NHIA), National Agency for the Control of Aids (NACA), National Primary Healthcare Development Agency (NPHCDA) and others where the Physician-CEOs have skewed privileges as well as other benefit packages in the direction of their Physician brethren.

“In one of the most bizarre development in contemporary times, the Physician dominated Federal Ministry of Health negated the Consultant Cadre status of Pharmacists which has met all components of due process as far back as 2011when the National Council on Establishment (NCE) approved the status. In 2020 and 2021, both the Office of the Head of Civil Service of the Federation and Federal Ministry of Health conclusively issued circulars to back up the NCE approval.”

Literature Review

Thorough neurological assessment of patients experiencing acute stroke is critical for accurate diagnosis, treatment, and care throughout hospitalization. Published guidelines for the early management of patients with ischemic stroke (Adams et al., 2003) detail the goals associated with early care, including observation for changes in patient condition that might prompt initiation of medical or surgical interventions and facilitation of measures aimed at improving outcome after stroke. Consistent use of a standardized assessment tool designed for stroke patients assists in the achievement of these goals.

The National Institutes of Health Stroke Scale (NIHSS) is a well-validated, reliable scoring system for use specifically with stroke patients (Goldstein, Bertels, & Davis, 1989; Lyden et al., 1999). It was designed by a group of stroke research neurologists to document the severity of neurologic deficits in acute stroke patients (Brott et al., 1989). It consists of 11 elements that reflect the wakefulness, vision, and motor, sensory, and language function of stroke patients (Figure 1).

The initial neurological examination of the acute stroke patient establishes the baseline stroke severity and can help identify individuals at greatest risk for hemorrhagic complications after thrombolytic therapy. Scores ≥20 have been associated with symptomatic intracerebral hemorrhage (NINDS t-PA Stroke Study Group, 1997). NIHSS scores have been shown to strongly predict outcome after stroke and therefore can help guide decisions related to aggressiveness of care and disposition (Adams et al., 1999; Schlegel et al., 2003; Weimar, Konig, Kraywinkel, Ziegler, & Diener, 2004).

After the initial assessment and determination of acute treatment, the focus of assessment shifts to monitoring for neurological change or deterioration. The condition of approximately 25% of patients worsens during the first 24-48 hours after stroke (Adams et al., 2003), although neurological decompensation can occur later as well. Stroke-related neurological changes can occur rapidly, and often they result in irreversible brain damage. It is therefore important to have a comprehensive neurological assessment tool that objectively tracks changes and provides a standardized means for clear communication among caregivers. The NIHSS provides a numerical value for comparison from one time period to the next (Lyden et al., 1999).

During a stroke patient's hospitalization, the NIHSS can also be used to help identify clinical findings that might put the patient at risk for complications. For instance, dysarthria and facial weakness can indicate that the patient may have difficulty swallowing. Identification of motor weakness and ataxia can alert the staff to fall risk (Spilker et al., 1997).

Despite evidence that the NIHSS is valid and reliable, there has been reluctance to adopt it within clinical settings. Some users believe that scale completion is too time consuming when compared to standard neurological assessments (Lai, Duncan, & Keighley, 1998). Other detractors perceive a lack of interrater reliability in scoring on certain questions, particularly the questions for ataxia and dysarthria assessment (Lyden, Lu, Levine, Brott, & Broderick, 2001). Others cite a "hemispheric bias" within the NIHSS, because 7 of the points are directly related to measurement of language (a left hemisphere function) and only 2 points are related to neglect (a right-hemisphere phenomenon). Hence, the NIHSS may underestimate stroke severity in the right hemisphere (Woo et al., 1999). In addition, although many components of the NIHSS are part of a standard neurological assessment, training is required for reliable use of the tool (Andre, 2002).

Although there are some limitations to use of the NIHSS, studies have demonstrated that it can reliably measure stroke severity. The interrater variability of users decreases with the use of videotaped training and certification (Criddle et al., 2003; Meyer, Hemmen, Jackson, & Lyden, 2002). The NIHSS becomes easier and less time consuming to administer as it is made a standard part of nursing practice and provides a language healthcare providers can use to communicate stroke severity (Criddle et al., 2003). When compared with other stroke scales (e.g., the Scandinavian, Mathew, and Orgogozo scales), the NIHSS was the most sensitive in detecting changes in stroke signs (Bessenyei, Fekete, Csiba, & Bereczki, 2001).