Добірка наукової літератури з теми "Mental component summary"

This study aimed to assess the validity and reliability of the mental component summary (MCS) and physical component summary (PCS) of SF-12. 140 Iranian elderly aged 60 years and older from the general population (100 male vs 40 female) of the Shiraz city were recruited by convenient sampling. The questionnaire on quality of life (SF-12, two dimensions: the physical component α = 0.68; and the mental component α = 0.71) was used to collect the data analyzed with the AMOS software. According to the structural equation model (SEM), four subscales of SF-12 (emotional role, social function, vitality and mental health) can predict mental component summary (respectively: coefficient = 0.65, 0.57, 0.78 and 0.90) and four subscales of SF-12 (general health, physical function, bodily pain and physical role) can predict physical component summary (respectively: coefficient = 0.58, 0.70, 0.74 and 0.88). The goodness-of-fit indices showed that the model for predicting mental and physical components in the elderly was excellent (X2 / df = 1.61, RMSEA= 0.07, CFI = 0.96 and NFI=0.92).

Background and objectivesThe effect of sex on longitudinal health-related quality of life remains unknown in CKD. Here we assess differences in the sex-specific evolution of health-related quality of life in older men and women with advanced CKD.Design, setting, participants, & measurementsThe European Quality Study on Treatment in Advanced Chronic Kidney Disease is a European observational prospective cohort study in referred patients with CKD and an incident eGFR<20 ml/min per 1.73 m2 who are ≥65 years of age not on dialysis. Health-related quality of life was measured using the 36-Item Short Form Survey at 3- to 6-month intervals between April 2012 and September 2020, providing Physical Component Summary and Mental Component Summary scores. Trajectories were modeled by sex using linear mixed models, and sex differences in health-related quality-of-life slope were explored.ResultsWe included 5345 health-related quality-of-life measurements in 1421 participants. At baseline, women had considerably lower mean Physical Component Summary (42) and Mental Component Summary (60) compared with men (Physical Component Summary: 55; Mental Component Summary: 69; P<0.001). However, during follow-up, Physical Component Summary and Mental Component Summary scores declined approximately twice as fast in men (Physical Component Summary: 2.5 per year; 95% confidence interval, 1.8 to 3.1; Mental Component Summary: 2.7 per year; 95% confidence interval, 2.0 to 3.4) compared with in women (Physical Component Summary: 1.1 per year; 95% confidence interval, 0.1 to 2.0; Mental Component Summary: 1.6 per year; 95% confidence interval, 0.7 to 2.6). This difference was partly attenuated after adjusting for important covariates, notably eGFR decline. Higher serum phosphate, lower hemoglobin, and the presence of preexisting diabetes were associated with lower Physical Component Summary and Mental Component Summary scores in men but to a lesser extent in women.ConclusionsAmong older men and women with advanced CKD, women had lower health-related quality of life at baseline, but men experienced a more rapid decline in health-related quality of life over time.

The quality of life (QOL) needs to be regularly assessed in hemodialysis patients. Hemodialysis patients suffer from average quality of life and survival. A descriptive research design was used, 96 respondents who had received haemodialysis treatment after completion of 1 month duration of hemodialysis in two different teaching hospital at Bharatpur, Chitwan. Data was collected by using standard tool Short Form-36 version2 through face to face structure interview schedule. The objective of study is to find out the quality of life (QOL) of haemodialysis patients. Various test such as one sample t-test, ANOVA test, independent t-test, Kruskal-Wallis test and Mann-Whittney U test, Pearson’s correlation was applied. The findings showed that higher proportion of respondents were from 40-59 years (41.0%) and male (62.2%). The mean±SD was 57.45±16.25, 55.72±22.41 and 60.04±11.50 in overall QOL, physical and mental component summary respectively which was slightly above the average. All dimention and sub scale was satistically significant. Younger respondents had statistically significant with overall QOL (p<0.001) and physical component summary (p<0.001). Non diabetics had better in overall QOL (p=0.040) and physical component summary (p=0.033). Level of educational had also positive impact in overall QOL(p=0.010), physical (p=0.006) and mental component summary (p<0.001). Employment status (p=0.020) and sex (p=0.037) was also statistically significant with mental component summary. There was correlation between physical and mental component summary with overall QOL 0.970(p<0.001) and 0.698(p<0.001), and between the physical and mental component summary was 0.502(p<0.001). Below average score were seen in the general health (32.86±25.74) and vitality (41.53±13.98) sub scale. In order to improve quality of life family, physician, nurses and policy makers can use this finding.

Objective: To investigate changes and predictors of change in physical and mental function over a 3-year period after rehabilitation.Design: Prospective cohort.Participants: Patients, across diseases, living in western Norway, accepted for somatic specialized interprofessional rehabilitation (n = 984).Methods: Physical and mental function were assessed at admittance (baseline), and after 1 and 3 years using the Medical Outcome Study Short Form 36 (SF-36). Associations between changes in SF-36 component summary scores and sense of coherence, pain, disease group (musculoskeletal, neoplasm, cardiovascular, neurological, other), exercise habits and demographic variables were analysed using linear mixed modelling.Results: In the total group, mean (standard deviation) physical component summary scores improved by 2.9 (8.4) and 3.4 (9.3) points at 1 and 3 years, respectively. Mental component summary scores improved by 2.1 (9.7) and 1.6 (10.8) points. Improvement in physical component summary was significantly greater for patients with higher sense of coherence (b = 0.09, p = 0.001) and for the neoplasm disease group (b = 2.13, p = 0.046). Improvement in mental component summary was significantly greater for patients with low sense of coherence (b = –0.13, p = < 0.001) and higher level of education (b = 3.02, p = 0.0302). Interaction with age (physical component summary: b = 0.22, p = 0.039/mental component summary b = 0.51, p = 0.006) indicated larger effect at 1 year than at 3 years.Conclusion: Physical and mental function improved in the total study group over the 3-year period. Sense of coherence at baseline was associated with improved physical and mental function, suggesting that coping resources are important in rehabilitation. LAY ABSTRACTRehabilitation aims to improve function among people with disabilities. This study investigated how physical and mental function change in a 3-year period after rehabilitation, and the factors related to these changes. In a cohort of 984 rehabilitation patients, physical and mental function were measured before rehabilitation (baseline) and at 1 and 3 years after rehabilitation. Both physical and mental function improved over a period of 3 years, with the greatest improvement from baseline to 1 year. Improved function at 1 year remained relatively stable over time. Participants with higher coping resources at baseline, measured by sense of coherence, had the greatest improvement in physical function, and less improvement in mental function. Participants’ disease group influenced change in physical function. Participants with a higher level of education demonstrated greater improvement in mental function. These results imply that coping resources should be addressed as an important part of rehabilitation.

Abstract Background The decline of health among university students represents an important and growing public health concern. Health problems and unhealthy lifestyle habits are common among many students, but factors influencing students’ health are not fully understood. Methods Italian university students from different study programs and curriculum years were asked to fill out a self-administered questionnaire, collecting data about age, gender, curriculum year, study program and health-related quality of life (QOL). Two latent factors were extracted: physical component summary score and mental component summary score. T-test, one-way ANOVA, multivariate and age and sex-stratified analyses were performed. Results Students scored relatively poor on health-related QOL, with an overall mental component summary score of 41,3% (± 10,0) and physical component summary score of 52,9% (±6,0), with significantly higher mental component summary score for male students (P = &lt; 0,005). Studying economics, law (b = −2,513, P = 0,007) or engineering (b = −2,762; P = 0,001) was associated to negatively influence students’ health. Conclusions Factors such as study program are associated with health-related QOL. Further longitudinal studies assessing additional socio-demographic factors are needed to fully assess what influences students’ health. Students’ health should be at the top of the agenda of public health researchers, academic supervisors and policy-makers.

Introduction: The coronavirus disease 2019 pandemic spurred unprecedented public health measures to curb its spread. Such measures might have negatively impacted adolescents’ participation in physical activity and health-related quality of life. However, the evidence is unclear in Nigerian adolescents. This study assessed the physical activity domains, levels, and health-related quality of life in Nigerian adolescents during the coronavirus disease 2019 pandemic. Methods: The sample consisted of 430 students in public secondary schools in Nsukka, Enugu State. The students were randomly selected to participate in the cross-sectional study between November 2020 and April 2021. The Demographic Profile Form, International Physical Activity Questionnaire, Short Form-36 Health Survey, and Perceived Susceptibility to coronavirus disease 2019 Infection Questionnaire were used for data collection. Descriptive statistics, Chi-square test, independent-samples t-test, univariate ANOVA, and multiple linear regressions were conducted using SPSS version 25. Results: The mean score of total physical activity (MET-min/week) was 1651.3 ( SD = 842.18). The mean overall score of health-related quality of life was 78.30 ( SD = 16.43). The mental health component of health-related quality of life showed that adolescents had poor mental health status. Female adolescents had higher mean scores in physical component summary ( M = 83.03; SD = 27.36) and mental component summary ( M = 51.19; SD = 8.69) than the male adolescents, physical component summary ( M = 69.0; SD = 21.65) and mental component summary ( M = 46.15; SD = 10.71). Conclusion: The findings showed a significant positive association among gender, class of study, parental type, perceived susceptibility to coronavirus disease 2019, and physical activity domains, levels, and health-related quality of life. In addition, boys had a higher mean score of total physical activity (MET-min/week) than the girls. More girls were less active than the boys. However, concerning the health-related quality of life, girls had higher mean scores in physical component summary and mental component summary than boys. Physical activity interventions that specifically target female adolescents’ physical activity participation are needed. Also, mental health interventions are needed to improve the mental health status of adolescents, especially boys in the post–coronavirus disease 2019 era.

Background/Aim. Previous studies on medical students? subjective perception of health and health-related quality of life (HRQoL) showed inconclusive results. Moreover, there are no published studies to compare HRQoL of medical students to non-medical university students. The aim of the study was to assess subjective perception of health-related quality of life (HRQoL) in medical students? sample, to compare it with non-medical university stu-dents and to ascertain predictors of better perception of HRQoL in medical students. Methods. Scores of all domains on the Mental and Physical Component Summary subscales and total score of the Short Form Health Survey (SF-36), used for assessment of HRQoL in samples of 561 medical and 332 non-medical university students were assessed and compared. In addition, linear regression to identify predictors of better perception of mental and physical components of HRQoL and overall HRQoL in the sample of medical students was used. The dependant variables were subscores and total score with the SF- 36, and independent variables were certain sociodemographic and academic characteristics of the students. Results. Medical students had statistically significantly higher scores on the Mental Component Summary and total SF-36 score compared to non-medical students. Linear regression analysis demonstrated that higher scores of Physical Component Summary were associated with age, male sex and the year of studies. The Mental Component Summary were associated with age, male sex, the year of studies and marital status. The total SF-36 score was associated with age, male sex and the year of studies. Conclusion. Medical students perceive their health much better than other university students do, but female, older and second grade medical students have worse perception of their HRQoL. Those points should be potential target areas for specific prevention and treatment in order to achieve better HRQoL.

Background and objectivesSleep duration has been associated with cardiometabolic risk and mortality. The health-related quality of life represents a patient’s comprehensive perception of health and is accepted as a health outcome. We examined the relationship between sleep duration and health-related quality of life in predialysis CKD.Design, setting, participants, & measurementsIn this cross-sectional study, data from 1910 adults with CKD enrolled in the Korean Cohort Study for Outcome in Patients with CKD were analyzed. Health-related quality of life was assessed with the physical component summary and mental component summary of the Short Form-36 Health Survey. Low health-related quality of life was defined as a Short Form-36 Health Survey score >1 SD below the mean. Using a generalized additive model and multivariable logistic regression analysis, the relationship between self-reported sleep duration and health-related quality of life was examined.ResultsSeven-hour sleepers showed the highest health-related quality of life. We found an inverted U-shaped relationship between sleep duration and health-related quality of life as analyzed by a generalized additive model. In multivariable logistic analysis, short sleepers (≤5 h/d) had lower health-related quality of life (odds ratio, 3.23; 95% confidence interval, 1.86 to 5.60 for the physical component summary; odds ratio, 2.37; 95% confidence interval, 1.43 to 3.94 for the mental component summary), and long sleepers (≥9 h/d) had lower health-related quality of life (odds ratio, 2.80; 95% confidence interval, 1.55 to 5.03 for the physical component summary; odds ratio, 2.08; 95% confidence interval, 1.20 to 3.60 for the mental component summary) compared with 7-hour sleepers. Sleep duration had a significant U-shaped association with low health-related quality of life.ConclusionsThese findings suggest that short or long sleep duration is independently associated with low health-related quality of life in adults with CKD.

Background: Teachers worldwide had to reinvent their work routine according to teleworking during the COVID-19 pandemic, a work format that negatively impacts individuals’ physical and mental health. This study evaluates the association between work hours, work–family balance and quality of life (QoL) among teachers during the Chilean health emergency of the COVID-19 pandemic. Teachers from across Chile were contacted via email and social media to answer an online survey. QoL was evaluated via the SF-36 questionnaire, work hours and work–family balance in the pandemic. A total of 336 teachers from across Chile participated in this study. Teachers had a low QoL score, associated with age (p < 0.05). Teachers who were ≤44 showed lower deterioration risks in the Physical Component Summary (OR: 0.54) than the ≥45-year-old age group; simultaneously, the younger group (≤44 years) had a greater risk (OR: 2.46) of deterioration in the Mental Component Summary than teachers over 45 years. A total of 78.7% of teachers reported having increased their work hours during the COVID-19 pandemic due to teleworking and 86% indicated negative effects on their work–family balance. Pandemic work hours and negative work–family balance increase the risk of reducing the Mental Component Summary (OR: 1.902; OR: 3.996, respectively). Teachers presented low median QoL scores, especially in the Mental Component Summary, suggesting that it would be beneficial to promote a better workload distribution for teachers in emergency contexts, considering the adverse effects of teleworking.

In this thesis I will discuss the shortcomings of the statistical methods used to derive scoring coefficients for the physical and mental health component summary scores of the Medical Outcomes Study SF-36 and SF-12 health status scales. I will propose an alternative statistical method for generating scoring coefficients for these scales, and produce scoring coefficients for both version 1 and version 2 of the SF-36 and SF-12. I will then demonstrate the superior measurement properties of summary scores generated using my method compared to the proprietary scoring, and discuss the limitations of the SF-36 author’s contention regarding international comparisons using this instrument. The study is articulated through several international peer reviewed publications, which provide a progressive story of the body of research. The papers themselves follow on from a wider discussion of the failure of the methods recommended for scoring the physical and mental component summary scores of the SF-36 and SF-12 and provide the argument for alternative scoring methods.
Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, Adelaide Medical School, 2017

This chapter highlights Project BEAMS (Behavioral Emotional and Mental Health Supports in Schools), an interdisciplinary personnel preparation program at San Diego State University. Project BEAMS is a five-year training grant funded by the Office of Special Education Programs (OSEP) to improve the preparation of school psychologists (SP) and special educators (SE) to deliver intensive, yet coordinated, interventions to address behavior and mental health. This chapter describes the training components and collaborative learning activities (e.g., core research-based courses, monthly project seminars, clinical practicum, summer institutes, and co-attendance at research conferences) that enable special educators and school psychologists to form teams that enhance academic, social-emotional, and behavioral outcomes for students with disabilities.

We have invited some practitioners who “do the work” to tell us what they do. Six program areas are covered here: parent involvement, after-school and summer programs, early childhood programs, primary health services, mental health services, and community development. These are the basic components of the community school model developed by The Children’s Aid Society (CAS); most other models include some or all of these activities as well. We have asked our experts from CAS to provide the rationale for what they do in their components, describe a working example, discuss implementation issues and sources of financing for the component, and tell us about the challenges they faced and the lessons they have learned from their experiences. Many of these components require space within the school—a designated area for parents to congregate, rooms for a primary health care clinic, private offices for mental health counseling, and classrooms and gyms for before- and after-school activities. Not every school can meet these space requirements, or at least many schools do not think that they have room for one more activity. I have observed, though, that more space becomes available in direct relationship to how essential the services become. One principal, reluctant to place a school-based clinic in his building, offered one very small room in a dark corner. Yet five years later, a full suite of rooms had been designated the “Health Place” with two examining rooms, a dental office, a meeting room, three private offices, and an attractive waiting room. The principal described the facility as “my clinic” when a newscaster came to do a story on the program. Unquestionably, full-service community schools require delicate negotiations over many issues, especially space. The CAS schools make full use of classrooms for after-school activities and need access to the gymnasium, auditorium, band room, restrooms, cafeteria, and playground. The principal and the community school director must work out the arrangements for the use of facilities and for cleaning and maintaining them. As you will see from these descriptions of the core components, this work is labor intensive. In every aspect of community school work, individual attention to students and their families is paramount.

One of the difficulties in mathematics education is providing a good answer to the “What can I do with mathematics?” question. Applied examples and projects within existing mathematics courses can help answer this but often aren’t close enough to real world applications and they can consume considerable course time. We have addressed this difficulty with a summer program that employs students to solve actual applied problems. The College of Wooster Applied Methods & Research Experience is a summer program that puts teams of students to work as consultants in the local community. Student teams are usually composed of three students with a mathematics or computer science faculty member acting as mentor. Clients of the program come from business, industry, government agencies, and service organizations. The program also includes a significant professional development component in order to increase the educational benefit to the participants.

Before The Children’s Aid Society (CAS) opened its first two community schools in Washington Heights (1992–1993), our staff and board had already begun to address the issue of sustainability—that is, how to plan for the long-term development, implementation, assessment, and institutionalization of this new line of work. Internal strategic planning led to decisions by CAS board and staff leadership to realign existing resources in support of this new work, while external planning resulted in explicit partnership agreements, forged in 1990, with the New York City Board of Education and Community School District 6 (see appendix to Coltoff, ch. 1 in this volume) that also set the stage for long-term sustainability. As CAS’s assistant executive director for community schools, my responsibilities include planning and overseeing our sustainability efforts. This chapter describes CAS’s experience in raising funds for its community schools and offers suggestions for how other practitioners might proceed. CAS views sustainability as involving not only aggressive fundraising but also public relations, constituency building, and advocacy, using a conceptual framework developed by the Finance Project, a national research and policy organization. These four components are interrelated; work in one area supports and complements efforts in the other three. For fiscal year 2003–2004, the operating budget for CAS’s 10 community schools totaled almost $13 million, which included approximately $8.6 million for the extended-day, summer camp, teen, parent, and adult education components and $2.8 million for health services (medical, dental, and mental health). In addition, two sites have Early Head Start and Head Start programs operated by CAS; the costs for these programs are covered entirely by federal grants totaling approximately $1.4 million. Because the programs differ, each school has a different budget, but the estimated additional cost per student per year of a fully developed community school is $1,000. CAS generates support for its community schools from a wide variety of sources. During the initial years, core support came primarily from private sources, including foundations, corporations, and individuals; the exception was the health and mental health services, which were financed partially by Medicaid and Child Health Plus (federally supported children’s health insurance), as well as by other public and private sources.

Since the COVID.19 pandemic is a serious crisis in many countries around the world, it is important to conduct empirical research aimed at identifying risks and factors protecting the functioning of people affected by it [1, 2]. For this reason, the goal of this research is to determine the structure of the relationship between physical activity and psychosocial functioning of 226 women and 226 men during the COVID.19 epidemic in Poland by looking at connections between physical activity, mental health disorders and cognitive processes and their significance for the quality of social relations. Methodologically, the research relies on IPAQ Questionnaire [3], GHQ-28 Questionnaires [4], TUS Test — 6/9 version [5] and the original SFS Scale. The structural model indicates that physical activity weakens the relationship between mental health disorders and cognitive processes, and gender is the moderator of these relationships. This suggests that physical activity adapted to the condition of health may be an important component of gender. individualized psycho. preventive interventions.

Abstract This paper covers the development of the preliminary design process, analysis, and cost modeling for the critical component specifications of a particle handling system, for a Pre-commercial 26.5 MW-e solid Particle Heating Receiver (PHR) based Concentrated Solar Power (CSP) systems in the Middle East North Africa (MENA) region.

Emergency Relief (ER) is a Department of Social Services (DSS) funded program, delivered by 197 community organisations (ER Providers) across Australia, to assist people facing a financial crisis with financial/material aid and referrals to other support programs. ER has been playing this important role in Australian communities since 1979. Without ER, more people living in Australia who experience a financial crisis might face further harm such as crippling debt or homelessness. The Emergency Relief National Coordination Group (NCG) was established in April 2020 at the start of the COVID-19 pandemic to advise the Minister for Families and Social Services on the implementation of ER. To inform its advice to the Minister, the NCG partnered with the Institute for Governance at the University of Canberra to conduct research to understand the issues and challenges faced by ER Providers and Service Users in local contexts across Australia. The research involved a desktop review of the existing literature on ER service provision, a large survey which all Commonwealth ER Providers were invited to participate in (and 122 responses were received), interviews with a purposive sample of 18 ER Providers, and the development of a program logic and theory of change for the Commonwealth ER program to assess progress. The surveys and interviews focussed on ER Provider perceptions of the strengths, weaknesses, future challenges, and areas of improvement for current ER provision. The trend of increasing case complexity, the effectiveness of ER service delivery models in achieving outcomes for Service Users, and the significance of volunteering in the sector were investigated. Separately, an evaluation of the performance of the NCG was conducted and a summary of the evaluation is provided as an appendix to this report. Several themes emerged from the review of the existing literature such as service delivery shortcomings in dealing with case complexity, the effectiveness of case management, and repeat requests for service. Interviews with ER workers and Service Users found that an uplift in workforce capability was required to deal with increasing case complexity, leading to recommendations for more training and service standards. Several service evaluations found that ER delivered with case management led to high Service User satisfaction, played an integral role in transforming the lives of people with complex needs, and lowered repeat requests for service. A large longitudinal quantitative study revealed that more time spent with participants substantially decreased the number of repeat requests for service; and, given that repeat requests for service can be an indicator of entrenched poverty, not accessing further services is likely to suggest improvement. The interviews identified the main strengths of ER to be the rapid response and flexible use of funds to stabilise crisis situations and connect people to other supports through strong local networks. Service Users trusted the system because of these strengths, and ER was often an access point to holistic support. There were three main weaknesses identified. First, funding contracts were too short and did not cover the full costs of the program—in particular, case management for complex cases. Second, many Service Users were dependent on ER which was inconsistent with the definition and intent of the program. Third, there was inconsistency in the level of service received by Service Users in different geographic locations. These weaknesses can be improved upon with a joined-up approach featuring co-design and collaborative governance, leading to the successful commissioning of social services. The survey confirmed that volunteers were significant for ER, making up 92% of all workers and 51% of all hours worked in respondent ER programs. Of the 122 respondents, volunteers amounted to 554 full-time equivalents, a contribution valued at $39.4 million. In total there were 8,316 volunteers working in the 122 respondent ER programs. The sector can support and upskill these volunteers (and employees in addition) by developing scalable training solutions such as online training modules, updating ER service standards, and engaging in collaborative learning arrangements where large and small ER Providers share resources. More engagement with peak bodies such as Volunteering Australia might also assist the sector to improve the focus on volunteer engagement. Integrated services achieve better outcomes for complex ER cases—97% of survey respondents either agreed or strongly agreed this was the case. The research identified the dimensions of service integration most relevant to ER Providers to be case management, referrals, the breadth of services offered internally, co-location with interrelated service providers, an established network of support, workforce capability, and Service User engagement. Providers can individually focus on increasing the level of service integration for their ER program to improve their ability to deal with complex cases, which are clearly on the rise. At the system level, a more joined-up approach can also improve service integration across Australia. The key dimensions of this finding are discussed next in more detail. Case management is key for achieving Service User outcomes for complex cases—89% of survey respondents either agreed or strongly agreed this was the case. Interviewees most frequently said they would provide more case management if they could change their service model. Case management allows for more time spent with the Service User, follow up with referral partners, and a higher level of expertise in service delivery to support complex cases. Of course, it is a costly model and not currently funded for all Service Users through ER. Where case management is not available as part of ER, it might be available through a related service that is part of a network of support. Where possible, ER Providers should facilitate access to case management for Service Users who would benefit. At a system level, ER models with a greater component of case management could be implemented as test cases. Referral systems are also key for achieving Service User outcomes, which is reflected in the ER Program Logic presented on page 31. The survey and interview data show that referrals within an integrated service (internal) or in a service hub (co-located) are most effective. Where this is not possible, warm referrals within a trusted network of support are more effective than cold referrals leading to higher take-up and beneficial Service User outcomes. However, cold referrals are most common, pointing to a weakness in ER referral systems. This is because ER Providers do not operate or co-locate with interrelated services in many cases, nor do they have the case management capacity to provide warm referrals in many other cases. For mental illness support, which interviewees identified as one of the most difficult issues to deal with, ER Providers offer an integrated service only 23% of the time, warm referrals 34% of the time, and cold referrals 43% of the time. A focus on referral systems at the individual ER Provider level, and system level through a joined-up approach, might lead to better outcomes for Service Users. The program logic and theory of change for ER have been documented with input from the research findings and included in Section 4.3 on page 31. These show that ER helps people facing a financial crisis to meet their immediate needs, avoid further harm, and access a path to recovery. The research demonstrates that ER is fundamental to supporting vulnerable people in Australia and should therefore continue to be funded by government.