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Case Study Questions Class 10 Science

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Download Case study questions for CBSE class 10 Science in PDF format from the myCBSEguide App . We have the new pattern case study-based questions for free download. Class 10 Science case study questions

This article will guide you through:

What are case study questions?

  • Sample Papers with Case Study questions
  • Class 10 Science Case Study question examples
  • How to get case-based questions for free?
  • How to attempt the case-based questions in Science?

Questions based on case studies are some real-life examples. The questions are asked based on a given paragraph i.e. Case Study.  Usually, 4-5 questions are asked on the basis of the given passage. In most cases, these are either MCQs or assertion & reason type questions. Let’s take an example to understand. There is one paragraph on how nitrogen is generated in the atmosphere. On the basis of this paragraph, the board asks a few objective-type questions. In other words, it is very similar to the unseen passages given in language papers. But the real cases may be different. So, read this article till the end to understand it thoroughly.

What is CBE?

CBSE stands for competency-based education. The case study questions are part of this CBE. The purpose of CBE is to demonstrate the learning outcomes and attain proficiency in particular competencies.

Questions on Real-life Situations

As discussed the case study questions are based on real-life situations. Especially for grade 10 science, it is very essential to have the practical knowledge to solve such questions. Here on the myCBSEguide app, we have given many such case study paragraphs that are directly related to real-life implications of the knowledge.

Sample Papers with Case Study Questions

Class 10 Science Sample Papers with case study questions are available in the myCBSEguide App . There are 4 such questions (Q.No.17 to 20) in the CBSE model question paper. If you analyze the format, you will find that the MCQs are very easy to answer. So, we suggest you, read the given paragraph carefully and then start answering the questions. In some cases, you will find that the question is not asked directly from the passage but is based on the concept that is discussed there. That’s why it is very much important to understand the background of the case study paragraph.

CBSE Case Study Sample Papers

You can download CBSE case study sample papers from the myCBSEguide App or Student Dashboard. Here is the direct link to access it.

Case Study Question Bank

As we mentioned that case study questions are coming in your exams for the last few years. You can get them in all previous year question papers issued by CBSE for class 1o Science. Here is the direct link to get them too.

Class 10 Science Case Study Question Examples

As you have already gone through the four questions provided in the CBSE model question paper , we are proving you with other examples of the case-based questions in the CBSE class 10 Science. If you wish to get similar questions, you can download the myCBSEguide App and access the Sample question papers with case study-type questions.

Case-based Question -1

Read the following and answer any four questions: Salt of a strong acid and strong base is neutral with a pH value of 7. NaCl common salt is formed by a combination of hydrochloride and sodium hydroxide solution. This is the salt that is used in food. Some salt is called rock salt bed of rack salt was formed when seas of bygone ages dried up. The common salt thus obtained is an important raw material for various materials of daily use, such as sodium hydroxide, baking soda, washing soda, and bleaching powder.

  • Phosphoric acid
  • Carbonic acid
  • Hydrochloric acid
  • Sulphuric acid
  • Blue vitriol
  • Washing soda
  • Baking soda
  • Bleaching powder

Case-based Question -2

  • V 1  + V 2  + V 3
  • V 1  – V 2  +V 2
  • None of these
  • same at every point of the circuit
  • different at every point of the circuit
  • can not be determined
  • 20 3 Ω 203Ω
  • 15 2 Ω 152Ω

Case-based Question -3

  • pure strips
  • impure copper
  • refined copper
  • none of these
  • insoluble impurities
  • soluble impurities
  • impure metal
  • bottom of cathode
  • bottom of anode

How to Attempt the Case-Based Questions in Science?

Before answering this question, let’s read the text given in question number 17 of the CBSE Model Question Paper.

All living cells require energy for various activities. This energy is available by the breakdown of simple carbohydrates either using oxygen or without using oxygen.

See, there are only two sentences and CBSE is asking you 5 questions based on these two sentences. Now let’s check the first questions given there.

Energy in the case of higher plants and animals is obtained by a) Breathing b) Tissue respiration c) Organ respiration d) Digestion of food

Now let us know if you can relate the question to the paragraph directly. The two sentences are about energy and how it is obtained. But neither the question nor the options have any similar text in the paragraph.

So the conclusion is, in most cases, you will not get direct answers from the passage. You will get only an idea about the concept. If you know it, you can answer it but reading the paragraph even 100 times is not going to help you.

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CBSE Class 10 Science Case Study Questions Download Free PDF

If you are looking for the CBSE Class 10 Science Case Study Questions in PDF, then you are in the right place. CBSE 10th Class Case Study for the Science Subject is available here. These Case studies can help the students to solve the different types of questions that are based on the case study.

case study grade 10 science

CBSE Board will be asking case study questions based on Science subjects in the upcoming board exams. Thus, it becomes an essential resource to study. 

The Science Subject case study for class 10th covers a wide range of chapters from the Science. Students willing to score good marks in their board exams can use it. The questions are highly interactive and it allows students to use their thoughts and skills to solve such kinds of questions.

Case Study Questions Class 10 Science

In board exams, students will find the questions based on assertion and reasoning . Also, there will be a few questions based on case studies. In that, a paragraph will be given, and then the MCQ questions based on it will be asked.

  • Case Study Questions for Chapter 1 Chemical Reactions and Equations
  • Case Study Questions for Chapter 2 Acids, Bases, and Salts
  • Case Study Questions for Chapter 3 Metals and Non-Metals
  • Case Study Questions for Chapter 4 Carbon and Its Compounds
  • Case Study Questions for Chapter 5 Periodic Classification of elements
  • Case Study Questions for Chapter 6 Life Processes
  • Case Study Questions for Chapter 7 Control and Coordination
  • Case Study Questions for Chapter 8 How do organisms reproduce?
  • Case Study Questions for Chapter 9 Heredity and Evolution
  • Case Study Questions for Chapter 10 Light reflection and refraction
  • Case Study Questions for Chapter 11 Human eye and colorful world
  • Case Study Questions for Chapter 12 Electricity
  • Case Study Questions for Chapter 13 Magnetic effects of current
  • Case Study Questions for Chapter 15 Our Environment

The above  Case studies  for CBSE Class 10 Science will help you to score good marks in the Case Study questions that have been coming in your examinations. These CBSE Class 10 Science Case Study have been developed by experts of cbseexperts.com   for benefit of Class 10 students.

Class 10 Science Assertion and Reason Questions

Case Study Type Questions in Science Class 10

Case Study Type Questions in Science Class 10 include the information or data. Students willing to solve them are required to read the passage carefully and then solve them. While solving the paragraph the ideal way is to highlight the key information or given data.

Because later it will ease them to write the final answers. Science Case study type questions consist of 4 to 5 questions that should be answered in an MCQ manner. 

While reading the paragraph students will get the clue in between about the possible answer of the question. They should definitely highlight those questions. This is the best way to solve such kind of Case study Type Questions.

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Important Case Study Questions for Class 10th Science Term 1 Exam 2021 (Published By CBSE)

Download case study questions for class 10 science to prepare for the upcoming cbse class 10 term 1 exam 2021-22. these multiple choice type questions are published by the cbse board to provide sample questions to students..

Gurmeet Kaur

CBSE Class 10 Science Term 1 Exam 2021-22 will have a set of questions based on case studies in the form of MCQs. The CBSE Class 10 Science Question Bank on Case Studies, provided in this article, can be very helpful to understand the new format of questions. This question bank is published by the CBSE Board itself that makes it a very reliable source for the board exam preparations. Each question has five sub-questions with each followed by four options and a correct answer. Students can easily download these sample questions in PDF format and refer to the same for exam preparations.

Note: Check the reduced CBSE Syllabus for Class 10 Science for Term 1   and then practice the case study questions accordingly for CBSE Class 10 Term 1 Exam 2021-22.  

Best Exam Writing Tips to Score Full Marks in Class 10 Science Term 1 Paper

CBSE Class 10 Science Important Questions for Last Minute Revision for Term 1 Exam

SCIENCE- Class X

Sample Case Studies

1. Read the following and answer any four questions from 1.1 to 1.5:

Marble’s popularity began in ancient Rome and Greece, where white and off-white marble were used to construct a variety of structures, from hand-held sculptures to massive pillars and buildings.

case study grade 10 science

1.1 The substance not likely to contain CaCO 3 is

a) Dolomite

b) A marble statue

c) Calcined gypsum

d) Sea shells.

Answer: c) Calcined gypsum

Check CBSE Class 10 Revised Syllabus 2021-2022 (All Subjects)

1.2 A student added 10g of calcium carbonate in a rigid container, secured it tightly and started to heat it. After some time, an increase in pressure was observed, the pressure reading was then noted at intervals of 5 mins and plotted against time, in a graph as shown below. During which time interval did maximum decomposition took place?

case study grade 10 science

a) 15-20 min

b) 10-15 min

c) 5-10 min

Answer: d) 0-5 min

1.3 Gas A, obtained above is a reactant for a very important biochemical process which occurs in the presence of sunlight. Identify the name of the process -

a) Respiration

b) Photosynthesis

c) Transpiration

d) sphotolysis

Answer: b) Photosynthesis

1.4 Marble statues are corroded or stained when they repeatedly come into contact with polluted rain water. Identify the main reason.

case study grade 10 science

a) decomposition of calcium carbonate to calcium oxide

b) polluted water is basic in nature hence it reacts with calcium carbonate

c) polluted water is acidic in nature hence it reacts with calcium carbonate

d) calcium carbonate dissolves in water to give calcium hydroxide.

Answer: c) polluted water is acidic in nature hence it reacts with calcium carbonate

1.5 Calcium oxide can be reduced to calcium, by heating with sodium metal. Which compound would act as an oxidizing agent in the above process?

b) sodium oxide

d) calcium oxide

Answer: d) calcium oxide

2. Read the following and answer any four questions from 2.1 to 2.5:

The reaction between MnO2 with HCl is depicted in the following diagram. It was observed that a gas with bleaching abilities was released.

case study grade 10 science

2.1 The chemical reaction between MnO 2 and HCl is an example of:

a) displacement reaction

b) combination reaction

c) redox reaction

d) decomposition reaction

Answer: c) redox reaction

2.2 Chlorine gas reacts with _______ to form bleaching powder.

a) dry Ca(OH) 2

b) dil. solution of Ca(OH) 2

c) conc. solution of Ca(OH) 2

Answer: a) dry Ca(OH) 2

2.3 Identify the correct statement from the following:

a) MnO 2 is getting reduced whereas HCl is getting oxidized

b) MnO 2 is getting oxidized whereas HCl is getting reduced.

c) MnO 2 and HCl both are getting reduced.

d) MnO 2 and HCl both are getting oxidized.

Answer: a) MnO 2 is getting reduced whereas HCl is getting oxidized

2.4 In the above discussed reaction, what is the nature of MnO 2 ?

a) Acidic oxide

b) Basic oxide

c) Neutral oxide

d) Amphoteric oxide

Answer: b) Basic oxide

2.5 What will happen if we take dry HCl gas instead of aqueous solution of HCl?

a) Reaction will occur faster.

b) Reaction will not occur.

c) Reaction rate will be slow.

d) Reaction rate will remain the same.

Answer: b) Reaction will not occur.

Also, check below other important study material released by the CBSE Board:

CBSE Class Maths Case Study Questions for All Chapters (Published by CBSE)

MCQs for Class 10 English Footprints without Feet (Published by CBSE)

Important* CBSE Class 10 Science Best Study Material for Board Exam 2021-22

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CBSE Class 10th - SCIENCE : Chapterwise Case Study Question & Solution

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CBSE Class 10th - SCIENCE : Chapterwise Case Study Question & Solution

In board exams, students will find the questions based on assertion and reasoning. Also, there will be a few questions based on case studies. In that, a paragraph will be given, and then the MCQ questions based on it will be asked. For Science subjects, there would be 5 case-based sub-parts questions, wherein a student has to attempt 4 sub-part questions.

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Case Study Questions Class 10 Science Life Processes

Case study questions class 10 science chapter 6 life processes.

life processes case study questions

At Case Study Questions there will given a Paragraph. In where some Important Questions will made on that respective Case Based Study. There will various types of marks will given 1 marks, 2 marks, 3 marks, 4 marks.

CBSE Case Based Questions Class 10 Science Chemistry Chapter 6

CASE STUDY : 1

Carbon and energy requirements of the autotrophic organism are fulfilled by photosynthesis. It is the process by which autotrophs take in substances from the outside and convert them into stored forms of energy. This material is taken in the form of carbon dioxide and water which is converted into carbohydrates in the presence of sunlight and chlorophyll. Carbohydrates are utilised for providing energy to the plant.

i) Write a chemical reaction which occur during photosynthesis?

Ans: 6CO2 +12H2O + Chlorophyll & sunlight👉 C6H12O6 + 6O2 + 6H2O

ii) In which form of carbohydrates does the plant stored in them?

Ans: The carbohydrates are stored in the form of starch as the internal energy.

iii) What is stomata?

Ans: The process present in the surface of a leaf or the stem of a plant to allow the exchange of gases.

iv) What are the functions of stomata?

Ans: i) Exchange of gases i.e oxygen and CO2

ii) Transpiration

v) What is Chloroplast?

Ans: Chloroplast is a cell organelles which contains photosynthetic pigment called as chlorophyll which help in the absorption of sunlight.

CASE STUDY : 2

The alimentary canal is basically a long tube extending from the mouth to the anus. In Fig. 6.6, we can see that the tube has different parts. Various regions are specialised to perform different functions.

We eat various types of food which has to pass through the same digestive tract. Naturally the food has to be processed to generate particles which are small and of the same texture. This is achieved by crushing the food with our teeth

i) Which enzyme is present in our mouth to digest starch?

Ans: Salivary amylase from salivary glands.

ii) What are the types of enzymes released by our stomach?

Ans: Hydrochloric acid, pepsin and a mucus.

iii) Which is the longest part of our alimentary canal in our body?

Ans: Small intestine

iv) What are villi?

Ans: Villi are finger like projection present inside the inner lining of the small intestine which increases the surface area for absorption.

v) What are the enzymes that are released by pancreas?

Ans: Enzyme released by pancreas – • trypsin- Digestion of protein

lipase – breakdown of emulsified fats

CASE  STUDY : 3

The food material taken in during the process of nutrition is used in cells to provide energy for various life processes. Diverse organisms do this in different ways – some use oxygen to break-down glucose completely into carbon dioxide and water, some use other pathways that do not involve oxygen (Fig. 6.8). In all cases, the first step is the break-down of glucose, a six-carbon molecule, into a three-carbon molecule called pyruvate. This process takes place in the cytoplasm.

i) What is anaerobic respiration?

Ans: The conversion of pyruvate into ethanol, CO2 & energy take place in the absence of air(oxygen),  it is called anaerobic respiration.

ii) Explain the process which happen in our muscle cells?

Ans- The conversion of pyruvate to lactic acid( 3 carbon molecule)  and energy due to the lack of oxygen.

iii) In which form our body used the energy?

Ans: It is in the form of ATP molecule i.e Adenosine Triphosphate.

iv) Why there is a faster breathing rate of aquatic animals then the terrestrial animals?

Ans- The amount of O2 dissolved in water is low as compared to amount of O2 present in air. Therefore, aquatic animals have faster breathing rate.

v) Write the name of organ used for respiration by different organism- fish, frog?

Ans- i) fish- gills

ii) frog- skin, lungs

CASE STUDY : 4

The excretory system of human beings includes a pair of kidneys, a pair of ureters, a urinary bladder and a urethra. Kidneys are located in the abdomen, one on either side of the backbone. Urine produced in the kidneys passes through the ureters into the urinary bladder where it is stored until it is released through the urethra.

i) What is the purpose of making urine?

Ans: Urine is to filter out the blood i e to remove waste product from the blood such as urea.

ii) What is Bowman’s capsule?

Ans: A cup shaped end of a coiled tube which is associated with capillaries to collect filterate.

iii) What is dialysis?

Ans: To remove nitrogenous waste from your blood by using machine when kidney does not its function i.e in case of kidney failure.

iv) What is the function of urinary bladder?

Ans: It is used to stored urine until the pressure comes from the brain to pass it out.

v) What are the different parts of nephrons?

Ans: Renal artery, Bowman’s capsule, glomerulus, tubular part of nephron and a collecting duct.

CASE STUDY : 5

The heart is a muscular organ which is as big as our fist. Because both oxygen and carbon dioxide have to be transported by the blood, the heart has different chambers to prevent the oxygen-rich blood from mixing with the blood containing carbon dioxide. The carbon dioxide-rich blood has to reach the lungs for the carbon dioxide to be removed, and the oxygenated blood from the lungs has to be brought back to the heart. This oxygen-rich blood is then pumped to the rest of the body.

i) How many chambers are present in the heart of mammals and reptiles?

Ans: Mammals- 4 chamber heart and reptiles- 3 chambered heart

ii) Who carry deoxygenated blood from body to heart?

Ans: Vena cava carries deoxygenated blood from body to heart.

iii) What do you meant by the term double circulation?

Ans: The blood goes through the heart twice during each cycle known as double circulation.

iv) What is hypertension?

Ans: The force that blood experts against the wall of a vessels is called hypertension or high blood pressure.

V) Which device measured blood pressure?

Ans: Sphygmomanometer

CASE STUDY : 6

Plant transport systems will move energy stores from leaves and raw materials from roots. These two pathways are constructed as independently organised conducting tubes. One, the xylem moves water and minerals obtained from the soil. The other, phloem transports products of photosynthesis from the leaves where they are synthesised to other parts of the plant

i) What are the different parts of xylem?

Ans: vessels, tracheids, xylem parenchyma and fibres.

ii) What do you meant by the term transpiration?

Ans: The loss of water in the form of vapour from the aerial parts of the plant.

iii) What are the advantages of transpiration?

Ans: i) help in the absorption and the upward movement of water

ii) temperature regulation

iv) What is translocation?

Ans: The transport of soluble products of photosynthesis is called translocation.

v) How does plant remove their waste product?

Ans: They remove their waste product in the form of fallen leaves, resins and gums.

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Watch CBS News

Supreme Court turns away affirmative action dispute over Virginia high school's admissions policies

By Melissa Quinn

February 20, 2024 / 10:34 AM EST / CBS News

Washington —  The Supreme Court on Tuesday turned away a challenge to the admissions policy at a prestigious Virginia high school that administrators say is designed to mitigate socioeconomic and geographic barriers for prospective students.

The decision from the high court not to take up the appeal by a group of parents challenging the admissions policies at Thomas Jefferson High School for Science and Technology leaves intact a lower court decision upholding the criteria, which school officials argue is race neutral. The U.S. Court of Appeals for the 4th Circuit concluded last year that the goal of the program is to foster diversity among the school's student body, though the parents that brought the case said it impermissibly discriminated against Asian-American students. 

Justices Samuel Alito and Clarence Thomas dissented from the court's decision not to hear the case. In a dissenting  opinion  joined by Thomas, Alito said the admissions model adopted by the high school "has been trumpeted to potential replicators as a blueprint for evading" the Supreme Court's affirmative action decision.

"The holding below effectively licenses official actors to discriminate against any racial group with impunity as long as that group continues to perform at a higher rate than other groups. That is indefensible," Alito wrote. He concluded that "the Court's willingness to swallow the aberrant decision below is hard to understand. We should wipe the decision off the books."

Affirmative action at the Supreme Court

The case is the latest involving affirmative action to arrive at the court since it issued its landmark ruling last June invalidating the race-conscious admissions policies at Harvard and the University of North Carolina. In the wake of its 6-3 decision, the Supreme Court has already been asked to temporarily stop the U.S. Military Academy at West Point from considering race in its admissions process, but declined to do so .

The challenge to West Point's policies arose out of a footnote in the majority opinion authored by Chief Justice John Roberts in the Harvard and University of North Carolina cases, in which he said the Supreme Court's decision did not apply to the nation's service academies. Roberts' opinion also warned that schools shouldn't try to get around the court's affirmative action ruling through application essays or other means, writing "'[w]hat cannot be done directly cannot be done indirectly.'"

This case involves the admissions process at an Alexandria, Virginia-based high school, which is considered to be one of the best in the country. A group of parents in Fairfax County, a wealthy enclave of Washington, D.C., argued that admissions criteria imposed at Thomas Jefferson High School seek to "indirectly" use race as a factor, which the Supreme Court said would be unlawful.

Admission to the magnet school, known as TJ, was previously based on standardized tests and a combination of GPA, teacher recommendations and essays until 2020. But that year, the Fairfax County School Board, which oversees the high school, eliminated entrance exams from Thomas Jefferson's admissions process and put in place a holistic system.

Thomas Jefferson High School in Alexandria, Virginia, on July 1, 2020.

The school board argued in court filings that under the old admissions processes, admitted classes overwhelmingly were made up of students from a small subset of Fairfax County's wealthiest areas. But under the new program, seats are reserved for top students from each of the county's middle schools.  The remaining spots are awarded to highest-evaluated applicants, as well as to students based on a number of socioeconomic factors, including whether students are from low-income families, are learning English as a second language or attended a "historically underrepresented" middle school.

The policy is race-neutral, according to the Fairfax County School Board, and admissions evaluators do not know an applicant's name, gender, race or ethnicity. They also cannot keep track of the racial composition of an incoming class during the admissions process, the board said in court papers.

But a grassroots group of parents called The Coalition for TJ sued the Fairfax County School Board in 2021, arguing that the revamped admissions policy is unconstitutional because it discriminated against Asian-American applicants.

In 2021, the first year under the new system, fewer Asian-American applicants were admitted than the prior year and the share of Asian-American students receiving admissions offers fell from 73% to 54%. Every other racial group saw an increase in admissions numbers, according to court filings: Admissions offers to White students rose from 18% to 22%; offers to Black students grew from less than 2% to nearly 8%; and offers to Hispanic students jumped from 3% to 11%.

A federal district court in Alexandria ruled for the coalition in February 2022, finding that the board's redesigned policy was "designed to increase Black and Hispanic enrollment which would, by necessity, decrease the representation of Asian-Americans at TJ," and adopted with discriminatory intent.

U.S. District Judge Claude Hilton blocked the board from implementing the policy, but a divided panel of three federal appeals court judges eventually reversed the ruling and upheld the admissions program. 

The 4th Circuit concluded that "the undisputed facts show only that the Board intended to improve the overall socioeconomic and geographic diversity of TJ's student body," and found that the coalition failed to prove that the board was motivated by discriminatory intent.

"The challenged admissions policy's central aim is to equalize opportunity for those students hoping to attend one of the nation's best public schools, and to foster diversity of all stripes among TJ's student body," the 4th Circuit said in its 2-1 decision. It continued: "Expanding the array of student backgrounds in the classroom serves, at minimum, as a legitimate interest in the context of public primary and secondary schools. And that is the primary and essential effect of the challenged admissions policy."

The Supreme Court was asked to weigh in at an earlier stage in the proceedings and denied a request from the Coalition for TJ for emergency relief in April 2022, more than a year before its affirmative action ruling. Justices Clarence Thomas, Samuel Alito and Neil Gorsuch said they would have granted the group's request to block the admissions policy.

The parents returned to the Supreme Court in August, asking the justices to decide whether the board violated the Constitution's Equal Protection Clause when it overhauled the admissions criteria at the high school. Citing the court's June affirmative action decision, the group warned that its "guarantees … might mean little if schools could accomplish the same discriminatory result through race-neutral proxies."

The coalition told the court in a filing that while it has said racial balancing through racial classifications is impermissible, it has not yet explicitly addressed whether student body diversity can be achieved through race-neutral means.

"The longer this question is not resolved, the more incentive school districts (and now, universities) will have to develop workarounds that enable them to racially discriminate without using racial classifications," its lawyers wrote.

But the Fairfax County School Board argued that the new policy removes socioeconomic barriers to admission to Thomas Jefferson High School and is race neutral and race blind. 

"The policy did not in fact result in a student body that matches the demographics of the County, maintains predetermined percentages of any racial group, or otherwise reflects racial balance of any sort," they said in a filing .

The board said there was no evidence supporting the coalition's "reckless" claim that Thomas Jefferson's admissions criteria were changed to discriminate against Asian-Americans, and noted that more Asian-American students from poor families living in less affluent areas of Fairfax County were admitted under the new policy.

Melissa Quinn is a politics reporter for CBSNews.com. She has written for outlets including the Washington Examiner, Daily Signal and Alexandria Times. Melissa covers U.S. politics, with a focus on the Supreme Court and federal courts.

More from CBS News

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Deptford school district plans to change new policy that limits student hours on issued laptops

Montco private school breaks barriers through student diversity

Police investigating alleged misconduct in Smyrna, Delaware, school

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  • Open access
  • Published: 19 February 2024

Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study

  • Bo Kim 1 , 2 ,
  • Jennifer L. Sullivan 3 , 4 ,
  • Madisen E. Brown 1 ,
  • Samantha L. Connolly 1 , 2 ,
  • Elizabeth G. Spitzer 1 , 5 ,
  • Hannah M. Bailey 1 ,
  • Lauren M. Sippel 6 , 7 ,
  • Kendra Weaver 8 &
  • Christopher J. Miller 1 , 2  

Implementation Science volume  19 , Article number:  16 ( 2024 ) Cite this article

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Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3–4 years after implementation support had concluded.

We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends.

CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): “Collaborativeness/Teamwork [Recipients],” “Staff/Leadership turnover [Recipients],” and “Having a consistent/strong internal facilitator [Facilitation]” during and after active implementation. At most high-sustainability sites only, (i) “Having a knowledgeable/helpful external facilitator [Facilitation]” was variably present and enabled sustainability when present, while (ii) “Clarity about what CCM comprises [Innovation],” “Interdisciplinary coordination [Recipients],” and “Adequate clinic space for CCM team members [Context]” were somewhat or less present with mixed influences on sustainability.

Conclusions

MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.

Peer Review reports

Contributions to the literature

We examined the ways in which the sustainability of the evidence-based Collaborative Chronic Care Model differed across nine outpatient mental health clinics where it was implemented.

This work demonstrates a unique application of the Matrixed Multiple Case Study (MMCS) method, originally developed to identify factors and their combinations that influence implementation, to investigate the long-term sustainability of a previously implemented evidence-based practice.

Contextual influences on sustainability identified through this work, as well as the systematic approach to multi-site examination offered by MMCS, can inform future efforts to sustainably implement and methodically evaluate an evidence-based practice’s uptake and continued use in routine care.

The sustainability of evidence-based practices (EBPs) over time is crucial to maximize the public health impact of EBPs implemented into routine care. Implementation evaluators focus on sustainability as a central implementation outcome, and funders of implementation efforts seek sustained long-term returns on their investment. Furthermore, practitioners and leadership at implementation sites face the task of sustaining an EBP’s usage even after implementation funding, support, and associated evaluation efforts conclude. The circumstances and influences contributing to EBP sustainability are therefore of high interest to the field of implementation science.

Sustainability depends on the specific EBP being implemented, the individuals undergoing the implementation, the contexts in which the implementation takes place, and the facilitation of (i.e., support for) the implementation. Hence, universal conditions that invariably lead to sustainability are challenging to establish. Even if a set of conditions could be identified as being associated with high sustainability “on average,” its usefulness is questionable when most real-world implementation contexts may deviate from “average” on key implementation-relevant metrics.

Thus, when seeking a better understanding of EBP sustainability, there is a critical need for methods that examine the ways in which sustainability varies in diverse contexts. One such method is Matrixed Multiple Case Study (MMCS) [ 1 ], which is beginning to be applied in implementation research to identify factors related to implementation [ 2 , 3 , 4 , 5 ]. MMCS capitalizes on the many contextual variations and heterogeneous outcomes that are expected when an EBP is implemented across multiple sites. Specifically, MMCS provides a formalized sequence of steps for cross-site analysis by arranging data into an array of matrices, which are sorted and filtered to test for expected factors and identify less expected factors influencing an implementation outcome of interest.

Although the MMCS represents a promising method for systematically exploring the “black box” of the ways in which implementation is more or less successful, it has not yet been applied to investigate the long-term sustainability of implemented EBPs. Therefore, we applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM), previously implemented using implementation facilitation [ 6 , 7 , 8 ], at nine VA medical centers’ outpatient general mental health clinics. An earlier interview-based investigation of CCM provider perspectives had identified key determinants of CCM sustainability at the sites, yet characteristics related to the ways in which CCM sustainability differed at the sites are still not well understood. For this reason, our objective was to apply MMCS to examine the interview data to determine factors associated with CCM sustainability at each site.

Clinical and implementation contexts

CCM-based care aims to ensure that patients are treated in a coordinated, patient-centered, and anticipatory manner. This project’s nine outpatient general mental health clinics had participated in a hybrid CCM effectiveness-implementation trial 3 to 4 years prior, which had resulted in improved clinical outcomes that were not universally maintained post-implementation (i.e., after implementation funding and associated evaluation efforts concluded) [ 7 , 9 ]. This lack of aggregate sustainability across the nine clinics is what prompted the earlier interview-based investigation of CCM provider perspectives that identified key determinants of CCM sustainability at the trial sites [ 10 ].

These prior works were conducted in VA outpatient mental health teams, known as Behavioral Health Interdisciplinary Program (BHIP) teams. While there was variability in the exact composition of each BHIP team, all teams consisted of a multidisciplinary set of frontline clinicians (e.g., psychiatrists, psychologists, social workers, nurses) and support staff, serving a panel of about 1000 patients each.

This current project applied MMCS to examine the data from the earlier interviews [ 10 ] for the ways in which CCM sustainability differed at the sites and the factors related to sustainability. The project was determined to be non-research by the VA Boston Research and Development Service, and therefore did not require oversight by the Institutional Review Board (IRB). Details regarding the procedures undertaken for the completed hybrid CCM effectiveness-implementation trial, which serves as the context for this project, have been previously published [ 6 , 7 ]. Similarly, details regarding data collection for the follow-up provider interviews have also been previously published [ 10 ]. We provide a brief overview of the steps that we took for data collection and describe the steps that we took for applying MMCS to analyze the interview data. Additional file  1 outlines our use of the Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist [ 11 ].

Data collection

We recruited 30 outpatient mental health providers across the nine sites that had participated in the CCM implementation trial, including a multidisciplinary mix of mental health leaders and frontline staff. We recruited participants via email, and we obtained verbal informed consent from all participants. Each interview lasted between 30 and 60 min and focused on the degree to which the participant perceived care processes to have remained aligned to the CCM’s six core elements: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support [ 12 , 13 , 14 ]. Interview questions also inquired about the participant’s perceived barriers and enablers influencing CCM sustainability, as well as about the latest status of CCM-based care practices. Interviews were digitally recorded and professionally transcribed. Additional details regarding data collection have been previously published [ 10 ].

Data analysis

We applied MMCS’ nine analytical steps [ 1 ] to the interview data. Each step described below was led by one designated member of the project team, with subsequent review by all project team members to reach a consensus on the examination conducted for each step.

We established the evaluation goal (step 1) to identify the ways in which sustainability differed across the sites and the factors related to sustainability, defining sustainability (step 2) as the continued existence of CCM-aligned care practices—namely, that care processes remained aligned with the six core CCM elements. Table  1 shows examples of care processes that align with each CCM element. As our prior works directly leading up to this project (i.e., design and evaluation of the CCM implementation trial that involved the very sites included in this project [ 6 , 15 , 16 ]) were guided by the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework [ 17 ] and i-PARIHS positions facilitation (the implementation strategy that our trial was testing) as the core ingredient that drives implementation [ 17 ], we selected i-PARIHS’ four domains—innovation, recipients, context, and facilitation—as relevant domains under which to examine factors influencing sustainability (step 3). i-PARIHS posits that the successful implementation of an innovation and its sustained use by recipients in a context is enabled by facilitation (both the individuals doing the facilitation and the process used for facilitation). We examined the data on both sustainability and potentially relevant i-PARIHS domains (step 4) by conducting directed content analysis [ 18 ] of the recorded and professionally transcribed interview data. We used the six CCM elements and the four i-PARIHS domains as a priori codes.

Additional file  2 provides an overview of data input, tasks performed, and analysis output for MMCS steps 5 through 9 described below. We assessed sustainability per site (step 5) by generating CCM code summaries per site, and reached a consensus on whether each site exhibited high, medium, or low sustainability relative to other sites based on the summary data. We assigned a higher sustainability level for sites that exhibited more CCM-aligned care processes, had more participants consistently mention those processes, and considered those processes more as “just the way things are done” at the site. Namely, (i) high sustainability sites had concrete examples of CCM-aligned care processes (such as the ones shown in Table  1 ) for many of the six CCM elements, which multiple participants mentioned as central to how they deliver care, (ii) low sustainability sites had only a few concrete examples of CCM-aligned care processes, mentioned by only a small subset of participants and/or inconsistently practiced, and (iii) medium sustainability sites matched neither of the high nor low sustainability cases, having several concrete examples of CCM-aligned care process for some of the CCM elements, varying in whether they are mentioned by multiple participants or how consistently they are a part of delivering care. For the CCM code summaries per site, one project team member initially reviewed the coded data to draft the summaries including exemplar quotes. Each summary and relevant exemplar quotes were then reviewed by and refined with input from all six project team members during recurring team meetings to finalize the high, medium, or low sustainability designation to use in the subsequent MMCS steps. Reviewing and refining the summaries for the nine sites took approximately four 60-min meetings of the six project team members, with each site’s CCM code summary taking approximately 20–35 min to discuss and reach consensus on. We referred to lists of specific examples of how the six core CCM elements were operationalized in our CCM implementation trial [ 19 , 20 ]. Refinements occurred mostly around familiarizing the newer members of the project team (i.e., those who had not participated in our prior CCM-related work) with the examples and definitions. We aligned to established qualitative analysis methods for consensus-reaching discussions [ 18 , 21 ]. Recognizing the common challenge faced by such discussions in adequately accounting for everyone’s interpretations of the data [ 22 ], we drew on Bens’ meeting facilitation techniques [ 23 ] that include setting ground rules, ensuring balanced participation from all project team members, and accurately recording decisions and action items.

We then identified influencing factors per site (step 6), by generating i-PARIHS code summaries per site and identifying distinct factors under each domain of i-PARIHS (e.g., Collaborativeness and teamwork as a factor under the Recipients domain). For the i-PARIHS code summaries per site, one project team member initially reviewed the coded data to draft the summaries including exemplar quotes. They elaborated on each i-PARIHS domain-specific summary by noting distinct factors that they deemed relevant to the summary, proposing descriptive wording to refer to each factor (e.g., “team members share a commitment to their patients” under the Recipients domain). Each summary, associated factor descriptions, and relevant exemplar quotes were then reviewed and refined with input from all six project team members during recurring team meetings to finalize the relevant factors to use in the subsequent MMCS steps. Finalizing the factors included deciding which similar proposed factor descriptions from different sites to consolidate into one factor and which wording to use to refer to the consolidated factor (e.g., “team members share a commitment to their patients,” “team members collaborate well,” and “team members know each other’s styles and what to expect” were consolidated into the Collaborativeness and teamwork factor under the Recipients domain). It took approximately four 60-min meetings of the six project team members to review and refine the summaries and factors for the nine sites, with each site’s i-PARIHS code summary and factors taking approximately 20–35 min to discuss and reach consensus on. We referred to lists of explicit definitions of i-PARIHS constructs that our team members had previously developed and published [ 16 , 24 ]. We once again aligned to established qualitative analysis methods for consensus-reaching discussions [ 18 , 21 ], drawing on Bens’ meeting facilitation techniques [ 23 ] to adequately account for everyone’s interpretations of the data [ 22 ].

We organized the examined data (i.e., the assessed sustainability and identified factors per site) into a sortable matrix (step 7) using Microsoft Excel [ 25 ], laid out by influencing factor (row), sustainability (column), and site (sheet). We conducted within-site analysis of the matrixed data (step 8), examining the data on each influencing factor and designating whether the factor (i) was present, somewhat present, or minimally present [based on aggregate reports from the site’s participants; used “minimally present” when, considering all available data from a site regarding a factor, the factor was predominantly weak (e.g., predominantly weak Ability to continue patient care during COVID at a medium sustainability site); used “somewhat present” when, considering all available data from a site regarding a factor, the factor was neither predominantly strong nor predominantly weak (e.g., neither predominantly strong nor predominantly weak Collaborativeness and teamwork at a low sustainability site)], and (ii) had an enabling, hindering, or neutral/unclear influence on sustainability (designated as “neutral” when, considering all available data from a site regarding a factor, the factor had neither a predominantly enabling nor a predominantly hindering influence on sustainability). These designations of factors’ presence and influence are conceptually representative of what is commonly referred to as magnitude and valence, respectively, by other efforts that construct scoring for qualitative data (e.g., [ 26 , 27 ]). Like the team-based consensus approach of earlier MMCS steps, factors’ presence and type of influence per site were initially proposed by one project team member after reviewing the matrix’s site-specific data, then refined with input from all project team members during recurring team meetings that reviewed the matrix. Accordingly, similar to the earlier MMCS steps, we aligned to established qualitative methods [ 18 , 21 ] and meeting facilitation techniques [ 23 ] for these consensus-reaching discussions.

We then conducted a cross-site analysis of the matrixed data (step 9), assessing whether factors and their combinations were (i) present across multiple sites, (ii) consistently associated with higher or lower sustainability, and (iii) emphasized at some sites more than others. We noted that any factor may have not come up during interviews with a site because either it is not pertinent or it is pertinent but still did not come up, although we asked an open-ended question at the end of each interview about whether there was anything else that the participant wanted to share regarding sustainability. To adequately account for these possibilities, we decided as a team to regard a factor or a combination of factors as being associated with high/medium/low sustainability if it was identified at a majority (i.e., even if not all) of the sites designated as high/medium/low sustainability (e.g., if the Collaborativeness and teamwork factor is identified at a majority, even if not all, of the high sustainability sites, we would find it to be associated with high sustainability). Like the team-based consensus approach of earlier MMCS steps, cross-site patterns were initially proposed by one project team member after reviewing the matrix’s cross-site data, then refined with input from all project team members during recurring team meetings that reviewed the matrix. Accordingly, similar to the earlier MMCS steps, we aligned to established qualitative methods [ 18 , 21 ] and meeting facilitation techniques [ 23 ] for these consensus-reaching discussions. We acknowledged the potential existence of additional factors influencing sustainability that may not have emerged during our interviews and also may vary substantially between sites. For example, adaptation of the CCM, characteristics of the patient population, and availability of continued funding, which are factors that extant literature reports as being relevant to sustainability [ 28 , 29 ], were not seen in our interview data. To maintain our analytic focus on the factors seen in our data, we did not add these factors to our analysis.

For the nine sites included in this project, we found the degree of CCM sustainability to be split evenly across the sites—three high-, three medium-, and three low-sustainability. Twenty-five total influencing factors were identified under the i-PARIHS domains of Innovation (6), Recipients (6), Context (8), and Facilitation (5). Table  2 shows these identified influencing factors by domain. Figure  1 shows 11 influencing factors that were identified for at least two sites within a group of high/medium/low sustainability sites—e.g., the factor “consistent and strong internal facilitator” is shown as being present at high sustainability sites with an enabling influence on sustainability, because it was identified as such at two or more of the high sustainability sites. Of these 11 influencing factors, four were identified only for sites with high CCM sustainability and two were identified only for sites with medium or low CCM sustainability.

figure 1

Influencing factors that were identified for at least two sites within a group of high/medium/low sustainability sites

Key trends in influencing factors associated with high, medium, and/or low CCM sustainability

Three factors across two i-PARIHS domains exhibited strong trends by sustainability status. They were the Collaborativeness and teamwork and Turnover of clinic staff and leadership factors under the Recipients domain, and the Having a consistent and strong internal facilitator factor under the Facilitation domain.

Recipients-related factors

Collaborativeness and teamwork was present with an enabling influence on CCM sustainability at most high and medium sustainability sites, while it was only somewhat present with a neutral influence on CCM sustainability at most low sustainability sites. When asked what had made their BHIP team work well, a participant from a high sustainability site said,

“Just a collaborative spirit.” (Participant 604)

A participant from a medium sustainability site said,

“We joke that [the BHIP teams] are even family, that the teams really do function pretty tightly and they each have their own personality.” (Participant 201)

At the low sustainability sites, willingness to work as a team varied across team members; a participant from a low sustainability site said,

“… I think it has to be the commitment of the people who are on the team. So those that are regularly attending, we get a lot more out of it than those that probably don't ever come [to team meetings].” (Participant 904)

Collaborativeness and teamwork of BHIP team members were often perceived as the highlight of pursuing interdisciplinary care.

Turnover of clinic staff and leadership was present with a hindering influence on CCM sustainability at most high, medium, and low sustainability sites.

“We’ve lost a lot of really, really good providers here in the time I’ve been here …,” (Participant 102)

said a participant from a low-sustainability site that had to reconfigure its BHIP teams due to clinic staff shortages. Turnover of mental health clinic leadership made it difficult to maintain CCM practices, especially beyond the teams that participated in the original CCM implementation trial. A participant from a medium sustainability site said,

“Probably about 90 percent of the things that we came up with have fallen by the wayside. Within our team, many of those remain but again, that hand off towards the other teams that I think partly is due to the turnover rate with program managers, supervisors, didn’t get fully implemented.” (Participant 703)

Although turnover was an issue for high sustainability sites as well, there was also indication of the situation improving in recent years; a participant from a high sustainability site said,

“… our attrition rollover rate has dropped quite a bit and I would really attribute that to [the CCM being] more functional and more sustainable and tolerable for the providers.” (Participant 502)

As such, staff and leadership turnover was deemed a major challenge for CCM sustainability for all sites regardless of the overall level of sustainability.

Facilitation-related factor

Having a consistent and strong internal facilitator was present with an enabling influence on CCM sustainability at high sustainability sites, not identified as an influencing factor at most of the medium sustainability sites, and variably present with a hindering, neutral, or unclear influence on CCM sustainability at low sustainability sites. Participants from a high sustainability site perceived that it was important for the internal facilitator to understand different BHIP team members’ personalities and know the clinic’s history. A participant from another high sustainability site shared that, as an internal facilitator themselves, they focused on recognizing and reinforcing the progress of team members:

“… I'm often the person who kind of [starts] off with, ‘Hey, look at what we've done in this location,’ ‘Hey look at what the team's done this month.’” (Participant 402)

A participant from a low sustainability site had also served as an internal facilitator and recounted the difficulty and importance of readying the BHIP team to function in the long run without their assistance:

“I should have been able to get out sooner, I think, to get it to have them running this themselves. And that was just a really difficult process.” (Participant 301)

Participants, especially from the high and low sustainability sites, attributed their BHIP teams’ successes and challenges to the skills of the internal facilitator.

Influencing factors identified only for sites with high CCM sustainability

Four factors across four i-PARIHS domains were identified for high sustainability sites and not for medium or low sustainability sites. They were the factors Details about the CCM being well understood (Innovation domain), Interdisciplinary coordination (Recipients domain), Having adequate clinic space for CCM team members (Context domain), and Having a knowledgeable and helpful external facilitator (Facilitation domain).

Innovation-related factor

Details about the CCM being well understood was minimal to somewhat present with an unclear influence on CCM sustainability.

“We’ve … been trying to help our providers see the benefit of team-based care and the episodes-of-care idea, and I would say that is something our folks really have continued to struggle with as well,” (Participant 401)

said a participant from a high sustainability site. “What is considered CCM-based care?” continued to be a question on providers’ minds. A participant from a high sustainability site asked during the interview,

“Is there kind of a clearing house of some of the best practices for [CCM] that you guys have … or some other collection of resources that we could draw from?” (Participant 601)

Although such references are indeed accessible online organization-wide, participants were not always aware of those resources or what exactly CCM entails.

Recipients-related factor

Interdisciplinary coordination was somewhat present with a hindering, neutral, or unclear influence on CCM sustainability. Coordination between psychotherapy and psychiatry providers was deemed difficult by participants from high-sustainability sites. A participant said,

“We were initially kind of top heavy on the psychiatry so just making sure we have … therapy staff balancing that out [has been important].” (Participant 501)

Another participant perceived that BHIP teams were helpful in managing.

… ‘sibling rivalry’ between different disciplines … because [CCM] puts us all in one team and we communicate.” (Participant 505)

Interdisciplinary coordination was understood by the participants as being necessary for effective CCM-based care yet difficult to achieve.

Context-related factor

Having adequate clinic space for CCM team members was minimal to somewhat present with a hindering, neutral, or unclear influence on CCM sustainability. COVID-19 led to changes in how clinic space was used/assigned. A participant from a high sustainability site remarked,

“Pre-COVID everything was in a room instead of online. And now all our meetings are online and so it's actually really easy for the supervisors to be able to rotate through them and then, you know, they can answer programmatic questions ….” (Participant 402)

Participants from another high sustainability site found that issues regarding limited clinic space were both exacerbated and alleviated by COVID, with the mental health service losing space to vaccine clinics but more mental health clinicians teleworking and in less need of clinic space. Virtual connections were seen to alleviate some physical workspace-related concerns.

Having a knowledgeable and helpful external facilitator was variably present; when present, it had an enabling influence on CCM sustainability. Participants from a high sustainability site noted how many of the external facilitator’s efforts to change the BHIP team’s work processes very much remained over time. An example of a change was to have team meetings be structured to meet evolving patient needs. Team members came to meetings with the shared knowledge and expectation that,

“… we need to touch on folks who are coming out of the hospital, we need to touch on folks with higher acuity needs.” (Participant 402)

Implementation support that sites received from their external facilitator mostly occurred during the time period of the original CCM implementation trial; correspondence with the external facilitator after that trial time period was not common for sites. Participants still largely found the external facilitator to provide helpful guidance and advice on delivering CCM-based care.

Influencing factors identified only for sites with medium or low CCM sustainability

Two factors were identified for medium or low sustainability sites and not for high sustainability sites. They were the factors Ability to continue patient care during COVID and Adequate resources/capacity for care delivery . These factors were both under i-PARIHS’ Context domain, unlike the influencing factors above that were identified only for high sustainability sites, which spanned all four i-PARIHS domains.

Context-related factors

Ability to continue patient care during COVID had a hindering influence on CCM sustainability when minimally present. Participants felt that their CCM work was challenged when delivering care through telehealth was made difficult—e.g., at a medium sustainability site, site policies during the pandemic required a higher number of in-person services than the BHIP team providers expected or desired to deliver. On the other hand, this factor had an enabling influence on CCM sustainability when present. A participant at a low sustainability site mentioned the effect of telehealth on being able to follow up more easily with patients who did not show up for their appointments:

“… my no-show rate has dropped dramatically because if people don’t log on after a couple minutes, I call them. They're like ‘oh, I forgot, let me pop right on,’ whereas, you know, in the face-to-face space, you know, you wait 15 minutes, you call them, it’s too late for them to come in so then they're no shows.” (Participant 102)

The advantages of virtual care delivery, as well as the challenges of getting approvals to pursue it to varying extents, were well recognized by the participants.

Adequate resources/capacity for care delivery was minimally present at medium sustainability sites with a hindering influence on CCM sustainability. At a medium sustainability site, although leadership was supportive of CCM, resources were being used to keep clinics operational (especially during COVID) rather than investing in building new CCM-based care delivery processes.

“I think that if my boss came to me, [and asked] what could I do for [the clinics] … I would say even more staff,” (Participant 202)

said a participant from a medium sustainability site. At the same time, the participant, as many others we interviewed, understood and emphasized the need for BHIP teams to proceed with care delivery even when resources were limited:

“… when you’re already dealing with a very busy clinic, short staff and then you’re hit with a pandemic you handle it the best that you can.” (Participant 202)

Participants felt the need for basic resource requirements to be met in order for CCM-based care to be feasible.

In this project, we examined factors influencing the sustainability of CCM-aligned care practices at general mental health clinics within nine VA medical centers that previously participated in a CCM implementation trial. Guided by the core CCM elements and i-PARIHS domains, we conducted and analyzed CCM provider interviews. Using MMCS, we found CCM sustainability to be split evenly across the nine sites (three high, three medium, and three low), and that sustainability may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators.

In comparison to most high sustainability sites, participants from most medium or low sustainability sites did not mention a knowledgeable and helpful external facilitator who enabled sustainability. Participants at the high sustainability sites also emphasized the need for clarity about what CCM-based care comprises, interdisciplinary coordination in delivering CCM-aligned care, and adequate clinic space for BHIP team members to connect and collaborate. In contrast, in comparison to participants at most high sustainability sites, participants at most medium or low sustainability sites emphasized the need for better continuity of patient-facing activities during the COVID-19 pandemic and more resources/capacity for care delivery. A notable difference between these two groups of influencing factors is that the ones emphasized at most high sustainability sites are more CCM-specific (e.g., external facilitator with CCM expertise, knowledge, and structures to support delivery of CCM-aligned care), while the ones emphasized at most medium or low sustainability sites are factors that certainly relate to CCM sustainability but are focused on care delivery operations beyond CCM-aligned care (e.g., COVID’s widespread impacts, limited staff availability). In short, an emphasis on immediate, short-term clinical needs in the face of the COVID-19 pandemic and staffing challenges appeared to sap sites’ enthusiasm for sustaining more collaborative, CCM-consistent care processes.

Our previous qualitative analysis of these interview data suggested that in order to achieve sustainability, it is important to establish appropriate infrastructure, organizational readiness, and mental health service- or department-wide coordination for CCM implementation [ 10 ]. The findings from the current project augment these previous findings by highlighting the specific factors associated with higher and lower CCM sustainability across the project sites. This additional knowledge provides two important insights into what CCM implementation efforts should prioritize with regard to the previously recommended appropriate infrastructure, readiness, and coordination. First, for knowledge retention and coordination during personnel changes (including any changes in internal facilitators through and following implementation), care processes and their specific procedures should be established and documented in order to bring new personnel up to speed on those care processes. Management sciences, as applied to health care and other fields, suggest that such organizational knowledge retention can be maximized when there are (i) structures set up to formally recognize/praise staff when they share key knowledge, (ii) succession plans to be applied in the event of staff turnover, (iii) opportunities for mentoring and shadowing, and (iv) after action reviews of conducted care processes, which allow staff to learn about and shape the processes themselves [ 30 , 31 , 32 , 33 ]. Future CCM implementation efforts may thus benefit from enacting these suggestions alongside establishing and documenting CCM-based care processes and associated procedures.

Second, efforts to implement CCM-aligned practices into routine care should account for the extent to which sites’ more fundamental operational needs are met or being addressed. That information can be used to appropriately scope the plan, expectations, and timeline for implementation. For instance, ongoing critical staffing shortages or high turnover [ 34 ] at a site are unlikely to be resolved through a few months of CCM implementation. In fact, in that situation, it is possible that CCM implementation efforts could lead to reduced team effectiveness in the short term, given the effort required to establish more collaborative and coordinated care processes [ 35 ]. Should CCM implementation move forward at a given site, implementation goals ought to be set on making progress in realms that are within the implementation effort’s control (e.g., designing CCM-aligned practices that take staffing challenges into consideration) [ 36 , 37 ] rather than on factors outside of the effort’s control (e.g., staffing shortages). As healthcare systems determine how to deploy support (e.g., facilitators) to sites for CCM implementation, they would benefit from considering whether it is primarily CCM expertise that the site needs at the moment, or more foundational organizational resources (e.g., mental health staffing, clinical space, leadership enhancement) [ 38 ] to first reach an operational state that can most benefit from CCM implementation efforts at a later point in time. There is growing consensus across the field that the readiness of a healthcare organization to innovate is a prerequisite to successful innovation (e.g., CCM implementation) regardless of the specific innovation [ 39 , 40 ]. Several promising strategies specifically target these organizational considerations for implementing evidence-based practices (e.g., [ 41 , 42 ]). Further, recent works have begun to more clearly delineate leadership-related, climate-related, and other contextual factors that contribute to organizations’ innovation readiness [ 43 ], which can inform healthcare systems’ future decisions regarding preparatory work leading to, and timing of, CCM implementation at their sites.

These considerations informed by MMCS may have useful implications for implementation strategy selection and tailoring for future CCM implementation efforts, especially in delineating the target level (e.g., system, organizational, clinic, individual) and timeline of implementation strategies to be deployed. For instance, of the three factors found to most notably trend with CCM sustainability, Collaborativeness and teamwork may be strengthened through shorter-term team-building interventions at the organizational and/or clinic levels [ 38 ], Turnover of clinic staff and leadership may be mitigated by aiming for longer-term culture/climate change at the system and/or organizational levels [ 44 , 45 , 46 ], and Having a consistent and strong internal facilitator may be ensured more immediately by selecting an individual with fitting expertise/characteristics to serve in the role [ 15 ] and imparting innovation/facilitation knowledge to them [ 47 ]. Which of these factors to focus on, and through what specific strategies, can be decided in partnership with an implementation site—for instance, candidate strategies can be identified based on ones that literature points to for addressing these factors [ 48 ], systematic selection of the strategies to move forward can happen with close input from site personnel [ 49 ], and explicit further specification of those strategies [ 50 ] can also happen in collaboration with site personnel to amply account for site-specific contexts [ 51 ].

As is common for implementation projects, the findings of this project are highly context-dependent. It involves the implementation of a specific evidence-based practice (the CCM) using a specific implementation strategy (implementation facilitation) at specific sites (BHIP teams within general mental health clinics at nine VA medical centers). For such context-dependent findings to be transferable [ 52 , 53 ] to meaningfully inform future implementation efforts, sources of variation in the findings and how the findings were reached must be documented and traceable. This means being explicit about each step and decision that led up to cross-site analysis, as MMCS encourages, so that future implementation efforts can accurately view and consider why and how findings might be transferable to their own work. For instance, beyond the finding that Turnover of clinic staff and leadership was a factor present at most of the examined sites, MMCS’ traceable documentation of qualitative data associated with this factor at high sustainability sites also allowed highlighting the perception that CCM implementation is contributing to mitigating turnover of providers in the clinic over time, which may be a crucial piece of information that fuels future CCM implementation efforts.

Furthermore, to compare findings and interpretations across projects, consistent procedures for setting up and conducting these multi-site investigations are indispensable [ 54 , 55 , 56 ]. Although many projects involve multiple sites and assess variations across the sites, it is less common to have clearly delineated protocols for conducting such assessments. MMCS is meant to target this very gap, by offering a formalized sequence of steps that prompt specification of analytical procedures and decisions that are often interpretive and left less specified. MMCS uses a concrete data structure (the matrix) to traceably organize information and knowledge gained from a project, and the matrix can accommodate various data sources and conceptual groundings (e.g., guiding theories, models, and frameworks) that may differ from project to project – for instance, although our application of MMCS aligned to i-PARIHS, other projects applying MMCS [ 2 , 5 ] use different conceptual guides (e.g., Consolidated Framework for Implementation Research [ 57 ], Theoretical Domains Framework [ 58 ]). Therefore, as more projects align to the MMCS steps [ 1 ] to identify factors related to implementation and sustainability, better comparisons, consolidations, and transfers of knowledge between projects may become possible.

This project has several limitations. First, the high, medium, and low sustainability assigned to the sites were based on the sites’ CCM sustainability relative to one another, rather than based on an external metric of sustainability. As measures of sustainability such as the Program Sustainability Assessment Tool [ 59 , 60 ] and the Sustainment Measurement System Scale [ 61 ] become increasingly developed and tested, future projects may consider the feasibility of incorporating such measures to assess each site’s sustainability. In our case, we worked on addressing this limitation by using a consensus approach within our project team to assign sustainability levels to sites, as well as by confirming that the sites that we designated as high sustainability exhibited CCM elements that we had previously observed at the end of their participation in the original CCM implementation trial [ 19 ]. Second, we did not assign strict thresholds above/below which the counts or proportions of data regarding a factor would automatically indicate whether the factor (i) was present, somewhat present, or minimally present and (ii) had an enabling, hindering, or neutral/unclear influence on sustainability. This follows widely accepted qualitative analytical guidance that discourages characterizing findings solely based on the frequency with which a notion is mentioned by participants [ 62 , 63 , 64 ], in order to prevent unsubstantiated inferences or conclusions. We sought to address this limitation in two ways: We carefully documented the project team’s rationale for each consensus reached, and we reviewed all consensuses reached in their entirety to ensure that any two factors with the same designation (e.g., “minimally present”) do not have associated rationale that conflict across those factors. These endeavors we undertook closely adhere to established case study research methods [ 65 ], which MMCS builds on, that emphasize strengthening the validity and reliability of findings through documenting a detailed analytic protocol, as well as reviewing data to ensure that patterns match across analytic units (e.g., factors, interviewees, sites). Third, our findings are based on three sites each for high/medium/low sustainability, and although we identified single factors associated with sustainability, we found no specific combinations of factors’ presence and influence that were repeatedly existent at a majority of the sites designated as high/medium/low sustainability. Examining additional sites on the factors identified through this work (as we will for our subsequent CCM implementation trial described below) will allow more opportunities for repeated combinations and other factors to emerge, making possible firmer conclusions regarding the extent to which the currently identified factors and absence of identified combinations are applicable beyond the sites included in this study. Fourth, the identified influencing factor “leadership support for CCM” (under the Context domain of the i-PARIHS framework) substantially overlaps in concept with the core “organizational/leadership support” element of the CCM. To avoid circular reasoning, we used leadership support-related data to inform our assignment of sites’ high, medium, or low CCM sustainability, rather than as a reason for the sites’ CCM sustainability. In reality, strong leadership support may both result from and contribute to implementation and sustainability [ 16 , 66 ], and thus causal relationships between the i-PARIHS-aligned influencing factors and the CCM elements (possibly with feedback loops) warrant further examination to most appropriately use leadership support-related data in future analyses of CCM sustainability. Fifth, findings may be subject to both social desirability bias in participants providing more positive than negative evidence of sustainability (especially participants who are responsible for implementing and sustaining CCM-aligned care at their site) and the project team members’ bias in interpreting the findings to align to their expectations of further effort being necessary to sustainably implement the CCM. To help mitigate this challenge, the project interviewers strove to elicit from participants both positive and negative perceptions and experiences related to CCM-based care delivery, both of which were present in the examined interview data.

Future work stemming from this project is twofold. Regarding CCM implementation, we will conduct a subsequent CCM implementation trial involving eight new sites to prospectively examine how implementation facilitation with an enhanced focus on these findings affects CCM sustainability. We started planning for sustainability prior to implementation, looking to this work for indicators of specific modifications needed to the previous way in which we used implementation facilitation to promote the uptake of CCM-based care [ 67 ]. Findings from this work suggest that sustainability may be related most strongly to (i) provider collaboration, (ii) knowledge retention during staff/leadership transitions, and (iii) availability of skilled internal facilitators. Hence, we will accordingly prioritize developing procedures for (i) regular CCM-related information exchange amongst BHIP team members, as well as between the BHIP team and clinic leadership, (ii) both translating knowledge to and keeping knowledge documented at the site, and (iii) supporting the sites’ own personnel to take the lead in driving CCM implementation.

Regarding MMCS, we will continuously refine and improve the method by learning from other projects applying, testing, and critiquing MMCS. Outside of our CCM-related projects, examinations of implementation data using MMCS are actively underway for various implementation efforts including that of a data dashboard for decision support on transitioning psychiatrically stable patients from specialty mental health to primary care [ 2 ], a peer-led healthy lifestyle intervention for individuals with serious mental illness [ 3 ], screening programs for intimate partner violence [ 4 ], and a policy- and organization-based health system strengthening intervention to improve health systems in sub-Saharan Africa [ 5 ]. As MMCS is used by more projects that differ from one another in their specific outcome of interest, and especially in light of our MMCS application that examines factors related to sustainability, we are curious whether certain proximal to distal outcomes are more subject to heterogeneity in influencing factors than other outcomes. For instance, sustainability outcomes, which are tracked following a longer passage of time than some other outcomes, may be subject to more contextual variations that occur over time and thus could particularly benefit from being examined using MMCS. We will also explore MMCS’ complementarity with coincidence analysis and other configurational analytical approaches [ 68 ] for examining implementation phenomena. We are excited about both the step-by-step traceability that MMCS can bring to such methods and those methods’ computational algorithms that can be beneficial to incorporate into MMCS for projects with larger numbers of sites. For example, Salvati and colleagues [ 69 ] described both the inspiration that MMCS provided in structuring their data as well as how they addressed MMCS’ visualization shortcomings through their innovative data matrix heat mapping, which led to their selection of specific factors to include in their subsequent coincidence analysis. Coincidence analysis is an enhancement to qualitative comparative analysis and other configurational analytical methods, in that it is formulated specifically for causal inference [ 70 ]. Thus, in considering improved reformulations of MMCS’ steps to better characterize examined factors as explicit causes to the outcomes of interest, we are inspired by and can draw on coincidence analysis’ approach to building and evaluating causal chains that link factors to outcomes. Relatedly, we have begun to actively consider the potential contribution that MMCS can make to hypothesis generation and theory development for implementation science. As efforts to understand the mechanisms through which implementation strategies work are gaining momentum [ 71 , 72 , 73 ], there is an increased need for methods that help decompose our understanding of factors that influence the mechanistic pathways from strategies to outcomes [ 74 ]. Implementation science is facing the need to develop theories, beyond frameworks, which delineate hypotheses for observed implementation phenomena that can be subsequently tested [ 75 ]. The methodical approach that MMCS offers can aid this important endeavor, by enabling data curation and examination of pertinent factors in a consistent way that allows meaningful synthesis of findings across sites and studies. We see these future directions as concrete steps toward elucidating the factors related to sustainable implementation of EBPs, especially leveraging data from projects where the number of sites is much smaller than the number of factors that may matter—which is indeed the case for most implementation projects.

Using MMCS, we found that provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators may be most strongly related to CCM sustainability in VA outpatient mental health clinics. Informed by these findings, we have a subsequent CCM implementation trial underway to prospectively test whether increasing the aforementioned factors within implementation facilitation enhances sustainability. The MMCS steps used here for systematic multi-site examination can also be applied to determining sustainability-related factors relevant to various other EBPs and implementation contexts.

Availability of data and materials

The data analyzed during the current project are not publicly available because participant privacy could be compromised.

Abbreviations

Behavioral Health Interdisciplinary Program

Collaborative Chronic Care Model

Consolidated Criteria for Reporting Qualitative Research

coronavirus disease

evidence-based practice

Institutional Review Board

Integrated Promoting Action on Research Implementation in Health Services

Matrixed Multiple Case Study

United States Department of Veterans Affairs

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Acknowledgements

The authors sincerely thank the project participants for their time, as well as the project team members for their guidance and support. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

This project was funded by VA grant QUE 20–026 and was designed and conducted in partnership with the VA Office of Mental Health and Suicide Prevention.

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Contributions

Concept and design: BK, JS, and CM. Acquisition, analysis, and/or interpretation of data: BK, JS, MB, SC, ES, and CM. Initial drafting of the manuscript: BK. Critical revisions of the manuscript for important intellectual content: JS, MB, SC, ES, HB, LS, KW, and CM. All the authors read and approved the final manuscript.

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Supplementary Information

Additional file 1..

COREQ (COnsolidated criteria for REporting Qualitative research) Checklist.

Additional file 2.

Data input, tasks performed, and analysis output for MMCS Steps 5 through 9.

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Kim, B., Sullivan, J.L., Brown, M.E. et al. Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study. Implementation Sci 19 , 16 (2024). https://doi.org/10.1186/s13012-024-01342-2

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case study grade 10 science

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Case Study Questions Class 10 Science Chapter 8 How Do Organisms Reproduce

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Case study Questions Class 10 Science Chapter 8  are very important to solve for your exam. Class 10 Science Chapter 8 Case Study Questions have been prepared for the latest exam pattern. You can check your knowledge by solving case study-based questions for Class 10 Science Chapter 8 How Do Organisms Reproduce

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In CBSE Class 10 Science Paper, Students will have to answer some questions based on  Assertion and Reason . There will be a few questions based on case studies and passage-based as well. In that, a paragraph will be given, and then the MCQ questions based on it will be asked.

How Do Organisms Reproduce Case Study Questions With Answers

Here, we have provided case-based/passage-based questions for Class 10 Science  Chapter 8 How Do Organisms Reproduce

Case Study/Passage-Based Questions

Question 1:

The male reproductive system consists of portions that produce the germ cells and other portions that deliver the germ cells to the site of fertilization. Testes are located outside the abdominal cavity in the scrotum because sperm formation requires a lower temperature than normal body temperature. It also has a role of secretion of male sex hormone which brings changes in appearance seen in boys at the time of puberty. Vas deferens unites with a tube coming from the urinary bladder. The urethra is a common passage for sperms and urine. The prostate gland and seminal vesicles add their secretions so that sperms are now in a fluid.

case study grade 10 science

(i) Name the sex hormone associated with males. (a) Testosterone (b) Progesterone (c) Oestrogen (d) None of these

Answer: (a) Testosterone

(ii) Which of the following statements is incorrect ? (a) Sperms are present in a fluid (b) Fluid provides nutrition to sperms (c) Fluid makes easier transportation of sperms (d) Fluid helps to bind the sperms together

(iii) Testes are located outside the abdominal cavity in scrotum because (a) sperms formation requires higher temperature than body temperature (b) sperms formation requires lower temperature than body temperature (c) it is easier to transport sperms from the scrotum (d) None of these

Answer: (b) sperms formation requires lower temperature than body temperature

(iv) Which of the following statement is incorrect? (a) Sperms and urine has a common passage from urethra.

(b) Sperms have long tail that helps them to move forward. (c) Sperms contain genetic material. (d) Sperms formation requires 1–3°C higher temperature than normal body temperature.

Answer: (d) Sperms formation requires 1–3°C higher temperature than normal body temperature.

(v) What is the nature of semen? (a) slightly acidic (b) Neutral (c) Slightly basic (d) Strongly basic

Answer: (c) Slightly basic

Question 2:

Rohit collected some pond water which was dark green in color in a test tube. She took out green-colored mass from it and separated its filaments by using needles. She broke some filaments into small fragments and put them in a Petri dish containing clean water. She observed that after a few days the small fragments gave rise to complete filaments.

2.1) What do you think the mass of green filament was ?  (a) It was a mass of Spirogyra filament. (b) It was a colony of Volvox algae. (c) It was large brown algae. (d) It was a mass of fungal filaments

Answer:(a) It was a mass of Spirogyra filament. ​

2.2) Organisms that reproduces in similar ways as Spirogyra is : (a) yeast (b) hydra (c) Planaria (d) Sea anemone

Answer: (d) Sea anemone ​

2.3) The small fragment gave rise to new filament. What does it indicate  ? (a) Spirogyra reproduces asexually through budding. (b) Spirogyra reproduces asexually through spore formation. (c) Spirogyra reproduces asexually through fragmentation. (d) Spirogyra reproduces asexually through fission

Answer: (c) Spirogyra reproduces asexually through fragmentation. ​

2.4) Which among the following organisms do not reproduce by fragmentation ? (a) Riccia  (b) Selaginella (c) Aurelia (d) Marchantia

Answer: (c) Aurelia. ​

2.5) Select the correct statement from the following. (a) Only multicellular organisms can undergo fragmentation. (b) Both unicellular and multicellular organisms can undergo fragmentation. (c) Fragmentation is sexual mode of reproduction. (d) Fragmentation is found only in algae

Answer: (a) Only multicellular organisms can undergo fragmentation ​

Question 3:

In humans, if the egg is not fertilized, it lives for about one day. Since the ovary releases one egg every month, the uterus also prepares itself every month to receive a fertilized egg. Thus its lining becomes thick and spongy. This would be required for nourishing the embryo if fertilization had taken place. Now, however, this lining is not needed any longer. So, the lining slowly breaks and comes out through the vagina as blood and mucous. This cycle takes place roughly every month and is known as menstruation. It usually lasts for about two to eight days.

3.1) What is the sexual cycle in human female that takes place every 28 days and marked by bleeding ? (a) Sexual cycle (b) Reproductive cycle (c) Menstrual cycle (d) Blood cycle

Answer: (c) Menstrual cycle ​

3.2) If fertilisation takes place, it results in the formation of : (a) an embryo (b) a zygote (c) a foetus (d) a placenta

Answer: (b) a zygote ​​

3.3) Why does vaginal bleeding occur in human females on attaining puberty ? (a) Unfertilised egg along with thick uterus lining come out of vagina in form of bleeding. (b) In human females, ovaries start releasing egg or ovum once every 28 days from the age of puberty. (c)  If fertilisation does not occur then menstrual flow occurs at the end of cycle. (d) All of these 

Answer: (d) All of these  ​​​

3.4) In what conditions vaginal bleeding will not occur in a human female who has attained puberty ? (a) If the ovum is fertilised (b) If the ovum is not fertilised (c) If there is some hormonal imbalance in female (d) Both (a) and (b)

Answer: (d) Both (a) and (b)  ​​​

3.5) Mark one change from the following associated with sexual maturation in boys ? (a) loss of milk teeth (b) weight gain (c) increase in height  (d) cracking of voice

Answer: (d) cracking of voice ​​​

Question 4: A newly married couple does not want have children for few years. They consulted a doctor who advised them barrier method and chemical method of birth control. Yet another couple who already have two children and are middle aged also consulted doctor for some permanent solution to avoid unwanted pregnancy. Doctor advised them surgical method of birth control.

Another category of contraceptives acts by changing the hormonal balance of the body so that eggs are not released and fertilisation cannot occur. These drugs commonly need to be taken orally as pills. However, since they change hormonal balances, they can cause side-effects too. Other contraceptive devices such as the loop or the copper-T are placed in the uterus to prevent pregnancy. Again, they can cause side effects due to irritation of the uterus.

4.1) What are the barrier methods of birth control ? (a) Condoms (b) Oral pills (c) Surgery (d) Both (a) and (c)

Answer: (a) Condoms ​​​

4.2) How physical barrier prevent pregnancy ? (a) They kill the sperms. (b) They kill the ovum. (c) They prevent intercourse. (d) They prevent fertilisation

Answer: (d) They prevent fertilisation. ​​​

4.3) How chemical methods prevent pregnancy ? (a) Vaginal pills contain chemical called spermicides which kill the sperms.  (b) Oral pills prevent ovulation so there will be no fertilisation. (c) Oral pills stop menstruation in females. (d) Both (a) and (b) 

Answer: (d) Both (a) and (b) ​​​

4.4) Select the correct statement regarding surgical method of birth control.  (a) It involves termination of pregnancies in women particularly after eight weeks of conception. (b) Small portion of sperm duct or vas deferences in males is removed by surgical operation and both cut ends are ligated properly. (c) Small portion of oviducts in females is removed by surgical operation and cut ends are ligated.  (d) Both (b) and (c) 

Answer: (d) Both (b) and (c) ​​​

4.5) Select the correct statement regarding birth control methods. (a) Barrier method of birth control also protects the couple from sexually transmitted diseases. (b) Some women experience unpleasant side effects on taking oral pills because of change in hormonal balance in body. (c) Surgical method in males is called vasectomy and in females is called tubectomy. (d) All of these

Answer: (d) All of these ​​​

Hope the information shed above regarding Case Study and Passage Based Questions for Class 10 Science Chapter 8 How do Organisms Reproduce with Answers Pdf free download has been useful to an extent. If you have any other queries of CBSE Class 10 Science How do Organisms Reproduce Case Study and Passage Based Questions with Answers, feel free to comment below so that we can revert back to us at the earliest possible. By Team Study Rate

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