Problems and needs of hard-of-hearing students and a model for the delivery of services to the schools.
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Adolescent↗
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Results for “Service delivery models”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Development of Australia's first psychiatric emergency centre.
OBJECTIVES: To describe the development of the first Australian psychiatric emergency centre co-located with the Emergency Department at the Royal Brisbane and Women's Hospital. This paper covers the current operational model, significant partnerships and benefits of this service, which assesses and treats over 7200 presentations per year. CONCLUSIONS: The co-location of the Psychiatric Emergency Centre and Emergency Department has created a unique model of service delivery and effective working relationships between the two services. The model improves clinical care providing multiple benefits for patients and the Emergency Department by means of direct access to specialized mental health staff, early mental health responsibility for patients and reduced access block.
Delivery of Health Care↗
School-based occupational therapy for children with fine motor difficulties: evaluating functional outcomes and fidelity of services.
Consultative occupational therapy services are becoming widely used in the school environment. However, few studies have evaluated the utility of and the process by which these services are delivered. This study examined whether the written communication and fine motor skills of 23 children with fine motor difficulties improved after receiving school-based occupational therapy from a program whose mandate was to deliver services according to a consultation model of service delivery. In addition, the study assessed the process of service delivery, including treatment fidelity, or the extent to which consultation services were implemented as intended. Statistically significant and practically meaningful improvement was found in written communication on the Vineland Adaptive Behavior Scales-Classroom Edition (VABS-C) and School Functional Assessment-Version 3.0 (SFA), and in fine motor skills on the SFA, but not on the VABS-C. An examination of the service delivery process revealed that therapists deviated from a purely consultative model, with 86% providing some direct therapy to children. Parents were mostly satisfied with services received, whereas teachers were indifferent or somewhat dissatisfied. Treatment fidelity is taken into consideration when discussing study findings. Recommendations to enhance school-based occupational therapy services delivered according to a primarily consultative model, and suggestions for future research, are provided.
Child↗
Assessing access constraints on system equity: source of care differences in the distribution of medical services.
This article shows how differences in source of care can affect the likelihood that a person will obtain the medical services that he or she requires. Previous work has shown that the setting where care is received can have important effects on the quality of the services that are provided. The present study extends this line of research to questions of system equity. Unlike prior work in the area, the present approach emphasizes systemic relations among different types of delivery sites as a means of formulating and testing alternative models of service delivery. Preliminary findings indicate significant differences in utilization patterns depending on whether one establishes contact in a physician's private office. The results of the study suggest the need for continued concern over the role of access constraints in determining service opportunities.
Health Services↗
Research on field-based services: models for reform in the delivery of mental health care to populations with complex clinical problems.
OBJECTIVE: Clinical services for psychiatrically impaired populations have only recently been studied with scientifically valid designs to explore innovations in structure, accessibility, and financing. Health systems reform in the United States has provided the impetus for better defining clinically effective and cost-sensitive models for mental health services. This article reviews assertive community treatment, used for adults with severe mental illnesses, and multisystemic therapy, used for adolescents with serious emotional disturbances, as examples of service system innovations that have been studied with controlled clinical trial designs and have demonstrated efficacy in treating difficult and costly clinical populations. METHOD: The authors reviewed the published controlled clinical trials of assertive community treatment and multisystemic therapy, focusing on the clinical and administrative elements that distinguish them from traditional service systems. RESULTS: A qualitative assessment of these two approaches suggests that they share common elements, with important implications for mental health policy. Specifically, the use of an ecological model of behavior applied to mental health patients is critical to both systems. In addition, therapeutic principles emphasizing pragmatic (outcome-oriented) treatment approaches, home-based interventions, and individualized goals are key elements of their success. Most important, both systems embody a therapeutic philosophy demanding therapist accountability, in which personnel are rewarded for clinical outcomes and therapeutic innovation rather than for following a prescribed plan. CONCLUSIONS: As empirically tested approaches, assertive community treatment and multisystemic therapy provide a scientific foundation for continued reform and serve to illustrate critical elements in designing new community treatment initiatives for behavioral as well as medical conditions.
Adolescent↗
The Alberta Hereditary Diseases Program: a regional model for delivery of genetic services.
Genetic counselling and related services are generally provided at major university medical centres because they are very specialized. The need for rurally based genetic services prompted the inclusion of an outreached program in the Alberta Hereditary Diseases Program (AHDP), which was established in 1979; the AHDP was designed to provide services to the entire province through two regional centres and seven outreach clinics. There is a community health nurse in almost every health unit whose duties are either totally or partially devoted to the AHDP; thus, genetic help and information are as close as a rural health unit. The AHDP is designed to provide complete clinical (diagnostic, counselling and some management) services and laboratory (cytogenetic, biochemical and molecular) services for genetic disorders. In addition, the program emphasizes education and publishes a quarterly bulletin, which is sent free of charge to all physicians, hospitals, public health units, social service units, major radio and television stations, newspapers and public libraries and to selected individuals and groups in Alberta.
Alberta↗
Alternative models for the delivery of rural health services.
A number of alternatives to the solo, fee-for-service physician model have been pursued in an attempt to alleviate some of the specific problems associated with the delivery of primary care in rural areas. This article reviews and critiques the literature published in the 1980s for four alternative models: organized group practices, community health centers, community-oriented primary care and managed care systems. The review examines the strengths and shortcomings of the existing literature, and identifies high-priority research areas for each model. These four alternative models were introduced and promoted during the 1970s with little in the way of research evidence to support them. The subsequent literature pertaining to their performance was primarily descriptive. Of the quantitative studies, many utilized 1970s data. Therefore, the effects of the many environmental changes in rural areas during the 1980s on the viability of these models is unknown. In addition, little, if anything, is known about the life cycle of these models. While longitudinal, cross-organizational studies present several logistic difficulties and require considerable resources for data collection, they hold the promise of extending the existing knowledge concerning alternative models beyond its present states.
Community Health Centers↗
Depression among youth in primary care models for delivering mental health services.
This article emphasizes the promise of efforts to improve care for depression within the primary care setting. These efforts, however face a number of potential obstacles. We have reviewed the literature on the detection and treatment of depression among youth in primary care settings and argue that primary care offers underutilized potential for reaching out to youth and improving access to high-quality care for depression. Much work remains to be done before this potential can be realized. The recommendations below highlight crucial directions for future research and clinical efforts: 1. Traditional primary care practices offer an opportunity to identify and reach youth who need care for depression. To reach youth who do not present in typical primary care settings, outreach is needed to emergency services, urgent care, and obstetric-gynecologic settings. The increased emphasis on developing school-based and school-linked health centers may also prove helpful for increasing the number of youth who are seen in primary care because there centers bring the services to a setting that is easily accessible to most youth. 2. Strategies for improving detection of depression in primary care settings must be developed and tested. Given the constraints of primary care visits, these strategies must be relatively brief and not require extensive primary care provider time. Use of nonphysicians such as practice assistants, nursing staff or associated mental health workers will be needed to support physician efforts. Furthermore, although brief self-report instruments may be useful in identifying a broad group of youth who may benefit from care, available instruments are likely to lead to over-identification and will require additional screening and triage of youth to appropriate services. Some identified youth may be require or want care; others may require further evaluation; others can be treated through primary care resources; and others will have complex conditions that require specialty consultation or referral. 3. Low rates of detection and evidence-based treatment for depression in primary care settings underscore the urgent need to understanding the barriers to care within primary care settings and to develop interventions that reduce potential barriers and improve access to high-quality care. 4. Detection efforts within primary care settings are likely to yield a somewhat different population than the population of youth identified in specialty mental health clinics or schools. Notable, physical health problems are likely to be more common in primary care populations. The limited extent data also suggest that, as in most non-primary care samples of depressed youth, youth with depression seen in primary care settings are likely to present with a number of comorbid mental health conditions. Thus, there is a need to test extent treatments within primary care settings, and adaptation may be required to meet the needs of youth seen through primary care. 5. Motivation for treatment is likely to be lower for youth identified through primary care than for those seen in specialty care, particularly when youth have not identified themselves as requiring treatment. Strategies need to be developed and tested to enhance motivation and to target treatment efforts at those youth who are most likely to benefit from services. 6. The confidential nature of the patient-provider relationship, particularly in primary care settings where youth have sought care for sensitive issues (e.g., pregnancy, birth control), underscores the need to develop effective strategies for working with families and mobilizing parents to support treatment and recovery. In primary care settings, parents may be less likely to be aware of youth problems, and youth may be reluctant to disclose difficulties to their parent. 7. Research is needed to identify service-delivery strategies tht are practical in real-world settings and are associated with improved quality of care and outcomes in children and adolescents treated for depression in primary care settings. 8. Collaborative models of service delivery seem to be promising. These models build on the strengths of primary care settings and relationships and suport primary care providers with resources that enables them to expand with diagnostic and treatment targets to include depression and other mental health problems. The recent and ongoing studies reviewed in this articles provide some examples of these models. Future research is needed to clarify the effectiveness, costs,and benefits of this approach.
Adolescent↗
A model of practice for the management of velopharyngeal dysfunction.
This paper reviews normal speech production, the speech characteristics associated with velopharyngeal dysfunction, the investigations required and treatment options. A model of service delivery is proposed which has been in place over the past 4 years. This model highlights multidisciplinary management by a specialist team. An audit of the service has been undertaken. Of the 225 patients audited, some interesting findings are presented on aetiology, diagnosis and trends in management. Systematic and comprehensive collection of data on large numbers of patients permits meaningful audit of process and outcome.
Articulation Disorders↗
Exploring a chronic care model in a regional healthcare context.
The episodic acute care model of service delivery that consumes the majority of healthcare funding is inadequate to meet the needs of a society experiencing an increasing burden of chronic illness. This article describes, in a regional Canadian healthcare context, the application and preliminary evaluation of a model of chronic care delivery developed in a managed care environment in the United States. The strategic goals of this model are to empower clients by providing a redesigned service delivery environment that supports self-management; support care providers by developing clinical information systems and decision supports; and align community resources, policies and organization of care to support an informed, activated client and a proactive practice team.
Aged↗
A new approach in psychiatric care delivery.
A unique approach for service in psychiatric care delivery has been used in a psychiatric setting at two sequentially tested inpatient locations. The patients in one setting were children and adolescents and in the other adolescents and adults. The approach used a psychiatric team comprising a psychiatrist, registered nurses, social workers, and a nurse practitioner. An overview of the psychiatric care delivery approach as it affects staff and patients is provided. The goal of this team-based model of service delivery is to provide quality care to patients in a caring and cost-effective manner.
Case Management↗
Students' preferences for service delivery: pull-out, in-class, or integrated models.
This study assessed students' preferences about where and by whom they receive instruction for learning difficulties. Subjects were 686 special, remedial, and regular education students in grades 2, 4, and 5, from classrooms that used a pull-out, in-class, or integrated model for specialized instruction. Results of student interviews indicated that children's preferences for in-class and pull-out services were affected by the service delivery model used in their classroom and their grade level. The majority of children preferred to receive additional help from their classroom teacher rather than from a specialist.
Child↗
Community-based learning in occupational therapy.
A community-based field work experience for senior occupational therapy students is described. The program was designed to meet five objectives: to provide students with an effective integration of theory and practice; to allow an application of theoretical concepts to early intervention and prevention programs; to enable students to confront complexities of community service delivery; to allow students to learn new roles in community programs; and to demonstrate the role of occupational therapy within a public health model of service delivery. In addition to these project objectives, placement sites, student roles, and organization of supervision are discussed. Examples are given to illustrate the diversity of student experience. Student and consumer feedback indicated that positive gains had been made toward fulfillment of the project objectives.
Boston↗
Variation in outpatient mental health service utilization under capitation.
BACKGROUND: To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ways to provide cost-effective services. STUDY AIMS: This study assessed outpatient service delivery to Medicaid-eligible consumers under this program. This paper is among the first to study variations in the delivery of specific types of outpatient mental health services under capitated financing systems. METHODS: This study uses claims data (1994-1997) from Colorado's Medicaid and Mental Health Services Agency. The fee-for-service (FFS) model served as the comparison model. Two capitated models under evaluation are: (i) direct capitation (DC), where the state contracts with a non-profit entity to provide both the services and administers the capitated financing, and (ii) managed behavioral health organization (MBHO), which is a joint venture between a for-profit company who manages the capitated financing and a number of non-profit entities who deliver the services. A sample of severely mentally ill patients who reported at least one inpatient visit was included in the analysis. Types of outpatient services of interest are: day-treatment visits, group therapy, individual therapy, medication monitoring, case management, testing, and all other services. Comparisons were set up to examine differences in service utilization and cost between FFS and each of the two capitated models, using a two-part model across three time periods. RESULTS: Results showed differences in service delivery among reimbursement models over time. Capitated providers had higher initial utilization in most outpatient service categories than their FFS counterparts and as a result of capitation, outpatient services delivered under these providers decreased to converge to the FFS pattern. Findings also suggest substitution between group therapy and individual psychotherapy. Overall, more service integration was observed and less complex service packages were provided post capitation. IMPLICATION FOR HEALTH CARE PROVISION AND POLICIES: Financing models and organizational arrangements have an impact on mental health service delivery. Changes in utilization and costs of specific types of outpatient services reflect the effects of capitation. Understanding the mechanism for these changes may lead to more streamlined service delivery allowing extra funding for expanding the range of cost-effective treatment alternatives. These changes pose implications for improving the financing of public mental health systems, coordination of mental health services with other healthcare and human services, and provision of services through a more efficient financing system.
Adolescent↗
Managed care and community-oriented care: conflict or complement?
Motivated by the need for fundamental change, reform of the health care delivery system is continuing despite the recent failure of national initiatives. One aspect of this reform is the restructuring of managed care systems to include low-income, at-risk populations in their health delivery program: It is a move that threatens current "safety-net" providers, which already serve these populations with programs that combine public health and traditional primary care. This paper explores this potential conflict by providing a brief history and comparison of the main features of the community-oriented primary care (COPC) and health maintenance organization (HMO) models. The authors provide a frame-work that contrasts the structure, process, and outcome characteristics of these two models, delineating key similarities and differences. The frame-work is used in profiling a service delivery system model that integrates the two systems and in discussing issues related to operationalizing the proposed integration.
Community Health Planning↗
A randomised controlled trial of patient self management of oral anticoagulation treatment compared with primary care management.
BACKGROUND: The increase in numbers of patients receiving warfarin treatment has led to the development of alternative models of service delivery for oral anticoagulant monitoring. Patient self management for oral anticoagulation is a model new to the UK. This randomised trial was the first to compare routine primary care management of oral anticoagulation with patient self management. AIM: To test whether patient self management is as safe, in terms of clinical effectiveness, as primary care management within the UK, as assessed by therapeutic international normalised ratio (INR) control. METHOD: Patients receiving warfarin from six general practices who satisfied study entry criteria were eligible to enter the study. Eligible patients were randomised to either intervention (patient self management) or control (routine primary care management) for six months. The intervention comprised two training sessions of one to two hours duration. Patients were allowed to undertake patient self management on successful completion of training. INR testing was undertaken using a Coaguchek device and regular internal/external quality control tests were performed. Patients were advised to perform INR tests every two weeks, or weekly if a dose adjustment was made. Dosage adjustment was undertaken using a simple dosing algorithm. RESULTS: Seventy eight of 206 (38%) patients were eligible for inclusion and, of these, 35 (45%) declined involvement or withdrew from the study. Altogether, 23 intervention and 26 control patients entered the study. There were no significant differences in INR control (per cent time in range: intervention, 74%; control, 77%). There were no serious adverse events in the intervention group, with one fatal retroperitoneal haemorrhage in the control group. Costs of patient self management were significantly greater than for routine care (pound 90 v pound 425/patient/year). CONCLUSION: These are the first UK data to demonstrate that patient self management is as safe as primary care management for a selected population. Further studies are needed to elucidate whether this model of care is suitable for a larger population.
Administration, Oral↗
Evaluating alternative treatments for homeless substance-abusing men: outcomes and predictors of success.
The present study was designed to explore the relative efficacy of three types of service delivery intervention models for homeless men with alcohol and/or drug problems: integrated comprehensive residential services provided at one site (Group 1); on-site shelter-based intensive case management with referrals to a community network of services (Group 2); and usual care shelter services with case management (Group 3). In addition to assessing the relative efficacy of these approaches in terms of drug and alcohol use, residential stability, economic and employment status, the project also sought to examine what personal factors best predicted successful outcomes for clients. Clients were assessed at baseline and approximately six months following discharge. All three treatment groups improved significantly over time in terms of reduced alcohol and cocaine use, increased employment, and increased stable housing, but no differential improvement was found among groups. Successful outcomes were predicted by lower recent and lifetime substance use, fewer prior treatment episodes, more stable housing at baseline, fewer incarcerations, and less social isolation.
Adult↗
Geropsychology post-doctoral training in public sector service delivery: the USF/Tampa VA fellowship model.
There is a growing need for geropsychologists who are specialists in practice, research, education, and advocacy for older adults. The combined USF/Tampa VA geropsychology fellowship program focuses on the training of three post-doctoral Fellows each year in public sector service delivery across diverse long term care (LTC) and primary care settings. Addressing the bio-psycho-social needs of frail, poor, and minority older adults within an interdisciplinary framework exposes geropsychology Fellows to the complex nature of mental health problems of older adults and the need for collaborative efforts across professional lines. The program builds on prior geropsychology training at the graduate and internship levels by providing an integrated framework to achieve clinical, didactic, program evaluation, and advocacy goals: (1) delivery of state-of-the-art evidence-based psychological services to disadvantaged older adults in geriatric public sector primary care sites; (2) mastery of the knowledge base on diversity and interdisciplinary teamwork as they relate to providing services to older adults, including those residing in rural areas; (3) gaining competence in the evaluation of services to disadvantaged older adults; and (4) experience in public health advocacy for improvement of the LTC system.
Aged↗