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At least 307 records · Page 17Linked to original sources
PubMed2005

Young adults' (16-25 years) suggestions for providing developmentally appropriate diabetes services: a qualitative study.

Managing the multiple demands of a chronic condition whilst negotiating the developmental tasks of adolescence and young adulthood is a process that is neither well described nor understood, particularly in relation to providing developmentally appropriate health care for young people. The importance of this issue is starting to be reflected within the literature, and although research into models of service delivery is emerging, a lack of user involvement in service development is apparent. This qualitative, user involvement study aimed to describe and understand the considered opinions of 19 young adults with diabetes who were receiving secondary care services about the provision of diabetes services for young people. The findings, gathered using semistructured interview and focus group methods, have potentially wide-reaching implications across primary and secondary health care, and across agencies providing services to children and young people, in terms of facilitating a person's transition through adolescence and into young adult life. Participants suggested key issues to address when developing services for young people, including staff consistency, civility, clinic structures which help a person navigate the health care system, provision of age-specific information, and support in relation to a range of health, emotional, social and developmental needs. Health care professionals can help young people to meet the expectations upon them as autonomous service users by modelling appropriate relationships, helping them to acquire skills and knowledge, and overcome barriers to them becoming active participants in their health care and achieving social participation in a fuller sense. It is somewhat arbitrary to delineate between adolescence and young adulthood in terms of age alone, but in this paper, 'adolescence' refers to the period between 11 and 15 years of age, and 'young adulthood' between 16 and 25 years of age. The phrase 'young people' will also be used to refer to people between 11 and 25 years.

Adolescent↗
PubMed2002

Reflections on.... Occupational therapy and assertive community treatment.

Occupational therapists can play a valuable role on Assertive Community Treatment Teams (ACT). ACT is a widely disseminated, community based model of service delivery for individuals with severe psychiatric disabilities and high support needs. This paper discusses the generalist and specialist functions of occupational therapists within ACT. It is argued that occupational therapy addresses the occupational health and well being of ACT clients by intervening at three levels: the individual, the program and the community. This occupational focus is consistent with the ACT goal of enhancing community adjustment and quality of life. The paper concludes with a discussion of the opportunities and the constraints that face occupational therapists working within ACT.

Canada↗
PubMed2004

Not the same: a comparison of female and male clients seeking treatment from problem gambling counselling services.

Previous studies of problem gamblers portray this group as being almost exclusively male. However, this study demonstrates that females comprised 46% of the population ( n = 1,520) of persons who sought assistance due to concerns about their gambling from the publicly-funded BreakEven counselling services in the state of Victoria, Australia, in one 12-month period. This suggests that the model of service delivery which is community based counselling on a non-residential basis may be better able to attract female clients than treatment centres where males predominate such as veterans centres. A comparative analysis of the social and demographic characteristics of female and male gamblers within the study population was undertaken. As with previous studies, we have found significant differences between males and females who have sought help for problems associated with their gambling. Gender differences revealed in this study include females being far more likely to use electronic gaming machines (91.1% vs. 61.4%), older (39.6 years vs. 36.1 years), more likely to be born in Australia (79.4% vs. 74.7%), to be married (42.8% vs. 30.2%), living with family (78.9% vs. 61.5%) and to have dependent children (48.4% vs. 35.7%), than males who present at these services. Female gamblers (A$7,342) reported average gambling debts of less than half of that owed by males (A$19,091). These gender differences have implications for the development and conduct of problem gambling counselling services as it cannot be assumed that models of service which have demonstrated effectiveness with males will be similarly effective with females.

Adult↗
PubMed2003

Using a nursing protocol to assure equitable delivery of cancer-related prevention services.

A nurse-administered, protocol-driven model (NP) for preventive services delivery was compared with a traditional physician reminder (PR) model with nursing back-up among 473 patients attending Internal Medicine and Family Medicine clinics. A total of 240 patients were randomized to the NP group and 233 to the PR group. Demographic characteristics including gender [71% female (NP) and 71% female (PR)], race (78% and 75% African American, respectively) and age (numbers of persons aged 18-54, 55-64 and 65+ years) were similar in each group. In the NP group 244/244 screening tests for breast, cervical and colon cancers and alcohol abuse were initiated or completed by nurses, while in the PR group 110/215 (51%) were initiated or completed by physicians. The NP group received 552/552 counseling services from nurses for tobacco, alcohol, nutrition, exercise and prostate screening, while in the PR group, physicians delivered 10% of the needed services (56/560). Aside from counseling for prostate cancer screening, which was 100% in both the NP and PR groups, all other between-group differences for each service were significant at the level of p<0.001. Results show the feasibility of a nursing protocol for initiating equitable cancer prevention services in a primary care setting.

Adolescent↗
PubMedDate not supplied

Integrating harm reduction therapy and traditional substance abuse treatment.

One-size-fits-all therapy has not worked well for a majority of substance users seeking help. New approaches to substance abuse treatment are desperately needed. Traditional models of service delivery offer little, if any, help to people who may not choose abstinence as a goal. To address this concern, the Bridging the Gap Conference was sponsored by the San Francisco Department of Public Health. The overall goals of the conference were to improve standards of care, develop best practice principles for integrating harm reduction approaches into traditional substance abuse services, and increase the accessibility of quality services to people in need of alcohol and drug treatment. G. Alan Marlatt gave a keynote address on the integration of harm reduction therapy into traditional treatment services, an expanded version of which is presented in this article. Such integration would broaden the scope of services available to a larger group of consumers of substance abuse treatment. Furthermore, harm reduction therapy would infuse traditional treatment practices with scientifically-based pragmatism that pays close attention to individual and community public health needs. Because of its tolerance of treatment goals other than abstinence, harm reduction therapy offers the greatest hope to expand the availability of substance abuse services to people who have not benefited from traditional abstinence-based treatment models.

Health Personnel↗
PubMed2025

Mainstreaming of clinical genetic testing: A conceptual framework.

PURPOSE: Demand for genetic testing is increasing across medicine, whereas the genetics workforce remains stable. In response, mainstreaming models are being introduced, in which nongeneticist clinicians are increasingly involved in the genetic testing pathway. Because a standardized approach would facilitate evaluation and optimal patient care, a unified framework is warranted. METHODS: Through a focus group with clinical genetics experts, a conceptual framework for the mainstreaming of clinical genetic testing is proposed. Through a consensus process, experts elucidated the steps in the diagnostic care pathway and defined a set of variables that influence which mainstreaming model is best suited to specific patient care scenarios. RESULTS: A total of 35 individuals representing 20 distinct clinical genetics services and all Canadian provinces participated in the development of the framework. The framework describes 4 generalizable mainstreaming models of care, each with varying levels of involvement of the clinical genetics service in the diagnostic care pathway. CONCLUSION: This framework will help guide clinical teams in the design and evaluation of mainstreaming efforts. It is critical that these programs are evaluated and shared in a standardized way so that we can implement strategies that allow optimal utilization of genetics resources and improve patient care.

Humans↗
PubMed2004

What does GP out of hours care cost? An analysis of different models of out of hours care in Scotland.

BACKGROUND: The changes to out of hours care provided by General Practitioners have led to wide variation in the types and costs of out of hours care across the country. AIM: To examine the costs of different models of service delivery for GP out of hours organisations. METHODS: This was a prospective cross-sectional survey of eight GP out of hours organisations and samples of their patients. A deputising service, rotas, and various types of GP co-operative across Scotland were surveyed. Information on the quantities of resources used by each organisation was combined with unit costs. Costs incurred by patients and other NHS costs subsequent to the out of hours contact were also calculated. RESULTS: Annual costs incurred by the GP out of hours organisation per 1,000 population ranged from pounds sterling 2,916 to pounds sterling 12,120. There was no relationship between costs and type and size of organisation. There was a three-fold variation in total costs per out of hours contact (pounds sterling 15 to pounds sterling 51). Costs per phone contact were lowest (pounds sterling 6 to pounds sterling 11), followed by cost per centre contact (pounds sterling 10 to pounds sterling 16) and cost per home contact (pounds sterling 21 to pounds sterling 60). Total costs per episode ranged from pounds sterling 78 to pounds sterling 136 for centre contacts, from pounds sterling 130 to pounds sterling 303 for home contacts, and from pounds sterling 70 to pounds sterling 553 for telephone contacts. Home contacts had the highest average cost per episode (pounds sterling 212), followed by telephone contacts (pounds sterling 117) and centre contacts (pounds sterling 85). CONCLUSIONS: There are wide variations in the costs of operating GP out of hours services, It is likely that the context in which organisations were set up and local geography infuence variations in costs, as well as the level of GP cover.

After-Hours Care↗
PubMed1997

Psychogeriatrics in South-East Asia.

A common phenomenon in South-East Asia is ageing of the population. This article describes the various stages of development of psychogeriatrics in Hong Kong, Singapore, Malaysia, Thailand, Indonesia and the Philippines. It is only in the last few years that more systematic development of psychogeriatric services has begun under the pressure of an ageing population. The model of service delivery in Hong Kong can serve as an example of development of psychogeriatric services in South-East Asia.

Aged↗
PubMed2005

Fife Rheumatic Diseases Unit 10 years on: a personal perspective.

May 2004 marked the 10th anniversary of the Fife Rheumatic Diseases Unit (FRDU) based at the Sir George Sharp Unit, Cameron Hospital in Fife. This article aims to share with the reader FRDU's particular model of service delivery, how FRDU, and the occupational therapy service in particular, has evolved over the past 10 years.

Journal Article↗
PubMed1980

"Emergency room" and "mobile response" models of emergency psychiatric services.

The present study surveyed federally-funded emergency psychiatric programs in 33 California community mental health centers (CMHCs). Four aspects of service organization were examined: (1) the availability of various response styles (telephone service, walk-in service, follow-up home visits, mobile initial response); (2) the types of staff providing the service; (3) the location of the programs, and (4) the organizational setting of the CMHCs (consortium or single agency centers). From these characteristics of service organization two contrasting types of emergency psychiatric programs were derived--the "emergency room" and "mobile response" models. The relationship between these two models of service delivery and catchment area demographic characteristics was examined and no remarkable trends emerged. The implications of developing a typology of emergency psychiatric programs are discussed with respect to a scheme for evaluating the relative effectiveness of services and for planning future programs.

Community Mental Health Services↗
PubMed1990

Community-based services and resources: the significance of choice and diversity.

Distinguished between partnership models of service delivery and consumer-run services. In order to understand the role of self-help and other consumer-run approaches in community support of persons with severe mental illness, we must appreciate the importance of (a) consumer choice and (b) diversity of service alternatives within consumer-run options. These issues are discussed in relation to the significance of self-selection in consumer-run services and the role of consumer-run approaches as adjuncts or alternatives to professional services. It is argued that our efforts to provide community services can be enhanced by (a) supporting diversity of service and resource options, both inside and outside of the professional mental health system; (b) developing services that are responsive to individuals needs as they define them; and (c) facilitating the process of consumer choice in selecting resource options.

Assertiveness↗
PubMed1994

Contrasting a shelter and day center for homeless mentally ill women: four patterns of service use.

This article examines a model of service delivery for homeless mentally ill women, a combined day center and shelter program. Using data from participant observation and in-depth interviews with 21 clients, four patterns of day center and shelter use are delineated. Overall, few women from the day center make the transition to the shelter, and then to permanent housing and mental health stability. In the absence of a comprehensive public mental health system and low-income housing, however, many more women benefit from periodic use of the shelter as respite from the streets and from daily support services provided by the day center.

Day Care, Medical↗
PubMed1996

School-based mental health services in the United States: history, current models and needs.

Children's mental health needs continue to be largely unmet, even when community services are provided. On-site mental health services in schools address unmet needs by improving access to, and relevance of services. As schools have increasingly been mandated to serve the needs of all children (including those who are emotionally disturbed) general health and mental health services have been increasingly placed in them. Although the provision of basic health care in schools began in the early part of the century, the concept of providing comprehensive services, in which mental health services are integrated into primary medical care, has only been implemented recently. We review the background of school-based mental health services, compare various models of service delivery, and highlight issues important to the future development and advancement of these services.

Affective Symptoms↗
PubMed2006

Children in foster care: mental health, service use and costs.

OBJECTIVE: To assess the prevalence of mental health problems in children in foster care, their families' use of services and the associated costs. METHODS: Information on mental health problems, service use and costs was collected, by postal questionnaires and home interviews, on 182 children, their foster carers and teachers from 17 local authorities in Central Scotland. RESULTS: Over 90% of the children had previously been abused or neglected and 60 % had evidence of mental health problems including conduct problems, emotional problems, hyperactivity and problems with peer relations. When compared with 251 children from local schools, the children in foster care had significantly higher symptom scores for Reactive Attachment Disorder. Those children with highest scores for mental health problems were attracting a high level of service support from a wide range of agencies, except Child and Adolescent Mental Health Services (CAMHS). Costs were associated with learning disability, mental health problems, and a history of residential care. CONCLUSIONS: Children in "mainstream" foster care are at greater risk of mental health problems, and are attracting greatest costs, but CAMHS are not successfully targeting these problems. CAMHS may need to develop new models of service delivery.

Adolescent↗
PubMed2006

Treating depression in substance abusers.

The literature on the diagnosis and treatment of depression is reviewed to arrive at recommendations for clinical practice, future research, and models of service delivery. The DSM-IV criteria are found to provide a sound basis for diagnosis, and a review of placebo-controlled trials of antidepressant medications among substance-dependent patients suggests medication is effective in the setting of careful diagnosis, preferably during a currently observed abstinent period. Clinical recommendations offered for the approach to patients with co-occurring depression and substance dependence include the following: 1) Initiate treatment for substance dependence and encourage abstinence; 2) Conduct a careful psychiatric history and apply DSM-IV criteria for primary or substance-induced depression; 3) If depression meets diagnostic criteria and persists despite treatment of substance use disorder, treat the depression. Future research should include trials of psychotherapeutic or behavioral treatments, studies of treatment algorithms and of integrated systems of care, and studies of methods for disseminating diagnostic and treatment methods in an effort to diminish traditional boundaries between the skill sets of mental health and substance abuse clinicians.

Comorbidity↗
PubMed1996

Treatment needs and experiences of Australian women with alcohol and other drug problems.

Two hundred and sixty-seven women were interviewed as part of a national survey examining the treatment needs and experiences of Australian women who had received assistance for their alcohol and other drug problems. The majority of women had previously received assistance for their substance use, and of these most had left alcohol and other drug treatment programs before completion. While the women cited a number of ways in which they were helped by such services, several areas were identified by the women as important and amenable to improvement. Among the service issues raised were access, models of service delivery, service structure and staffing, physical environment, physical and psychological safety and the handling of issues such as health status and sexual assault.

Adolescent↗
PubMed2005

Funding, technical assistance, and other resources for school-based health centers.

To facilitate the successful implementation of school-based health centers (SBHCs), funding streams and technical assistance are needed from various resources. The core funding models for service delivery include federal grants, state grants, local funding, community partnerships, foundations, and patient revenue. Technical assistance opportunities are available through professional organizations, SBHC associations, state health departments, and primary care associations at the national and state levels. This article explores the various federal, state, and local funding sources, and the technical assistance resources and opportunities available to SBHCs and their staff.

Adolescent↗
PubMedDate not supplied

A survey of psychiatric liaison services for older adults in the eastern region of the United Kingdom.

AIMS AND METHODS: The aim of this study was to investigate the provision of liaison services for older adults in the Eastern Region of the UK. We surveyed all the acute general hospitals for current service and problems encountered in delivering and developing these services. RESULTS: The survey had a 100% response. Sixty-two percent did not have a dedicated liaison service. The predominant model of service delivery was nurse led. The majority of the services had evolved over the last 2 years and had time limited funding only. In two hospitals the service had ceased due to lack of continuing funding. CLINICAL IMPLICATIONS: The survey has highlighted liaison services for older people and show that they remain a neglected area. This survey provides information that will be useful to commissioners and providers who are developing liaison psychiatry services for older people.

Aged↗