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PubMed1996

Interest in a stepped approach model (SAM): identification of recruitment strategies for university alcohol programs.

This study evaluates interest in a stepped approach model (SAM) of service delivery and identifies variables to enhance recruitment to alcohol programs. Subjects were 2,443 college student drinkers (1,420 men and 1,023 women) at a large midwestern university (selected by stratified systematic sampling) who completed a questionnaire on drinking behavior and interest in five intervention steps. Results indicated that there was more interest in interventions that required less time, which supports predictions of SAM. Overall lack of interest peaked at 67% for men and 65% for women and did not change significantly across the last three steps of SAM, which included traditional interventions of group and individual counseling. The data suggest that the stepped approach is more viable than conventional approaches, recruitment is unquestionably an exigent research priority because of the overwhelming lack of interest in alcohol programs, and specific variables that were identified may be important for recruiting particular subgroups.

Adolescent↗
PubMed1986

Personality assessment and Native Americans.

Personality assessment services for Native Americans have been culturally inappropriate and historically underutilized as a consequence. A framework for personality assessment is presented including components of relevant cultural knowledge, assessment techniques, assessor characteristics, and relationship style. Emic and etic approaches are described as serving different assessment functions. Acculturation measures and awareness of acculturation effects on different instruments provide temporary palliatives. A biopsychosocial model for service-delivery with linkages to family, tribal, county, state, and federal resources would be desirable and potentially effective. Ameliorations in techniques and service-delivery cannot substitute for genuine professional commitment to recruitment and training of indigenous assessment service-providers.

Journal Article↗
PubMed1998

Psychosocial factors and birth outcome: African American women in case management.

The relationship between psychosocial risk factors and birth outcomes among African American pregnant women is explored. The study focuses on social/environmental stressors and proposes a workable model for delivery of services based on case management principles. Unstable income, perinatal medical problems, alcohol use, smoking, access to prenatal care, internal barriers to care, compliance problems, negative experiences with providers, depression, unresolved grief, and fetal substance exposure were significantly associated with low birthweight. Unstable income, compliance problems, internal barriers to care, and poor access to care were significantly associated with preterm delivery. Specific interventions aimed at providing social support, facilitating access to care, health education, and encouragement to verbalize feelings about problems were significantly associated with the number of problems that the client was able to solve. The data indicated the importance of psychosocial, environmental and medical risk factors in the prediction of low birthweight and preterm delivery in a high-risk population.

Adolescent↗
PubMed2001

Collaborative development of a new course and service in Sri Lanka.

Great Ormond Street Hospital (GOSH) has a long established service development and research programme with Sri Lankan colleagues. The Centre for International Child Health (CICH) is an academic unit with public health interests in the countries of the South. Together a group of collaborators at GOSH, CICH and in Sri Lanka worked together to plan how a cadre of health workers could be prepared to work with people with communication disabilities. This is not an uncommon aim in under-served countries and there is a small published literature about the courses which have been developed. Choices about models for training, service delivery and ensuring sustainability in emerging services for people with communication disabilities are complex. Links can be made with development work in other disciplines. The literature relating to these issues in countries such as Sri Lanka is examined.

Developing Countries↗
PubMed2001

Rural initiatives at the James Cook University School of Medicine: a vertically integrated regional/rural/remote medical education provider.

Building on the success of the former North Queensland Clinical School/Royal Australian College of General Practitioners collaboration in North Queensland, the James Cook University School of Medicine continues to develop a model of close collaboration with stakeholder groups that provides medical education services to dispersed communities in northern Australia. The flagship themes of the programme (rural & remote, Indigenous and tropical health) are essential to the regional mission to improve the health care of people in northern Australia. Selection processes target regional and rural background students and Aboriginal and Torres Strait Islander students. An innovative curriculum design reinforces interest in and relevance to regional health needs. The present paper provides an overview of the roles and early progress of the new School of Medicine, with the aim of keeping rural doctors informed about the continuing development of a successful 'national standards/local collaboration and control' model of education service delivery.

Curriculum↗
PubMed2004

Gender impact on the socioprofessional identification of women dentists in Bulgaria.

Women comprise 73 percent of all dentists in Bulgaria. Almost all of them started their careers as salaried, and now they are self-employed. The purpose of this study was to show how female dentists in Bulgaria met the challenges of the social and health reforms during the period of transition from totalitarian to democratic rule. A field sociological survey was carried out between October 1996 and June 1997, involving a sample of 842 dentists. The questionnaire was designed to give information on dental demography trends, pattern of participation and practice of female dentists, and their career development. The data were treated statistically using an SPSS package. Results show that for the period 1991-96 women dentists owned more than 50 percent of the newly opened private practices in Bulgaria. They were more interested in improving their qualifications and more successful in obtaining specialty status than male dentists. Dentists in Bulgaria by the late 1990 s, with no gender difference, tend to identify themselves as liberal practitioners within the pluralistic model of dental services delivery. The volume of services delivered and profile of women in professional practice and their social and professional mobility are highly competitive, despite the growing problems of maternity leave coverage and funding to re-enter the profession.

Bulgaria↗
PubMed2004

Working together for a sustainable urgent care system: a case study from south eastern Australia.

CONTEXT: A small, isolated community in the south east of Australia, Malacoota, had a long-standing concern about the adequacy of their emergency medical systems. There was no hospital, the local medical practitioners were under stress and their ambulance services were limited. Following an approach through the local Division of General Practice in August 2002, the School of Rural Health at Monash University was invited to assist. ISSUES: A policy development toolkit was used to improve the rural urgent care systems through engagement with community members. The process involved community consultation, a meeting of key stakeholders, and the formation of a representative Steering Committee to oversee the local management of the project. Project officers worked with a university facilitator and other stakeholders to implement the Transforming Rural Urgent Care Systems (TrUCs) process from August 2002 to June 2003. A proposal of recommendations was put to the Victorian State Minister of Health and this was accompanied by a degree of political action. The submission raised the issues of poor interstate communications, ambulance staffing, support for medical practitioners, facilities for the stabilisation of patients, and access to air ambulance services. Funding was obtained for the implementation of a community paramedic model. Ambulance service communications systems improved and an innovative model of ambulance service delivery for isolated communities was implemented. LESSONS: A number of lessons have been identified, including the crucial role of the project officers, and communication within the community and among specific stakeholders. The approach used could be adopted in other rural locations hoping to improve their emergency health services.

Journal Article↗
PubMed1993

Alzheimer's disease: case management in a rural setting.

This article describes a case management model developed under the guidelines of the Medicare Alzheimer's Disease Demonstration. This delivery model currently provides services to over 400 Alzheimer's disease victims and their family caregivers who reside in predominantly rural communities in east central Illinois and western Indiana. Client and caregiver characteristics are provided as well as service utilization patterns. The model incorporates intervention strategies that facilitate communication and coordination of services, integrates formal and informal support systems, and allows for client advocacy and system development.

Aged↗
PubMed2004

Evaluating children's rehabilitation services: an application of a programme logic model.

OBJECTIVES: To apply a programme logic model to evaluate the effectiveness of a new therapy service for children with special needs who were in transition from pre-school to kindergarten. SETTING: A children's outpatient rehabilitation centre in Ontario, Canada. MAIN OUTCOMES: The short-term outcomes included parents' perceptions of the transition process itself and the information they required, the children's skill development for the transition to kindergarten, and parents' perceptions of services and satisfaction with resources. METHODS: A combination of quantitative methods [Goal Attainment Scaling (GAS), Measure of Processes of Care (MPOC), Client Satisfaction Questionnaire (CSQ)] and qualitative interviews were used to evaluate both the process ('Outputs') and outcomes ('Short-term objectives') of the new therapy service. RESULTS: The children involved in the evaluation met or exceeded goals that were set by therapists and parents. Parents' perceptions of, and satisfaction with, the new service were higher than the provincial average. Qualitative data from interviews with parents and service providers supported the findings from standardized measures, and provided suggestions for future service delivery. CONCLUSIONS: The programme logic model provided researchers and service providers a collaborative and systematic approach to conducting programme evaluation in a relatively short-time frame. It appears to be a useful option for evaluation of other children's services.

Attitude to Health↗
PubMed2006

The development of nurse practitioners via flexible learning: toward an innovative Masters degree curriculum in Thailand.

The changing health system in Thailand has provided Thai people with more equitable opportunities in accessing health care services. As a result of medical practitioner shortages and a strong desire for nurses to expand their scope of practice, the Thailand Nursing and Midwifery Council (TNC) plans to increase the number of nurse practitioners at master degree level to staff primary care units (PCUs) and Health Centres around the country. Nursing master degree curricula in Thailand are currently offered using the traditional on-campus face-to-face mode of delivery and have low numbers of student enrolments. Furthermore, research indicates that many graduate nurses in Thailand are seeking entry to master degree curricula, but accessibility, convenience and availability of curricula locally are limiting enrolments. Nursing education globally is a dynamic and iterative process. Educational curricula are based on the principles of adult learning, continuing professional education and life-long learning, which advocate flexible and learner-oriented education. Flexible learning, which has the ability to closely match the professional and academic needs of the learner, has the potential to lead nursing education toward meeting the TNC policy and health system reform in Thailand. It is essential that nursing education in Thailand be revolutionised, embracing flexible delivery modes by traditional higher education providers. This paper presents a new model of health care service delivery and the mechanism used to integrate the principles of flexible learning into a new master degree curriculum for nurse practitioners (NPs) in Thailand.

Curriculum↗
PubMed1981

The interlocking treatment system: a model for the delivery of state hospital-CMHC services.

A state hospital began a program in 1975 to integrate the treatment services of the hospital with those of six community mental health centers. The interlocking treatment system that resulted made use of mini-teams of hospital and center staff to recommend referrals to the hospital, develop inpatient treatment programs, and supervise the client's return to the community. The linkages between the hospital and the centers helped ensure continuity of care for clients and to ease their return to community living. A study of hospital wards participating in the system and those not participating showed that participating wards discharged significantly more clients over an 18-month period.

Community Mental Health Services↗
PubMed2003

A large university medical center delivery system for therapeutic apheresis services.

The clinical applications of therapeutic apheresis (TA) encompass a broad spectrum. Diversity exists not only in the age and acuity of patients treated, but also in the range of therapeutic approaches and technology. Particularly over the past decade, there has been rapid expansion of TA for primary, adjuvant, and empiric therapies for myriad clinical settings. Recognizing this context, it is not surprising that a variety of delivery models for providing TA services have emerged. In this paper, the structure of an apheresis service at a large academic university hospital will be described to illustrate one example of an effective apheresis delivery model. Alternatives to this delivery model are certainly possible. The discussion will also indicate where some organizational variations may occur within this category of facility.

Academic Medical Centers↗
PubMed1994

[The integrated approach to social reintegration: beyond "case management" and psychosocial rehabilitation].

Recently in western countries mental health systems are, slowly but systematically, adopting case management (CM) as a system of service delivery. Nonetheless, case management remains undefined, poorly described and its characteristics uncharted and unresearched. Social reintegration is a comprehensive model that incorporates strategies of service delivery aimed at solving the problems encountered by CM in the maintenance, enhancement of clients quality of life and social functioning and, social and community acceptance are addressed and issues of costs and collaboration between institutions is explored in depth.

Community Mental Health Services↗
PubMed2001

Evaluation of the impact and acceptance of a nutrition program in an HIV community clinic.

The present paper describes the evaluation of a nutrition service and research model for human immunodeficiency virus (HIV)-positive clients within a community based HIV acquired immune deficiency syndrome (AIDS) medical clinic. This program was designed to develop an effective, practical, replicable model for the delivery of nutrition services in the ambulatory HIV care setting. The objectives of evaluating the model were to define the ways that nutrition services in HIV/AIDS impacted clients, the clinic, and referral sources, and to continually refine the model by determining what services provide greatest benefit to clients, especially in view of the changing landscape of HIV therapy. Four evaluation activities completed during the study period of 5 years are described. These included a focus group and semistructured interview with clients, a semistructured interview with workers from the local network of service referral agencies and a client satisfaction survey at study "close-out." These evaluation processes confirmed or prompted programmatic modifications that improved access, confidentiality, and the relevance of specific components for clients. Providers/stakeholder's concerns were addressed through more frequent communication about clients' specific nutrition issues, clearer and easier referral and cooperation in recruiting patients. Also, the evaluation activities provided a platform for the communication of general and specific information about the program and for outreach. Although clients' and workers' priorities differed in some details of program implementation, there was strong agreement on the value of addressing nutrition concerns in HIV. Favorable feedback about the program gave impetus to continue nutrition services in the clinic after the project period ended and supports its application in other sites and settings.

Adult↗
PubMed2006

Better access to psychology services in primary mental health care: an evaluation.

INTRODUCTION: The Access to Allied Psychological Services program was introduced as part of the Better Outcomes in Mental Health Care initiative in 2001-2002. Divisions of General Practice are funded to establish programs that allow GPs to refer patients for psychological treatments. The University of New South Wales evaluated programs run by the Southern Highlands and Illawarra Divisions of General Practice. This paper presents the findings of these evaluations. METHOD: Both evaluations analysed process and patient outcomes. This was obtained from a combination of program data and qualitative satisfaction data. RESULTS: The two program models differed in the mechanism of retention of the psychologists and the method of referral of patients. Anxiety and depression were the main reasons for referral, and clinical data showed there was improvement in patient outcomes. Patients, GPs and psychologists expressed satisfaction with the programs. DISCUSSION: The Access to Allied Psychological Services programs in both Divisions have proven popular. Flexibility in the program structure allows Divisions to develop a model which suits their local circumstances. There is support for ongoing Commonwealth funding and the challenge is to find the most effective and financially sustainable model of delivery for psychological services in primary care.

Adult↗
PubMed1994

The media/information richness model as prescription for some health care service ills.

Because consumers are demanding more and better information from their health care providers, improving effectiveness and efficiency of communications is one way that health care providers can gain a competitive edge. The authors propose that health care communication effectiveness and efficiency can be improved by using the Media/Information Richness Model (MIR) in planning service delivery systems.

Communication↗
PubMed1975

Role of behavior modification in community mental health.

This paper briefly reviews the original concept of the community mental health movement; points to ways in which current service delivery systems deviate from this; offers and alternative framework for service delivery, that is, a behavioral model; and argues that its implementation would move community services closer to this conception. The implications of this model for intervention in the natural environment as well as for transitional and prosthetic facilities are described and examples given of its use. Emphasis is placed on working in the natural environment whenever possible via the use and cultivation of significant others as well as via provision of training in self-directed behavior change in addition to the blending of case management with careful evaluation of service.

Behavior Therapy↗