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PubMed1999

Ecological factors impacting provider attitudes towards human service delivery reform.

Although reform efforts are substantially altering the structural operations and guiding ideological framework of the human service delivery system, little empirical work has been done to systematically examine these transformations. This study examines providers' attitudes regarding two reform elements that are being widely implemented: an increased emphasis on interagency collaboration and a shift from a medical model service delivery philosophy, that focuses on client deficits, to one that emphasizes consumer strengths. Through survey data collected from 186 providers from 32 human service agencies in one county, the relationship between providers' perceptions of contextual support for human service delivery reform and providers' attitudes towards these initiatives is explored. The findings from this study support the importance of attending to the ecology in which we initiate system reform efforts. For both reform elements, working within contexts that are perceived as providing ideological and functional support for change was associated with positive provider attitudes towards those changes. Staffs' perceptions of the external environment played the most critical role in shaping staff attitudes. Interestingly, unique aspects of providers' work environments were related to positive attitudes towards the two different reforms. The implications of these findings for the success of human service delivery reform are discussed.

Attitude↗
PubMed1989

The effects of consumer characteristics and type of employment model on individual outcomes in supported employment.

Although recent federal legislation has led to a proliferation of supported employment programs throughout the country, little information is available that documents the success of these programs. In the present study, we examined the effect of different consumer characteristics and alternative supported employment service delivery models on key employment outcomes including hourly wage, hours worked per week, increase in earnings after supported employment participation, and level of integration on the job. The employment outcomes of a sample of 1,550 individuals receiving supported employment services through 96 local programs in eight states were analyzed to determine the effects of the key independent variables of primary disability and type of employment model. Results indicate that all groups of individuals, regardless of their primary disability, benefited significantly from supported employment participation. Further, data indicate that the individual placement model generated employment outcomes superior to those resulting from group employment options, particularly work crews. Implications of the results for future program development activities are discussed.

Persons with Disabilities↗
PubMed1998

Management competencies required of administrative and clinical practitioners in the new millennium.

Changes in the health care environment necessitate revisiting management-related competencies for both clinical and administrative practitioners. Major changes include the shift from recruitment to reengineering, direct service to multiple service models, department to program management, professional standards to market-driven standards, and single-system to multisystem management. Important competencies include the ability to identify and implement flexible staffing, to use communication technologies to support staff members across multiple sites, to understand of the business of health care, and to create innovative service delivery models consistent with the core values of the profession.

Administrative Personnel↗
PubMed1998

Community parenteral therapy project: a pilot study.

The pilot study reported in this paper was devised to develop and compare service delivery models that would achieve the provision of high quality parenteral therapy care to patients in the Gold Coast District Health Service community. All data were collected on 113 patients for a 12-month period, January to December 1996. The study compared the provision of outreach nursing services and contracted nursing services on measures of satisfaction and cost. The study showed that patient and carers indicated a preference for community care, medical officers advocated the benefits of administering parenteral therapies in the community, general practitioners were interested in managing future community parenteral therapies, and contracted (nurse) service providers endorsed the development of a parenteral therapy resource centre. The findings also revealed considerable potential cost savings in community-based care.

Adult↗
PubMed1987

Life Care at Home: a new model for financing and delivering long-term care.

In this paper we describe the Life Care at Home (LCAH) concept, a new long-term care insurance and service delivery model that combines the financial and health security of a continuing care retirement community (CCRC) with the freedom and independence of living at home. LCAH retains risk pooling for long-term care and provides other benefits and guarantees of CCRCs, including unlimited nursing home care. Because subscribers live in their own homes as long as they can, LCAH costs are substantially lower than those of CCRCs and more individuals can participate. Our market research indicates that LCAH has strong appeal among the elderly. We suggest that LCAH has a market potential of 10% to 25% of all elderly.

Aged↗
PubMed1999

Care of the mentally ill offender. A model service.

Caring for mentally ill offenders has been a contentious issue in almost all parts of the world. In some countries such as New South Wales in Australia, a humane approach has gradually evolved over the years. This paper describes a successful service delivery model for forensic patients in a metropolitan psychiatric hospital in Sydney. Issues relating to selection criteria, problems associated with caring for the mentally ill offender in a general psychiatric hospital environment and the integration of the forensic patients with civilian psychiatric patients are discussed.

Community Mental Health Services↗
PubMed2004

Does harm reduction programming make a difference in the lives of highly marginalized, at-risk drug users?

Harm reduction is a controversial model for treating drug users, with little formal research available on its operation and effectiveness. In order to advance the field, we first conducted participatory research of harm reduction with 120 clients using nominal-group technique to develop culturally relevant outcomes to measure progress. Second, we conducted focus group interviews with a different group of clients to help validate the outcomes. Third, we used the outcomes in an evaluation of the largest harm reduction program in New York City, which involved a representative sample of 261 and entailed baseline, post, and six follow-up assessments. The participatory research resulted in outcomes of 10 life areas important to drug users. Evaluation results showed that program participants made positive improvements across most outcomes, with the most substantial progress made in how clients dealt with drug-use problems. Along with their participation in the program, progress in some outcomes was also associated with clients' type of drug use (i.e., stable vs. chaotic), where more stable drug use was associated with better ways of making an income and types of housing. Surprisingly, progress was not associated with the kinds or numbers of services received or the length of time in the program. This was attributed to the service delivery model of harm reduction, in which clients are less inclined to associate their success with a single staff person or with a single service or intervention received than with the program as a whole.

Journal Article↗
PubMed2002

Paying for reproductive health services in Bangladesh: intersections between cost, quality and culture.

In 1997 a consortium of non-governmental organizations (NGOs) in Bangladesh began to implement health sector reform measures intended to expand access to and improve the quality of family planning and other basic health services. The new service delivery model entails higher costs for clients and requires that they take greater initiative. Clients have to travel further to get certain services, and they have to pay more for them than they did under the previous door-to-door family planning model. This paper is based on findings from a qualitative study looking at client and community reactions to the programme changes. It examines a number of barriers to access and constraints to cost recovery, including gender, class and ideas about entitlements, the role of government and obligations among people. The NGOs want to maximize cost recovery while making the basic services they offer accessible to most people. The findings suggest that this requires more than the establishment of an appropriate pricing structure. Attitudes related to charging and paying for services must also change, along with the institutional policies and practices that support them.

Attitude to Health↗
PubMed2026

Care Models for the Genetic Evaluation of Dilated Cardiomyopathy at Sites of the DCM Consortium.

BACKGROUND: Clinical genetic evaluation for patients with dilated cardiomyopathy (DCM) is minimally implemented and models of care are not defined. To understand current genetics care for DCM, a systematic needs assessment was conducted. METHODS: Principal Investigators (PIs) of the DCM Consortium convened at the Summer Scientific Symposium in July 2025. An electronic needs assessment was collected from the 24 PIs in advance to define current care models by evaluating which Heart Failure Society of America-recommended genetic evaluation components are conducted, by whom, and time required. Descriptive statistics were generated to characterize model features. Focus group discussions explored barriers and facilitators to implementing genetic services. RESULTS: Four care models emerged from the PI responses: 1 - Traditional-Synchronous (25%, n=6, requiring the most time per patient), 2 - Traditional-Asynchronous (33%, n=8), 3 - Externally Sourced (17%, n=4), and 4 - Physician/Advanced Practice Provider Conducted (25%, n=6, requiring the least time per patient). All models used genetic testing, whereas other components were implemented variably or not at all. Models 1 (15.7±4.1) and 2 (15.4±3.0) were rated more acceptable than Model 4 (9.8±2.9; 1 vs 4: p=0.027; 2 vs 4, p=0.023). Notably, 88% of PIs used genetic information for treatment decisions, including ICD placement (83%; n=20) or cardiac transplant (63%; n=15). Major facilitator themes from focus group discussions included having a genetic counselor on the HF team and developing authoritative standards directing provision of DCM genetic services. Barrier themes included operational challenges, limited personnel, clinician under-recognition, need for new service delivery models, and billing/reimbursement. CONCLUSIONS: DCM genetic care models and components were highly variable across the 24 sites of the DCM Consortium, even though all sites discussed similar factors that enable or hinder implementing genetic services for DCM. Understanding the basis of practice model variability may provide insight to yield more scalable care approaches.

clinical genetics↗
PubMed2026

Care Models for the Genetic Evaluation of Dilated Cardiomyopathy at Sites of the DCM Consortium.

BACKGROUND: Clinical genetic evaluation for patients with dilated cardiomyopathy (DCM) is minimally implemented, and models of care are not well defined. To understand current genetic care for DCM, a systematic needs assessment was conducted. METHODS: Principal investigators of the DCM Consortium convened at the Summer Scientific Symposium in July 2025. An electronic needs assessment was conducted among the 24 principal investigators in advance to define current care models by evaluating which genetic evaluation components recommended by the Heart Failure Society of America were conducted, by whom, and the time required for each component. Descriptive statistics were generated to characterize model features. Focus group discussions explored barriers and facilitators to implementing genetic services. RESULTS: Four care models emerged from the principal investigator responses: model 1: Traditional-Synchronous (25%, n=6, requiring the most time per patient); model 2: Traditional-Asynchronous (33%, n=8); model 3: Externally Sourced (17%, n=4); and model 4: Physician/Advanced Practice Provider Conducted (25%, n=6, requiring the least time per patient). All models used genetic testing, whereas other components were implemented variably or not at all. Models 1 (15.7±4.1) and 2 (15.4±3.0) were rated more acceptable than model 4 (9.8±2.9; model 1 versus model 4; P=0.027; model 2 versus model 4; P=0.023). Notably, 88% of principal investigators used genetic information for treatment decisions, including implantable cardioverter defibrillator placement (83%; n=20) and cardiac transplantation (63%; n=15). Major facilitator themes from focus group discussions included having a genetic counselor as part of the heart failure team and developing authoritative standards directing provision of DCM genetic services. Barrier themes included operational challenges, limited personnel, clinician under-recognition, need for new service delivery models, and billing/reimbursement. CONCLUSIONS: DCM genetic care models and components were highly variable across the 24 sites of the DCM Consortium, although all sites discussed similar factors that enable or hinder the implementation of genetic services for DCM. Understanding the basis of practice model variability may provide insight to yield more scalable care approaches.

cardiomyopathy, dilated↗
PubMed2006

Comparative analysis of state requirements for the training of substance abuse and mental health counselors.

Data on minimum state requirements for drug and alcohol counselors and mental health counselors in all 50 states and Washington, DC, suggest that training as a mental health counselor is primarily structured through formal education, whereas training as a substance abuse counselor resembles an apprentice model. Fewer states offer or require certification or licensure of substance abuse counselors, compared to mental health counselors. States that do offer such credentials for substance abuse counselors generally require more hours of supervised work experience and continuing education, but fewer hours of formal course work and practicum courses, and a lower level of formal education. Although these different models for training are valid, they each have different implications for clinical practice, dissemination of research findings to practice, and management within the service delivery model.

Certification↗
PubMedDate not supplied

Inclusion or pull-out: which do students prefer?

The purpose of this study was to better understand students' perceptions of and preferences for inclusion or pull-out service delivery models. Thirty-two students with and without learning disabilities who had participated in both models during the past 2 or 3 years were interviewed individually. Key questions assessed their perceptions of which model was most conducive to academic learning and which was most likely to yield social benefits, and the reasons for their beliefs. Results indicated that students' views varied. Overall, more children identified pull-out as the model of choice, but many children were confident that inclusion was meeting their academic and social needs. We interpret the results of this study as providing support for maintaining a continuum of service delivery options and for considering the placement of each child individually, based on his or her unique needs.

Achievement↗
PubMed2003

[After care for puerperal women. A literature review].

BACKGROUND: The length of stay in hospital after child delivery has decreased in almost all western countries over the last decades. It is unclear what the consequences of an early discharge regarding the feelings of women in childbed are and which types of caring after discharge are provided. AIM: To investigate the literature on how early discharge is defined and which are the consequences on young mothers. Particular focus is set on services including relief in household. RESULTS: The term "early discharge" is defined very broadly depending on each country and its health policy. The well-being of women in childbed, mostly influenced by fatigue and postnatal depression, has a frightening prevalence rate. It has been demonstrated that post delivery fatigue is not a short time disturbance of energy level but exhaustion lasting several months. Postnatal depression is rarely measured in women and accordingly, is not treated. All investigated longitudinal studies show that the assumption that physical and mental normality is restored within eight weeks is not true. The decision to discharge was rarely based on scientific knowledge but on economical factors. In the investigated after delivery service models practical services in household are hardly described. Housekeeping seems to be no part of interdisciplinary tasks. CONCLUSION: Satisfaction and self-experience in women after delivery seem to depend on their control of decision making about endurance, frequency and timing of support. Early discharge is increasing and must be accompanied by competent support and advice by well prepared home carers.

Aftercare↗
PubMed2005

Survey of clinical allergy services provided by clinical immunologists in the UK.

BACKGROUND: The UK National Health Service is failing to meet the need for diagnosis and treatment of allergic disorders, which are common and increasing in prevalence. The House of Commons select committee report on allergy services highlighted the inequalities and urgent need for investment. AIM: To survey the allergy workload provided by clinical immunologists to inform service planning and resource allocation. METHODS: The allergy services performed by clinical immunologists during a 12 month period from 1 April 2003 to 31 March 2004 were surveyed by means of a questionnaire via supra-regional audit groups. RESULTS: The immunology centres surveyed serve 32 million people and offer almost the complete repertoire of a specialised allergy service. There were large variations in clinic capacity, new referrals, appointment duration, and service configuration. Services were largely consultant delivered, but availability of joint clinics with paediatricians and anaesthetists was locally variable. Novel service delivery models utilising nurses and clinical assistants have been developed and merit further investigation. CONCLUSION: Consultant immunologists and trainees currently make a major contribution to the development and provision of specialised allergy services. Consultant immunologists will probably remain key providers of tertiary level allergy care in the UK in the long term (in line with other countries) and will be pivotal in supporting and developing the provision of equitable national access to specialist allergy services in a timely manner. Rapid progress in developing the new specialty of allergy and securing better access to services for patients in the short term will be best served by strengthening the collaborative relationship between allergists and clinical immunologists.

Adult↗
PubMed1997

A typological approach to the study of rural HIV service delivery networks.

Despite the rapid growth of AIDS cases in nonmetropolitan areas, little is known about the characteristics and needs of HIV-positive rural residents or how rural areas are responding to the epidemic. This paper proposes a typology for distinguishing among rural environments and examining variations in HIV service networks. The typology identifies three dimensions that have a major effect on the development of rural HIV service networks: degree of rurality, the prevalence of AIDS, and the epidemiological and demographic characteristics of the infected populations. Data from four case studies are used to illustrate how variations in rural environments can affect the organization and delivery of HIV/AIDS care. The typology contributes to public policy discussions by identifying key attributes of rural environments that influence program planning and implementation and the transferability of service delivery models.

Adolescent↗
PubMed1980

Support services in the school setting: the nursing model.

The multiple components of the school-based services for the handicapped are collapsed into a support service/instructional intent matrix which gives visual expression to new dimensions in school health services. Student needs for care and coping skills are addressed by a network of professional joint-practice arrangements built into a nursing service delivery model. A challenge is made to providers for a reciprocal relationship, to improve professional preparedness and thus promote access, excellence and equity in programs for the handicapped.

Child↗
PubMed2026

Substance use and co-occurring mental health conditions among adolescents and young adults in North America: a systematic review.

BACKGROUND: Substance use and co-occurring mental health conditions are common among adolescents and young adults and represent an important clinical and public health concern in North America. Trauma exposure, psychiatric symptoms, and social adversity frequently co-occur with substance-related problems in this population. This systematic review aimed to synthesize evidence on prevalence patterns, associated clinical and psychosocial factors, and care-related implications described in the literature on adolescents and young adults with substance use and co-occurring mental health conditions. METHODS: This systematic review followed PRISMA guidelines and was preregistered in PROSPERO (CRD42024581685). A systematic search was conducted in MEDLINE (Ovid), Embase, PsycINFO, and Google Scholar. Eligible studies examined adolescents and young adults (≤ 25 years) in North America. A combination of subject headings, keywords, and synonyms for the concepts "adolescents," "young adults," "substance use disorders," and "co-occurring mental health conditions" was used. Of 1,882 records identified, 29 studies met the inclusion criteria. Given the heterogeneity of the literature, findings were synthesized narratively. RESULTS: The included studies showed heterogeneity in population, setting, denominator, and ascertainment method. Across the literature, depressive, anxiety-related, trauma-related, and externalizing mental health presentations were frequently reported alongside substance-related problems in adolescents and young adults. Trauma exposure, adverse childhood experiences, and broader social adversity were also commonly reported in association with substance-related problems across studies. Care-related implications were more limited and were largely derived as future directions mentioned across studies rather than direct evaluations of youth-specific service models. CONCLUSION: Co-occurring mental health and substance-related problems were frequently reported among adolescents and young adults in high-risk and service-engaged populations in North America. Trauma and social adversity were prominent across the reviewed literature, while direct evidence for evaluated, integrated, youth-specific care models remains limited. These findings support the relevance of developmentally appropriate, integrated, and trauma-informed approaches to care and highlight the need for further research directly evaluating improved service delivery models for this population. CLINICAL TRIAL NUMBER: Not applicable.

Humans↗
PubMed1992

Job ending among youth and adults with severe mental illness.

This study examined job leaving over a 36-month period among 326 persons (74 youth and 252 adults) with severe mental illness who were participating in an urban vocational rehabilitation program. Data from 627 job endings indicated that younger clients displayed job-ending patterns that were different in some aspects from such patterns for nondisabled youth (such as displaying a lower average job tenure) yet similar to job-ending patterns for nonhandicapped youth in other ways (such as displaying a high frequency of job changing). Youth and their adult counterparts with mental illness displayed similar tenure on agency-sponsored placements but significantly different tenure on independent jobs. While adults held their independent jobs for an average of seven months, youth averaged only three months at competitive employment. Youth also were significantly more likely than adults to be fired from both placements and independent jobs. These findings and others are discussed in terms of their implications for development of public policy and service delivery models for providing on-going job support to youth and adults with severe psychiatric disabilities.

Adolescent↗