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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↗
PubMed2006

Improving drug treatment services for Hispanics: research gaps and scientific opportunities.

Delivery of services to Hispanic drug users remains a great challenge, as shown by low service access and retention, and disproportionate negative consequences of drug abuse in the Hispanic population. This paper provides a critical analysis of current services research on Hispanics with drug abuse problems, identifies gaps in the knowledge, and offers recommendations for scientific opportunities to address these gaps, focusing on four central needs: (1) the need to understand the circumstances of Hispanics in their own communities (i.e., community context); (2) the need to develop and test service delivery models tailored to Hispanics' circumstances and special needs; (3) the need to remove client, provider, and system barriers to utilization; and (4) the need to establish links between drug abuse services, social services, and other service sectors to optimize treatment outcomes. The authors suggest an approach that begins with a focus on the local Hispanic community and builds understanding of the cultural context, inclusion of indigenous resources, recognition of barriers to enrollment and retention, and coordination of related services.

Hispanic or Latino↗
PubMed1995

The role of social workers in providing comprehensive health care to pregnant women.

Prenatal care is an important women's health care issue. Numerous studies have shown that early monitoring and continuous care during pregnancy is associated with more favorable birth outcomes. Using data from a survey of service providers, this paper describes innovative service delivery models that are a part of Washington state's new, comprehensive maternity care system. Washington's program departs from traditional medical prenatal care in making both support and case management services available to pregnant women. The services are described, highlighting the roles that social workers play in providing maternity services.

Female↗
PubMed2006

Improving the supervision of therapy assistants in Western Australia: the Therapy Assistant Project (TAP).

INTRODUCTION: Multidisciplinary therapy assistants (TAs) are increasingly seen as a model suited to the provision of allied health services in rural and remote areas. Supervision is a key aspect of therapy assistant practice. The rural context presents many challenges in supervising TAs including: a multidisciplinary TA role, outreach service delivery models, inexperienced allied health professionals (AHPs) and a high turnover of AHPs. At present there are no accepted standards for supervising TAs in this context. This study aimed to improve the supervision of TAs by AHPs in a rural setting. Improving supervision formed one aspect of the Therapy Assistant Project (TAP). METHODS: Minimum standards for supervision were developed, a process for recording TA supervision introduced, and training in supervision skills was delivered to AHPs. A mixed method study design was used to determine the impact of introducing minimum standards and supervisor training on supervision practices. RESULTS: Minimum supervision standards included: program and administrative discussion, observation, and demonstration of therapy sessions. Methods recommended for supervising allowed regular supervision of TAs in small, distant rural towns. Developing minimum standards for supervision, a process for recording supervision, and training in supervisory skills resulted in increased supervision between AHPs and TAs. AHP and TA participants expressed satisfaction with minimum supervision standards. The frequency and amount of supervision increased although videoconferencing for supervising TAs in distant towns was not widely used for supervision. CONCLUSION: This study provides a new resource for supervision practices for rural TAs. The minimum standards for supervision would be a suitable resource to assist health services seeking to improve supervision of TAs or commencing a TA program. Further exploration of the use of videoconferencing for supervising TAs in distant rural towns is suggested. Training in supervision skills for AHPs should include introductory and complex supervision methods. This study represents one step in defining standards for rural and remote TA practice.

Allied Health Personnel↗
PubMed2000

Building home care into managed long-term care: the VNS CHOICE model.

New approaches to home and community-centered long term care offer strategic opportunities for home health providers to thrive by providing expanded service options for the growing population of chronically ill, frail elders. The traditional expertise of home health providers makes a powerful combination with the flexibility of capitation financing to successfully meet both the needs of dually eligible older adults and government mandates to reduce overall expenditures. VNS CHOICE, a home-centered, managed long-term care program, is built on the principles and delivery system of home health care. By understanding the VNS CHOICE service delivery model and lessons learned from its first two years of operating experience, home care providers across the country may identify innovations to incorporate into their agency product lines.

Aged↗
PubMedDate not supplied

A Canadian perspective on learning disabilities.

Canadian practice and research with children and adults with learning disabilities are described and analyzed. After an examination of the historical basis for current practice, the societal and cultural factors affecting education of children with learning disabilities, services for adults, and research are discussed. It was found that policy and legislation regarding special education vary considerably from province to province, and identification practices and service delivery models vary even within provinces. The fact that Canada has two official languages (English and French), a large multicultural community, and a Native population with special needs often arising from poverty has an impact on the education of children with learning disabilities and on sample description in research. Although school-age children are relatively well served, services for preschool children and adults with learning disabilities are minimal. The positive features of Canadian service delivery are that most programs are publicly funded, decision making tends to be nonadversarial and collaborative, and the needs of the whole child are typically considered.

Adult↗
PubMed2002

Collaborative medication management services: improving patient care.

OBJECTIVE: To implement and evaluate a collaborative medication management service model. DESIGN: Participatory action research. SETTING AND PARTICIPANTS: The study was conducted from March 1999 to March 2000; 1000 patients, 63 pharmacists and 129 general practitioners from six Divisions of General Practice in South Australia participated. INTERVENTIONS: A collaborative service delivery model, involving a preliminary case conference, a home visit and a second case conference, was agreed through discussions with medical and pharmacy organisations and then implemented. OUTCOME MEASURES: Medication-related problems; actions recommended; actions implemented; and outcomes after actions taken. RESULTS: Overall, 2764 problems were identified. The most common medication-related problem (17.5% of all problems) was the need for additional tests. Thirty-seven per cent of problems related to medicine selection, 20% to patient knowledge, and 17% to the medication regimen. Of 2764 actions recommended to resolve medication-related problems, 42% were implemented. Of the 978 problems for which action was taken and follow-up data were available, 81% were reported to be "resolved", "well managed" or "improving". CONCLUSION: This implementation model was successful in engaging GPs and pharmacists and in assisting in the resolution of medication-related problems.

Aged↗
PubMedDate not supplied

Family planning operations research in Africa: reviewing a decade of experience.

Between 1979 and 1990, Columbia University conducted 26 family planning operations research (OR) projects in 13 sub-Saharan African countries. Most of these projects were implemented in settings where family planning service delivery had not yet been initiated or was new and poorly developed. In keeping with program needs in the early stages of development, the majority of the OR projects were based on demonstration or diagnostic designs. Only four of the 23 projects were comparative or quasi-experimental in design. Projects demonstrated the growing demand for family planning, and the feasibility and acceptability of a range of service delivery models. Sixteen of the projects have been sustained or replicated by national or local governments and institutions following the initial OR phase, replication of two others is planned, and another four resulted in policy formulation or improvements in existing national programs. OR in Africa played an important role in generating political and medical support for contraceptive services, and served to improve project management. OR proved more useful in the implementation and strengthening of individual programs than in generating universal lessons regarding service delivery. In order to maximize OR's utility in Africa, simple research designs and methods should be adopted.

Africa↗
PubMed1997

Integrating primary care and methadone maintenance treatment: implementation issues.

Linking primary medical care with methadone maintenance treatment brings critical services to drug users, many with HIV/AIDS, tuberculosis and other illnesses. However, a variety of important philosophical, ethical, and systems issues may impede the process of implementing a "linked" service delivery model. Conflicting paradigms, such as the traditional "doctor-patient" relationship with its emphasis on continuity of care and the substance abuse treatment model of limit-setting and behavioral consequences, create tension in the treatment system. This article describes these tensions and uses clinical vignettes to demonstrate how to address these implementation issues. In conclusion, solutions are proposed for successfully integrating services for medically ill substance abusers.

Adult↗
PubMed2002

Chronic disease guidelines and the indigenous Coordinated Care Trials.

The establishment of the NT Coordinated Care Trials in 1997 provided an opportunity for the funding and development of detailed guidelines, designed specifically for the Indigenous population, covering screening and clinical management of major chronic diseases. All guidelines were incorporated into the NT Coordinated Care Trials Information System on the Tiwi Islands and in the Katherine West region, and used to generate individual and population care plans. In contrast to what is usually written, a broad range of guidelines can be developed in a relatively short period of time utilising a dedicated multi-disciplinary team and local working groups. Having a receptive service delivery model, such as the Coordinated Care Trials, allows for a high level of uptake and use. The key features were the linking of guidelines to a computerised information system that translated them into items of service and presented them to the clinician at the time of consultation, combined with ongoing education of clinicians and clients.

Australia↗
PubMed2000

Attitudes toward family-centered care and clinical decision making in early intervention among physical therapists.

Family-centered care is the mandated service delivery model in early intervention. The purpose of this study was to examine the attitudes of physical therapists toward family-centered care and to describe clinical decision making factors in determining frequency and duration of service. A convenience sample of 25 physical therapists working in early intervention participated in a mail survey. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and the Physical Therapist Questionnaire. Mean subscale scores on the modified version of the MPOC-SP varied from 6.04-6.43 on a seven-point scale with highest scores on the Respectful and Supportive Care subscale. Therapists' attitudes toward family-centered care correlated with attitudes toward direct intervention items (r = 0.43-0.66, p < 0.05). Child considerations were most important to therapists and administration considerations were least important when determining levels of service. Results suggest that therapists are sensitive to the needs of families and children and value parents as partners on the early intervention team. The relationship between therapists' family-centered care attitudes and intervention are consistent with a systems approach. Results on clinical decision making reflect the role of the physical therapist in early intervention and suggest a potential conflict with administrative policies when determining levels of service.

Journal Article↗
PubMed1987

[Development of community-based services for the mentally handicapped in the USA--on the way toward an integrated life].

Services for mentally retarded adults have undergone major changes over the past 15 years in the United States of America. Through the impact of "normalization", the calls for implementing fundamental civil rights for all citizens, and by applying methods of an essentially behavioural nature, services have gradually been moved out of the institutional sector and into the local communities. A regional service delivery model established in the state of Nebraska illustrates this development toward individualized living and competitive employment in the community.

Community Mental Health Services↗
PubMed1984

A description of independent living projects in the United States: various programmatic strategies for fiscal coping.

Independent living facilities in the United States provide numerous services to a large number of residential clients using a diversity of human service personnel. The facilities are often homogeneous in the range of services offered, the large nature of the facility, client population, staff, and sometimes budget. Most facilities feel that various styles of residential programs should be researched. A clearly defined service delivery model and fiscal models for prudent operations appears to be lacking in most agencies. Almost all the programs rent part of their building space to outside business interests. An absence of Federal money would eliminate or vastly reduce the services of most of the surveyed programs.

Activities of Daily Living↗
PubMedDate not supplied

Marketing telehealth to align with strategy.

Telehealth is a twenty-first century solution to an old problem-how to deliver quality health services with shrinking resources. Telehealth enables healthcare providers to interact with and monitor patients remotely, thus adding value to service delivery models. On occasion, telehealth can substitute for live encounters, saving time and resources. Furthermore, as the geriatric population increases, telehealth will support independent living by supplementing the existing network of care. To be used most effectively, however, telehealth services must be carefully planned and executed. This study investigated management practices used to promote telehealth services, focusing on strategic goals for adopting telehealth. Interviews with senior managers from 19 home health agencies identified three strategic goals for adopting telehealth: (1) clinical excellence, (2) technological preeminence, and (3) cost containment. Organizational documents were analyzed to determine the extent to which the telehealth program was featured in marketing materials. Documents included the organization's brochure, newspaper ads and articles, and each home health agency's web site. Results showed that marketing practices vary widely but are correlated with motivations to adopt telehealth. The organizations with the highest marketing scores emphasize clinical excellence as a major reason for using telehealth, whereas those with the lowest marketing scores tend to focus on cost containment. Although this study focused on management practices in home health agencies, results are applicable to hospital and outpatient services as well as to other community-based programs. Using a strategic management framework, the authors offer recommendations to help organizations develop effective marketing approaches for telehealth programs.

Guidelines as Topic↗
PubMed2002

Strengthening primary health care: building the capacity of rural communities to access health funding.

Present health funding models can place onerous pressures on rural health services. Staff may lack the time, resources, access to data, and the expertise needed to complete complex and lengthy funding submissions. This present study describes an innovative capacity-building approach to working with Victorian rural communities seeking to access health care funding through the Regional Health Services Program. This approach used several strategies: engaging stakeholders in targeted rural communities, developing an information kit and running a workshop on preparing submissions to the Regional Health Services Program, facilitating community consultations, and providing ongoing support with submissions. Six rural communities were supported in this way. Four have been funded to date, with a combined annual recurrent budget for new primary health care services of over $2.5 million. Each community has developed a service delivery model that meets the particular needs of their local area. This capacity-building approach is both effective and replicable to other health funding opportunities.

Budgets↗
PubMed2005

A pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care-methodology of the Palliative Care Trial [ISRCTN 81117481].

The demand for palliative care is increasing, yet there are few data on the best models of care nor well-validated interventions that translate current evidence into clinical practice. Supporting multidisciplinary patient-centered palliative care while successfully conducting a large clinical trial is a challenge. The Palliative Care Trial (PCT) is a pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status and pain intensity. Four hundred sixty-one consenting patients and their general practitioners (GPs) were randomized to the following: (1) GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care in Adelaide, South Australia (3:1 randomization). Main outcome measures included patient functional status over time, pain intensity, and resource utilization. Participants were followed longitudinally until death or November 30, 2004. The interventions are aimed at translating current evidence into clinical practice and there was particular attention in the trial's design to addressing common pitfalls for clinical studies in palliative care. Given the need for evidence about optimal interventions and service delivery models that improve the care of people with life-limiting illness, the results of this rigorous, high quality clinical trial will inform practice. Initial results are expected in mid 2005.

Aged↗
PubMed1996

Mental health services for rural elderly: innovative service strategies.

This paper reviews issues in planning and delivering mental health services to rural dwelling elderly. First, comparative data on the prevalence of mental illness among rural elderly, and the availability and accessibility of mental health services in rural areas are presented to provide a basis for subsequent discussion. Next, several strategies for improving the development and delivery of geriatric mental health services to rural areas are discussed. These include: increasing the number and quality of rural mental health providers; adapting or developing diagnostic techniques to improve case identification among rural elderly; providing culturally sensitive mental health services; strengthening informal and formal care linkages in rural communities; developing innovative service delivery models building upon the strengths of rural settings; and emphasizing fluidity as well as continuity in treatment models.

Aged↗
PubMed1995

Fieldwork in schools: a model for alternative settings.

OBJECTIVE: An exploratory study was conducted at the University of New Hampshire to increase the number of school-based fieldwork opportunities for occupational therapy students and to guide the development of a model for first-time fieldwork supervisors in schools. METHOD: Responses to a questionnaire completed by 119 occupational therapists working in schools in northern New England provided a description of both school-based occupational therapy practice and of their needs as supervisors. Interviews with 12 occupational therapists who had supervised fieldwork students in schools provided qualitative information. RESULTS: Findings suggested that school-based practice issues such as working part time, traveling between schools, and using a variety of service delivery models created particular challenges for fieldwork supervisors in schools. A process of addressing fieldwork supervisors' concerns during recruitment and in a fieldwork supervisor seminar and providing ongoing support resulted in successful fieldwork experiences for occupational therapy students. DISCUSSION: This process of studying a practice setting in order to develop a model for fieldwork that addresses the uniqueness of the setting may be used to develop fieldwork opportunities in other practice settings as well.

Child↗