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PubMed2004

Special section: the most critical unresolved issues associated with contemporary vocational rehabilitation for substance users. The critical relationship between employment services and patient motivation.

Several interventions and service delivery models now exist to help unemployed people in treatment for substance use disorder seek gainful employment (Platt, 1995). Some of these interventions can be conveniently offered within substance user treatment settings. One of the best known examples of these interventions is job seeking skills training and support services that help patients develop resumes, complete employment applications, learn effective networking strategies, and develop and practice effective responses to common issues and questions raised during employment interviews. A wide range of more comprehensive off-site employment programs that provide intensive vocational training and rehabilitation also exist in many communities. The growing availability of on-site services in substance user treatment programs also creates the

Employment↗
PubMed1989

Models of vocational assessment of handicapped students.

During the last twenty years, increasing emphasis has been placed upon the provision of comprehensive vocational assessment to disabled and disadvantaged persons to assist them in obtaining employment. Vocational evaluation programs have proliferated in rehabilitation facilities, manpower programs, vocational-technical schools and public schools. An increasing body of literature and research has delineated service-delivery models and competencies needed by vocational evaluation specialists. Increasing numbers of universities have implemented graduate training programs in vocational evaluation; and a national professional certification process has been developed. Most of this activity has been centered at rehabilitation facilities at the same time that public schools are becoming the norm for educating disabled students. As vocational assessment for disabled students moves into this relatively new setting, it is being modified. This article explores models of vocational assessment for disabled students which incorporate modifications to suit the special needs of the public school setting.

Persons with Disabilities↗
PubMed1992

Family-centered early intervention: an opportunity for creative practice in speech-language pathology.

Services for developmentally delayed children from birth to age three consider the family first. Eligibility for services is determined through a multidisciplinary assessment. Once a child qualifies for service, a multidisciplinary team that includes the family develops an IFSP. The SLP may serve as the service coordinator for the plan or as a team member. The plans must contain specific information that includes documentation of current status and major outcomes for the coming year. An SLP may find that contributing effectively to an IFSP requires new competencies. First, the SLP will need to learn to function in the family-centered, multidisciplinary process of early intervention. Second, the SLP may need to develop creative models to deliver effective service. SLPs can contribute valuable information to the IFSP by finding ways to activate daily life routines to promote a child's communication skills. SLPs can explore the child's life-space, including routines and partners, as a source of contexts for treatment. SLPs also can explore partner communication strategies, note their effects on the child's communication experiences, and recommend additional strategies for treatment. The case study illustrated an individual, home-based intervention program (Gillette, 1989; Lombardino and Magnan, 1983). Other service delivery models can include classroom-based approaches (Wilcox, Kouri, and Caswell, 1991); group parent training approaches (Weistuch, Lewis, and Sullivan, 1991; Cheseldine and McConkey, 1979); and video-assisted approaches (McConkey, 1988; Johnson and Harrison, 1990; Gillette, in press). Many SLPs may find that the process of early intervention with the birth-to-three population offers unique opportunities for practice in their profession. To function effectively in this process, the SLP needs communication-based information to promote the child's communication skills within his or her daily life and sensitivity with which to design a plan that considers the family first, yet meets the needs of the child. Although alternative models of delivering speech-language service have been explored, the process of early intervention will continue to require professionals who can creatively match family priorities with the child's intervention needs.

Child↗
PubMed1996

Waiting times: the search for equitable solutions. Case study: Mater Misericordiae Adult Public Hospital Continuum of Care Model.

For the survival of any health care organisation, evidence-based practice is fundamental, particularly in today's economic climate. The Mater Misericordiae Adult Public Hospital in Brisbane is committed to providing a flexible health care system that is responsive and accountable to the needs of the customers. As part of the Mater's continuous quality improvement program, a Continuum of Care Service Delivery Model was developed. This model comprises many innovative clinical management systems which have evolved over recent years. Clinical pathways, care management, pre-admission clinics, variance management and evidence-based practice are core components of the model.

Admitting Department, Hospital↗
PubMedDate not supplied

Care of the elderly as a global nursing issue.

The size of the world's elderly population is growing at a rapid rate, with the 60 and older population of Europe and North America outpacing total population growth in recent decades. As life expectancy lengthens, the quality of that life becomes an issue of importance to nursing practitioners and nursing educators. Developed countries and developing countries will be faced with different challenges when determining service delivery models for their aging populations. Innovation in delivery models and comprehensive and longitudinal data are needed if the goal of aging in place is to be achieved.

Aged↗
PubMedDate not supplied

The challenges of eliminating racial and ethnic health disparities: inescapable realities? Perplexing science? Ineffective policy?

Despite the accomplishments of American medical science and the impressive array of healthcare facilities and service delivery models available in this country, the existence of significant health disparities is a matter of urgent national and state health policy priority. Policies to address these issues should address fundamental problems having to do with access to care (such as health insurance coverage and the availability and the geographic and culturally-appropriate accessibility of personal health services), the educational preparation of healthcare professionals for the challenge of caring for the increasing diversity of patients in a truly "patient-centered" healthcare system of the future, efforts to deal with widespread problems of health literacy that reduce the likely impact and effectiveness of healthcare, and a more aggressive effort to assure that future medial science continues to include minorities and women (and they continue to participate) as subjects in clinical trials of innovative therapeutic interventions. The policy agenda to address these issues is both broad and demanding, as would be expected of any set of problems which is so widespread and complex. But, America is no stranger to challenges, and few are more worthy of the effort than this.

Ethnicity↗
PubMed2003

Identifying best practices of community participation in providing services to refugee survivors of torture: a case description.

There is an increased interest in best practices in the design and implementation of specialized programs for refugee survivors of torture. The processes taking place in the development of such a program also warrant assessment. In particular, this paper addresses the importance of community participation. Using the Host Support Program for Survivors of Torture as a case study, we identify the community participation practices that emerged during stages of program development and describe how these practices have made possible a collaborative service delivery model and facilitated community capacity building that addresses the complex needs of refugee survivors of torture. The process of community collaboration is discussed as central to the process of effective community participation and organizing. The illustrated benefits of community participation position this model as a best practice.

Alberta↗
PubMed2001

The fall and rise of the South Australian telepsychiatry network.

The Rural and Remote Mental Health Service (RRMHS) has delivered telepsychiatry services through the use of videoconferencing to South Australian communities since May 1994. The survivability of the service results from a combination of factors that have seen the RRMHS expand to 48 centres and deliver an average of 100 clinical sessions a month. The key factors responsible for the success of the service lie in the model of service delivery, management support, and the implementation of a system for the scheduling and reporting of videoconference activity. The current model of service delivery has evolved over the past seven years and is fundamentally different to the infrastructure established at the implementation stage of the project. A retrospective analysis shows the shift in service delivery models necessary for the sustainability of telepsychiatry services in South Australia.

Community Mental Health Services↗
PubMed2003

Antiretroviral therapy in a community clinic--early lessons from a pilot project.

OBJECTIVES: To report on operational and clinical problems encountered during the first 6 months of a community-based antiretroviral therapy (ART) programme. METHODS: ART was implemented in a primary care setting utilising an easily replicable service-delivery model based on a medical officer and nurse. Therapeutic counsellors, themselves HIV-infected, provided counselling and adherence support. Drug and monitoring costs were charitably funded and provincial health authorities supplied the medical infrastructure. The HIV Research Unit, University of Cape Town, supplied training and additional clinical support. Local HIV primary care clinics provided patient referrals. Standardised ART regimens were used with strict entry criteria (AIDS or CD4 count < 200 cells/microliter). RESULTS: Demand for the service was high. Referred patients had advanced disease (AIDS 57%, median CD4 count 96/microliter) and high pre-treatment mortality (83/100 person-years). Mycobacterial disease was a major contributor to this mortality (40%). Scheduled clinic visit hours were six times higher during recruitment than maintenance. Attributable costs were: drugs 61%, staff 27%, viral load and CD4 cell counts 10% and safety monitoring 2%. Viral load after 16 weeks of therapy was < 400 copies/ml in the first 16 patients. CONCLUSIONS: ART can be successfully implemented within a primary care setting. Drug purchases and staff salaries drive programme costing. The service model is capable of managing 250-300 patients on chronic ART, but staffing needs to be increased during recruitment. Attention must be given to the diagnosis of tuberculosis during screening and early ART. Incorporating therapeutic counsellors into the programme increased community involvement and utilised a valuable and previously untapped resource.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Recurrent pain, emotional distress, and health service use in childhood.

OBJECTIVES: To determine the psychosocial correlates of recurrent pediatric pain and its relationship to health service use and medical presentations for "unexplained" symptoms in primary care. STUDY DESIGN: Children 4 to 15 years of age who complained frequently of aches and pains to parents were compared with those with infrequent or no pain on measures of demographics, psychopathology, school attendance and performance, perceived health, and service use. Univariate analysis was followed by logistic regression. RESULTS: Children who complained often of aches and pains used more health services, had more psychosocial problems, missed more school, and did worse academically. After controlling for health service use and demographics, recurrent pain was significantly associated with negative parental perceptions of child health and the presence of internalizing psychiatric symptoms. Higher levels of ambulatory health service use were associated with negative perceptions of child health, recurrent pain, visits for "unexplained" symptoms, and internalizing psychiatric symptoms. CONCLUSIONS: Pediatric recurrent pain challenges traditional service delivery models characterized by segregated systems of care for physical and mental disorders. Longitudinal and psychobiological studies of the relationship between recurrent pain, internalizing psychopathology, and health beliefs are warranted to direct future treatment efforts.

Adolescent↗
PubMed2000

Transforming Allied Health.

In 1995, the Division of Allied Health at the Women's and Children's Hospital Adelaide (WCH) began a process of critical review of its service delivery models and organisational structure in order better to meet the vision and values of the WCH and the needs of consumers. This paper describes the change management process. Barriers to and facilitators of change are highlighted. The outcomes of the change process are described, including the new multidisciplinary team and program-based organisational structure and culture.

Adult↗
PubMed2006

An evaluation of the "Youth en Route" program.

Youth En Route (YER) is a transition program for youth and young adults with multiple disabilities. It offers a multifaceted approach that includes self-discovery, skill development, and community experience. Underlying the service delivery model is a philosophy of self-determination. This program evaluation measured the self-determination skills, sense of personal control over life choices, and community participation of 34 youth prior to and one year following their involvement with YER. Youth reported statistically and clinically significant improvement from pretest to posttest with respect to both self-determination and sense of personal control. Moreover, youth reported spending significantly more time at posttest than at pretest engaged in volunteer/work activities and community leisure activities. On average, youth reported high satisfaction with YER services. Practical and research implications are discussed.

Adolescent↗
PubMed1990

Shared-risk arrangement between employers and insurers.

Development of and initial experience with a shared-risk arrangement between an employer, Allied-Signal, Incorporated, and a health insurer, CIGNA Corporation, are discussed. Rapidly rising health-plan costs and projections for even greater increases in the next three years, coupled with other related considerations, spurred Allied-Signal to undertake a major re-evaluation of its employee health plan in 1987. After extensive discussions and consultation, Allied-Signal negotiated a shared-risk contract with CIGNA, a dual-option insurer, under which premium price increases are capped for a period of three years. CIGNA is at risk for any costs that exceed premium revenue; if costs are less than premium revenue, CIGNA will retain the surplus. Price and geographic accessibility to Allied-Signal beneficiaries were the two key factors in the choice of CIGNA Corporation. The company selected a point-of-service delivery model, which grants employees greater freedom of choice in the use of health-care providers; those who use network providers pay a fixed copayment while those who use nonnetwork providers pay a fixed copayment providers pay an annual deductible plus 20% of medical expenses incurred above the deductible. During the first year of the program, 75% of beneficiaries used network providers from 95% to 100% of the time. The actual costs for the first 18 months were less than projected and much less than increases experienced by fee-for-service plans during that same period. The shared-risk contract between Allied-Signal and CIGNA Corporation has been successful thus far.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost Control↗
PubMed2004

Point-of-care monitoring of anticoagulant therapy by rural community pharmacists: description of successful outcomes.

Warfarin is a recognised high-risk drug for adverse events. Patients from rural and remote regions are at increased risk of these events because of problems of access to health care providers and services, and there is some reluctance to prescribe warfarin to patients in rural areas because of the difficulties in monitoring anticoagulated patients. The availability of portable international normalised ratio (INR) monitors is particularly attractive in rural or remote settings because of the lack of access to pathology services. Pharmacists and other health professionals in rural areas are ideally placed to assist general practitioners in the management of their anticoagulated patients through the use of portable INR monitors. The present article describes three cases of successful outcomes of pharmacist-assisted anticoagulation monitoring in the rural setting. Innovative service delivery models like these are needed to meet the needs of the increasing number of rural Australians requiring warfarin therapy.

Anticoagulants↗
PubMed1993

Health work force planning in the 90s, Part II: Enough in the right place at the right time?

The focus of this discussion has been on achieving a distribution of health care professionals that meets the objective of making health services available to the total population. The need for a systematic approach to planning, not only for the health care work force, but for the system in general, has been recognized as the highest priority for the health care systems of industrialized countries for over a decade. Overall, the goal of health care work force planning the world over is "to provide the right type of education and training for the right number and type of people needed to render effectively and safely the right types of service when and where required by the population." What is needed is a readiness to evaluate existing service delivery models, to retain those found to be effective and efficient, and to re-direct resources from outdated or ineffective strategies into new approaches found to better meet this goal. We need to envision the health care work force as a whole; work toward making it as efficient as possible, and thereby maintain our national commitment to universal health care.

Canada↗
PubMed1993

Integrated play groups: a model for promoting the social and cognitive dimensions of play in children with autism.

This investigation provides a description of a multifaceted model to promote peer play, and an evaluation of its impact on the social and cognitive dimensions of play in three children with autism. A combination of quantitative and qualitative methodologies were used to evaluate the effectiveness of the model application. A multiple-probe design across participants demonstrated (a) decreases in isolate play and collateral gains in more social forms of play, and (b) decreases in stereotyped object play and collateral gains in functional object play. While no symbolic play was observed in any of the participants during baseline, two participants demonstrated symbolic play in the final condition. Generalization and social validation measures indicated (a) advances in play behaviors were not limited to the play groups but observed in other contexts, and (b) were accompanied by language gains. Implications are discussed in terms of preferred service delivery models as well as of the importance of social interaction for the development of play and language.

Autistic Disorder↗
PubMed2006

Developing research capacity building for Aboriginal & Torres Strait Islander health workers in health service settings.

INTRODUCTION: Aboriginal and Torres Strait Islander health workers (hereafter called health workers) can play a major role in facilitating culturally appropriate health care delivery and program development through the acquisition of improved skills in the planning, monitoring and evaluation of these programs (RCB). However, many Aboriginal and Torres Strait Islander people and communities remain concerned about research and related activities. Health workers are well placed to assist communities to not only embrace research, but to be active players and promoters of relevant, appropriate and acceptable research. One means of achieving the twin goals of RCB and community acceptance and involvement in research, is through health workers undertaking research of health priority issues and evaluation of activities, such as program delivery, that are of direct relevance to their community's aim of improving or enhancing service delivery. This article outlines the development and content of a community-based RCB framework for health workers. The focus is on the major issues that enhance a proactive service delivery model using culturally appropriate research methods. Development process: The RCB framework described here was developed, over a period of time, through community workshops and consultations aimed at deriving general consensus on the key issues and components of a culturally-appropriate, community-based training process. The framework has subsequently been reviewed by Aboriginal and Torres Strait Islander community representatives from across Australia. The overall aim of the framework is to supplement current (institutionally-based) education and training resources for health workers with community-based research training modules. These modules can be tailored to provide research and evaluation skills relevant to health workers taking a more proactive role in facilitating health and wellbeing programs in their own communities. The use of collaborative consultation and participatory methods are intended to be a two-way education process. Course content: A visual pathway is used that encompasses the impact of health and practice in the community for health workers at a grass-roots level. This enables elements of the RCB process to be divided into a series of connected modules. These are: (i 'assessing' Existing Services; (ii) methods and measures for Identifying Need at various levels; (iii) important issues in Program Development; (iv) how the former contributes to Service Improvement; (v) resultant Outcomes that will impact on community and service provision; and (vi) Evaluation Methods and applying findings to service delivery. CONCLUSIONS: Active participation by the Aboriginal and Torres Strait Islander community is fundamental for effective research practices and outcomes. The aim is to provide health workers and community members with a working knowledge of research ethics and methods so that they can assist, monitor and steer the development of culturally appropriate research activities that will lead to provision of the highest quality services 'back' to the community. This RCB framework will enable health workers to be more proactive, self-reliant and self-sufficient within their community and healthcare settings.

Community Health Planning↗
PubMed1997

The development of a model for geodesic learning: the geodesic information processing model.

The current article suggests that alternatives to the current traditional learning methods are essential if learning institutions are to provide people with effective life skills that enable them to be autonomous learners. This suggestion is based on a body of literature on alternative learning which stresses the need for fundamental change and hence, a paradigm shift in the perception of learning in order to cope with the world-wide information explosion. The alternative non-traditional approach proposed is geodesic learning which stresses learning how to learn and self-directed inquiry as essential life-skills which enable systems as well as the people in the systems to bring about their own transformation in response to changing situations and requirements. The current article discusses an alternative service delivery model, the geodesic information processing model, which falls within the realms of the geodesic philosophy. The implications of this alternative approach for the speech-language therapist are discussed.

Child↗