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PubMed2001

The development of a community-based comprehensive mental health service delivery system for the Cayman Islands (1989-2001).

This paper reviews the development of mental health services in the Cayman Islands throughout a twelve-year period (1989 to 2001). I was appointed the resident consultant psychiatrist to the islands in 1989, after which time a consultative process between the Ministry of Health, Senior Management of the George Town Hospital and myself allowed the development and establishment of a comprehensive community-based mental health service delivery system (MHSDS), specifically designed to suit the needs of the Cayman Islands. The components of the MHSDS and their evolution in the absence of adequate facilities are reported. The framework for the service is outlined, and the concerns and objectives of the MHSDS are discussed, along with short-term and long-term goals.

Community Mental Health Services↗
PubMed1997

Nursing science in the global community.

Knowledge development and research are generally embedded in cultural values and perspectives. This article examines the development of knowledge in nursing in a global context and addresses the degree to which Western values and the social environment in the United States shape nursing theory development. Three perspectives illustrate the influence of US values and contextual factors. Questions are raised about the relevance of knowledge to other cultural or national contexts. Recommendations are made for nursing inquiry that makes knowledge more applicable to the global community.

Cultural Characteristics↗
PubMed1986

The meaning of community in community mental health.

This article critically reviews the development of community mental health in both theory and practice and explores new directions and dilemmas for future policy and programs. First, we trace the dialectical development of the ideology of community mental health and the rediscovery of community. Second, we outline the two key transitions: (a) from professionals to natural helpers and (b) from catchment areas to natural networks. Third, we offer alternative conceptions of community from the sociological literature and suggest ways that these can benefit new program planning. We conclude with a series of policy questions that legitimate the expansion of community mental health beyond the parochial confines of the local community.

Catchment Area, Health↗
PubMedDate not supplied

Participatory research: getting the community involved in health development.

The Alma Ata Declaration states that "the people have the right and duty to participate individually and collectively in the planning and implementation of their health care." This means that community involvement in health development is fundamental in the battle for health. And, as the author demonstrates below, its participation in health research is necessary in the process of finding better ways and methods to provide health for all.

Asia↗
PubMed1986

In vitro fertilization children: early psychosocial development.

Following community concerns regarding the status of children conceived by in vitro fertilization (IVF), 33 children who had received pediatric follow-up were seen for a psychosocial evaluation. Parents were interviewed in a semistructured format by a child psychiatrist regarding their child's development, child-centered problems, parental problems, marital issues, parenting experience, and experience of the IVF program. The Bayley Scales of Infant Development were administered to the children by a clinical psychologist. Children's ages ranged from 12 to 37 months (the majority between 12 and 20 months). There was a high incidence of prematurity and twins in the population seen. Twenty-two children had no current problems and seven presented minor problems. Of the four with significant developmental problems, two had been very low-birth weight infants with significant neurological problems and one had severe congenital heart disease. Overall Bayley Scale scores were within the normal range and parents as a group were seen to function well. Problems presented were in accordance with those expected in a population of this age range, particularly considering the high incidence of prematurity.

Child Behavior↗
PubMed2002

Training community-responsive physicians.

OBJECTIVE: The "community-responsive" primary care provider has a population health perspective and is prevention-oriented, culturally competent, collaborative, and an active community leader and patient advocate. To encourage residents to value this level of community involvement and possess the requisite knowledge and skills, St. Luke's family practice residency program has developed a longitudinal community medicine curriculum designed to teach the four domains of physician-community involvement: (1) insight into sociocultural aspects of patient care, (2) familiarity with community health resources, (3) community-oriented primary care skills, and (4) community involvement.(1) Training physicians with the desire and skills to practice in medically underserved communities is a program goal. DESCRIPTION: The three-year community medicine curriculum begins during residency orientation with a windshield survey of the communities served by the campus-related clinics. During the first year, all residents participate in a four-week community medicine rotation. By providing health education and clinical services to diverse populations in community clinics, agencies, and schools, they begin to develop community health-improvement skills, while observing role models, developing advocacy skills, expanding cultural awareness, and experiencing interdisciplinary collaboration. At the end of the first year, residents select a community clinical site, where they will see patients and develop a community health-improvement project during the last two years of training. A required "capstone presentation" describes the scope and nature of each resident's project by focusing on process and outcome measures. Innovative qualitative evaluation tools include a written portfolio of reflections and sequential "video journaling." An attribute-based progression matrix developed by Alverno College was adapted to facilitate serial identification and tracking of resident growth in eight domains: communication, analysis, problem solving, aesthetic responsiveness, global perspectives, valuing in decision making, social interaction, and effective citizenship.(2) Support for this program is provided by HRSA, Wisconsin AHEC, Aurora Health Care, and the medical school. DISCUSSION: A recent program graduate, now a faculty member, demonstrated the potential for this educational strategy by developing a local "Reach Out and Read" program. Targeting literacy as a factor related to the cycle of poverty and poor health, she implemented an intervention in which residents read with their pediatric patients during each visit and give the child a book to take home. As each residency class implements health-promoting interventions, this longitudinal community medicine residency curriculum will improve community health through "service learning," as well as develop a cadre of young physicians who practice community-responsive clinical medicine and have the skills and confidence to choose to serve underserved populations.

Community Medicine↗
PubMed1996

Reliability and validity of the FIM for persons aged 80 years and above from a multilevel continuing care retirement community.

OBJECTIVE: Development of accurate functional assessment instruments will help clinicians evaluate treatment outcome and plan realistic rehabilitation goals for elderly patients. The reliability, validity, and appropriateness of the Functional Independence Measure (FIM) were examined for a population aged 80 years and more from a multilevel, continuing care retirement community. DESIGN: Forty-nine residents (average age 89.7 years, range 80 to 104 years; 46 women), were randomly selected. SETTING: Subjects were grouped according to their residence in either an Independent community (18 subjects), Sheltered Care (16 subjects), or Skilled Nursing Facility (15 subjects). MEASUREMENTS: Subjects were evaluated twice using the FIM. Motor and cognitive scores were converted into interval measures (logits) using Rasch Analysis with the BIGSTEPS statistical package. Parametric statistical procedures were utilized to further analyze data. RESULTS: FIM motor and cognitive items formed 2 unidimensional and linear subscales. Hierarchical levels of FIM item difficulties were identified. Bladder management, bowel management, and grooming were misfitting motor items. Memory misfit for the cognitive subscale. High test-retest reliability for 45 repeated FIM assessments for the motor, (ICC = .9) and cognitive subscales (ICC = .8) was demonstrated. One way ANOVA for FIM ratings for the 3 groups demonstrated significant differences for both the motor subscale, F(2,46) = 34.71, p < .05, and the cognitive subscales, F(2,46) = 12.42, p < .05. CONCLUSION: Construct validity of the FIM was demonstrated. High test-retest reliability was demonstrated. Environmental context and operational definitions influenced FIM ratings. Subjects' FIM ratings, abilities, and time to complete the locomotor walking item correlated with their current residence in increasingly dependent environments. These findings suggest that with certain caveats, the FIM may be useful as a functional assessment instrument for persons who are 80 or more years old.

Activities of Daily Living↗
PubMedDate not supplied

Community-based rehabilitation: a development programme in Negros Occidental.

This paper describes the establishment of a community-base rehabilitation (CBR) programme from its initiation to the current situation in the Philippine Republic. The impetus for the CBR project arose from an initiative of a non-government organization in the state of Negros Occidental. The administrative structure, manpower recruitment and training, and the close working relationship between government and non-government organizations are also described.

Adolescent↗
PubMed1996

Culturally appropriate measures for monitoring child development at family and community level: a WHO collaborative study.

Culturally appropriate techniques for monitoring child psychosocial development were prepared and tested in China, India and Thailand on a total of 28,139 children. This is the largest study of its kind ever undertaken. Representative groups aged between birth and 6 years were examined and the results were used to produce national development standards-separately for rural and urban children in China and India, and for all children combined in Thailand-which are considered to be more satisfactory than foreign-based standards. In each country, between 13 and 19 key milestones of psychosocial development were selected for a simplified developmental screening operation and these have been incorporated on a home-based record of a child's growth and development. Between 35 and 67 tests have been devised in each country to test the children at first-referral level.

Child↗
PubMed1999

Community-based trauma system development: key barriers and facilitating factors.

BACKGROUND: Local progress in developing trauma systems has been slow, because of a variety of political, financial, social, and organizational challenges. The purpose of this study is to discuss effective community strategies for dealing with these obstacles to trauma system development. METHODS: In-depth case studies were conducted in 12 study sites across the United States. These communities had similar sociodemographic characteristics (e.g., resident populations of 1 million or more) but had varying progress in the development of trauma systems. RESULTS: Several factors were identified in community and leadership characteristics that promoted the development of comprehensive trauma systems. CONCLUSION: The most important strategies included broad-based participation of key stakeholders (especially community representatives), local trauma leaders who were patient and resourceful, local events (some of which were orchestrated) that demonstrated the need for change in trauma delivery, and financial programs that recognized the needs of trauma centers with high numbers of uninsured patients.

Community Health Planning↗
PubMed2002

Institutional impact of a part-time faculty development fellowship program for osteopathic community-based physicians.

Evaluation of faculty development programs for medical educators has often focused on the satisfaction of individual learners. Long-term outcomes of skills and knowledge acquired during faculty development programs have been more difficult to evaluate. The impact on the institutions where the "developed" faculty teaches has been even less studied. This article discusses the results of a survey that focused on the institutional impact of a year-long part-time faculty development fellowship program for community-based physician faculty. The Statewide Campus System of Michigan State University College of Osteopathic Medicine (SCS MSU-COM) faculty development program conducted a survey of its graduates to ascertain the impact on the educational processes in their home institutions and the impact of the program on the graduates as medical educators. Responding graduates reported increased use of educational concepts and greater participation in the educational activities of their home institutions. The study demonstrates that a faculty development program addressing the needs of community-based physician faculty changes the perceptions of participants as medical educators and appears to have a positive impact on the educational process in their home institutions.

Faculty, Medical↗
PubMed1993

Community violence, children's development, and mass media: in pursuit of new insights, new goals, and new strategies.

Community violence that victimizes children is an unmitigated evil that is exacerbated by vast economic and social forces that leave people in central cities and the rural countryside adrift on seas of rolelessness, hopelessness, group disintegration, and alienation. The contemporary drug scene and the easy availability of guns greatly intensify violence on a local scale, while crimes of violence, especially with guns, appear to be level or declining in the nation as a whole. Claims that the persistently high levels of violence in mass media, mostly television, are largely responsible for violence in society represent narrow views of very large issues. These narrow views overlook essential elements of both phenomena--violence and media. Direct models of interpersonal violence in families and in the community probably give rise to more violent behavior than indirect models in media. Disinhibitory and provocative aspects of media probably do as much or more to trigger violent behavior than violent narratives and violent actions. Comprehensive meta-analysis indicates that prosocial messages on television can have greater effects on behavior than antisocial messages. These data support the contention that mass media can play a strong and positive role in alleviating some of the distress of victims of community violence, and in redirecting the behavior of some of its perpetrators so as to protect the children.

Antisocial Personality Disorder↗
PubMed2004

Nurse leadership within primary care: the perceptions of community nurses, GPs, policy makers and members of the public.

AIM: The aim of this section of a wider study was to seek the views of community nurses, general practitioners, members of the public and policy makers on nursing leadership in primary care. The wider study aimed to review the role and function of primary care services and community nursing with reference to developments in practice, education, research and policy. BACKGROUND: Key messages, challenges and opportunities for leaders within nursing have been highlighted in the literature and in turn emphasis placed on the positive effect this would have on improved quality of services [Department of Health and Social Services (1998) Valuing Diversity...A Way Forward. Department of Health and Social Service, Belfast]. In order to grasp these opportunities, nursing has to invest in the development of leaders. METHODS: A two round Delphi technique was employed using a focus group approach in round one and a postal questionnaire in round two. Semi-structured interviews were carried out with senior policy makers. RESULTS: Findings show that there was agreement that strong leadership was needed for the development of community nursing but that at present there is confusion and disagreement over whether it exists currently. Other findings focus on problems inherent in identifying future nurse leaders. CONCLUSION: The traditional subservient culture of community nursing is blamed for the perceived inability to nurture strong leaders. Recommendations are made for the development of nurse leaders.

Community Health Nursing↗
PubMed1993

Developing and implementing a community intergenerational program.

Although intergenerational programs are becoming increasingly popular, there has been little documentation linking independent yet isolated seniors with children. This article discusses the development and implementation of a community intergenerational program. Elementary school students interacted with seniors at a nearby senior citizen apartment complex during eight 2-hr after-school meetings. Various recruitment strategies were needed to reach this vulnerable senior population, and activities had to be carefully monitored to promote intergenerational exchange. Evaluation of the program showed both the value of such interaction to the students and seniors and the importance of the nurse's role in ensuring that the program's benefits were realized.

Aged↗