The Virginia Community Cadre Network: community reintegration of persons with spinal cord injury.
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Information technology (IT) has the potential to assist disadvantaged communities in gaining access to mainstream resources, and to a new kind of community health-supporting infrastructure. Federal and state information technology policy will affect how and how well community institutions can reach their goals, collaborate with service agencies, and effectively advocate investing essential, health-supporting resources in their communities. The current information technology focus of the health professions is institution and provider-oriented. It should have a wider scope to include community-based organizations. Laborious efforts undertaken by community-based organizations (CBOs) with only a patchwork of resources and without policy support suggest their value to the public's health. Increasingly burdened public health organizations should examine the public health interest in closing the gap between IT-poor and IT-rich organizations and develop a strategy for building inclusive electronic webs with CBOs.
The authors describe a program, developed under the auspices of the Association for the Care of Children's Health (ACCH), that focuses on community networking among children with chronic illnesses and their families. The program rests on two beliefs: (a) that a network can successfully focus on the generic needs of children with chronic or handicapping conditions and of their families; and (b) that a network can improve care by enhancing coordinating collaboration among existing services without creating new ones. Efforts of the past two years have centered on three specific areas: preparation and dissemination of written materials; creation of new links among families, health and education professionals, organizations, associations, and community institutions; and training in networking techniques. ACCH has prepared two pamphlets for families, schools, and health professionals on community issues and on hospitalization. In addition, a demonstration model for community networking has been established in the Houston/Galveston area. Finally, training programs in the skills of community networking have been established. Work is beginning to replicate the community networking model through other ACCH regional affiliates.
Outreach has a long history in health and social service programs as an important method for reaching at-risk persons within their communities. One method of "outreach" is based on the recruitment of networks of community members (or "networkers") to deliver HIV prevention messages and materials in the context of their social networks and everyday lives. This paper documents the experiences of the AIDS Community Demonstration Projects in recruiting networkers to deliver HIV prevention interventions to high-risk populations, including injecting drug users not in treatment; female sex partners of injecting drug users; female sex traders; men who have sex with men but do not self-identify as gay; and youth in high-risk situations. The authors interviewed project staff and reviewed project records of the implementation of community networks in five cities. Across cities, the projects successfully recruited persons into one or more community networks to distribute small media materials, condoms, and bleach kits, and encourage risk-reduction behaviors among community members. Networkers' continuing participation was enlisted through a variety of monetary and nonmonetary incentives. While continuous recruitment of networkers was necessary due to attrition, most interventions reported maintaining a core group of networkers. In addition, the projects appeared to serve as a starting point for some networkers to become more active in other community events and issues.
A major aspect of a clinical trial is the ability to successfully recruit patients. There is a paucity of information concerning the nuances of recruiting study patients, especially those from minority communities. As minorities generally have been underrepresented in the health-care system, they may be less likely to participate in clinical trials or other studies. Thus, a strategy is needed to overcome this potential shortfall. One of our solutions has been the development of a community network to help disseminate information about our program. We believe that a key aspect has been the involvement of community members during pre-trial planning, community awareness programs, and our Community Advisory Panel. We also believe that it may be a major error to bring a health-care initiative unannounced into a targeted community without extensive pre-program planning in cooperation with that community. As our community awareness scheme suggests (Figure), there are many possible avenues to heighten awareness about a health-care program. While the church remains an important institution for religious and cultural activities in the African-American community, we have found that the news, television, and radio media also can be a powerful source for spreading awareness. Thus, we recommend creating awareness about an initiative through a "grassroots" approach of church and community organizations, along with a global approach through news, television, and radio media. As part of the awareness promotion campaign, it must be emphasized that the study is safe and provides benefits to enrollees. The success of health programs is largely dependent on community acceptance, which must be established in the pre-program planning stages of the initiative. This concept of obtaining community approval and acceptance prior to program initiation is not a new one, nor does it exclusively apply to the African-American community. Community leaders and members need to have a vested interest in such a program and a sense of empowerment. Through this type of communication, patient enrollment and community satisfaction can be substantial. Such success can serve as a springboard for other targeted health-care studies or programs in high-risk communities.
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This paper outlines a method of working with troubled children that draws upon structural family therapy, school consultation, patient advocacy, and community mental health work. This blending of approaches is presented as the basis for an evolving mode of treatment referred to as community network therapy. Four of its principal dimensions are described, and examples of its clinical application are offered.
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The work of the Road Trauma Support Team highlights the ongoing impact of road trauma on rural communities. Small population size and close social networks mean that road trauma can have a negative effect on social relations across the whole community. Much of the 'flow-on' effect of road trauma, in the form of community distress, can be alleviated by increased skills, information about responding to road trauma, and the establishment of supportive community networks. This paper reports on the implementation and evaluation of a project that addressed knowledge, skills and awareness of road trauma in rural communities. Funded by the Rural Health Support Education and Training (RHSET) program and conducted by the Road Trauma Support Team, the project focused on the impact of traumatic events in small communities and strategies to maximise effective participation of community members and health workers in response to trauma. Piloted in six rural communities in northern Tasmania, the project has developed an educational resource package.
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People in rural areas often lack the financial resources, workforce, and professional network needed to sustain a diabetes education pro gram in their own community. HealthInsight, a nonprofit organization that works to improve the quality of health care in its community, developed a 2-day seminar in an effort to facilitate the networking of rural health professionals who educate patients with diabetes and to help those educators better learn how to use existing resources. Participants included nurses, dietitians, diabetes educators, quality managers, and education directors from hospitals and home health agencies in both rural and metropolitan areas. Speakers presented information on a variety of topics related to program development, and a resource manual containing numerous materials was given to each participant. At the end of the seminar, the group turned in goals for their own programs. Too often, providers of health care compete rather than collaborate with one another. There is a great need for such networking opportunities among health care professionals working on common goals--especially in rural areas.
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Computer networks serve as convenient, efficient, and enduring vehicles for delivering nursing services to patients at home. The ComputerLink, a nurse-supervised computer network, provides information, decision support, and communication services to caregivers of people with Alzheimer's Disease [1]. The data obtained in the original experiment included daily logs of each caregiver's use of ComputerLink (n=606 days), records of each caregiver's ComputerLink access behavior (47 subjects; 3875 accesses), and transcripts of the public communications (n=749) posted on the ComputerLink's open electronic bulletin board. In this paper, we present a case study of an early user's pattern of connections to ComputerLink as an atypical example of how elders make use of computer networks.
To explore the determinants of support provision in the natural disaster context, we followed House (1981) and developed a model that specifies how characteristics of the providers, their personal networks, and the community contexts in which they live facilitate or impede their ability to provide support. All three sets of factors affected support provision during Hurricane Andrew, but the pattern of effects differs for the preparation and short-term recovery phases of the hurricane. Age, income, network density, and local economic conditions had significant effects on support provision in the preparation phase. Income did not have a significant effect on short-term recovery support, but religion, house damage, the size and diversity dimensions of network structure, and the local bonds and sentiments dimensions of community attachment did. After comparing the explanatory power of our model in the two phases, we conclude by investigating the implications of this test for understanding the determinants of support provision more generally.