The Evolution of Community Mental Health Services in Asian American Communities

This paper explores the history of Asian immigration to the United States, and its intersections with the mental health system. As mental health care have evolved since the 1960s from institutions to the community, public mental health services for Asian Americans have become increasingly culturally relevant. Major policy shifts, trends in immigration, and mental health practice will be presented with a focus on the Bridge Program at the Charles B. Wang Community Health Center. Integrative practice and research models that extend evidence-based knowledge to Asian American communities and practice implications are discussed.     

The theory of change of the evaluation support program: Enhancing the role of community organizations in providing an ecology of care for neurological disorders

This paper discusses the Ontario Brain Institute’s theory of change for the Evaluation Support Program, a program designed to enhance the role of community organizations in providing care and services for people living with a brain disorder. This is done by helping community organizations build evaluation capacity and foster the use of evidence to inform their activities and services. Helping organizations to build capacities to track the ‘key ingredients’ of their successes will help ensure that successes are replicated and services can be improved to maximize the benefit that people receive from them. This paper describes the hypothesized outcomes and early impacts of the Evaluation Support Program, as well as how the program will contribute to the field of evaluation capacity building.     

Transition and the community college: a Career Keys model for students with disabilities

Transition models are needed that address multiple phases in the postsecondary education of students with disabilities. These models must first address the recruitment of high school students with disabilities for community colleges through career exploration experiences that help students clarify their educational and vocational interests and relate those interests to a two-year postsecondary program. Students with disabilities then need a comprehensive service program while attending community college to help them identify accommodation needs in classroom and workplace environments and develop the skills to request such accommodations from their instructors and employers. With this skill base, they are well prepared to initiate the next transition in their lives, that is, the movement from the community college to a four-year educational institution or to employment. Programs are needed to facilitate this transition, such as a placement planning seminar involving rehabilitation professionals and employers and an accommodation follow-up assessment with students in their new educational and employment settings. The "Career Keys" model describes how to deliver the services needed in each of these critical transition phases.     

Aging in Place or Relocation: Perceived Awareness of Community-Based Long-Term Care and Services

ABSTRACT

This study used data from the Community Partnership for Older Adults Program Survey (N = 4,611) to examine associations between the perceived awareness of community-based long-term care and supportive services and the anticipation for aging in place and relocation. Respondents varied substantially in their knowledge about services and anticipation for aging in place and relocation. Perceived availability and unavailability of a series of community services was associated with the likelihood of anticipating aging in place and relocation, and awareness of the lack of visiting nurses, personal assistance, or transportation was related to respondents reporting a younger age at which they anticipated needing help to age in place or anticipating a need to relocate. Findings have implications for raising the public awareness of community-based services in addressing the needs of community-dwelling elders for aging in place and relocation.     

Public relations in hospital

In this paper, the authors have dealt with the salient features of public relations function in a hospital situation while providing health care services to the patients. Public relations is an important function to build up corporate image of the hospitals in the minds of the public and the patients. The authors, therefore, suggest that proper attention may be paid to this aspect for greater appreciation of the services by the community at large.     

Brief admission program. An alliance of inpatient care and outpatient case management

1. Brief planned and crisis admissions to an inpatient psychiatric unit are presented as a component supportive of outpatient care and case management for chronically mentally ill patients. 2. Typical patients admitted to this inpatient short-term program are those experiencing a life stress or temporary crisis; chronically mentally ill patients who cycle and experience exacerbations of their illness; and those who need to make the transition from an acute inpatient unit to community living. 3. The Brief Admission Program treats the individual's response to and the consequences of a lifelong illness and enables the patient to return to his previous level of functioning and continue necessary outpatient treatment.     

The Longitudinal Discharge Planning and Treatment Model (LDPTM)

Abstract

A longitudinally based discharge planning and treatment model that integrates essential components of other successful approaches (PACT, PACED, and Bridge to Discharge) is described. The development of linkages between the inpatient and community mental health providers during the early stages of hospitalization could improve the continuity of care and establish an aftercare plan rooted in existing community resources. Placing the client's need first will ensure a smoother transition from the structure of the inpatient ward to the community while maintaining continuity of care and reducing potential re-admissions to the hospital. Potential barriers that may prevent the adoption and implementation of such a system are discussed. Belcher and DeForge (2005) in Part 1 provided a review of case management and discharge planning, as well as a critique of case management models. In Part 2, DeForge and Belcher (2005) present and describe the components of the longitudinally based discharge planning and treatment model (LDPTM).     

Understanding engagement in the Program of Assertive Community Treatment (PACT) from the perspectives of individuals receiving treatment

ABSTRACT

Engagement of individuals with serious mental illnesses in community mental health services is a significant challenge. The Program of Assertive Community Treatment (PACT) is an individual-centered and self-contained mental health program that provides psychiatric treatment, rehabilitation, and support services to persons with serious mental illness who have a history of or likelihood of disengagement with services. Understanding what helps and hinders consumers’ involvement in PACT services may provide information on how to tailor engagement strategies to individuals based on their treatment needs and preferences. The current study builds on existing studies by exploring factors that help and hinder engagement in PACT services from the perspectives of individuals receiving treatment. We conducted open-ended, semi-structured interviews with 17 individuals receiving PACT services. Nine themes were identified through thematic analysis: Desirable qualities of PACT, Focusing on positive outcomes, PACT as a safety net, Recovery orientation, Practical barriers, Conflictual relationships, and Medication side-effects. We conclude that the development of a trusting, therapeutic relationship that is collaborative and person-centered and that is facilitated by both practical and emotional support is critical to engaging individuals in treatment and maximizing positive outcomes.     

The Logical Difference Between Prevention and Treatment

The authors have spent 2 1/2 years investigating the process of change in family systems presenting with addictive symptoms in one or more of their members. The context of this research has been the systemic family therapy of more than 36 families in a hospital based drug and alcohol service. Emergent from this research is evidence of potentially destructive effects upon families and addicts who present requesting help, by referring them to programmes which are educative or preventative in nature. The case will be put for a clear distinction to be made between the functions of ‘prevention’ and ‘treatment’ in multi-disciplinary teams in addiction services (and by implication other community health services); and for establishing a more rigorous intake system based upon such a distinction and designed to respond more appropriately to presenting requests by potential users of such a service.     

An Assessment of Independent Living Needs Among Emancipating Foster Youth

This study used a mixed methods approach to assess the independent living services needs of emancipating foster youth in Lucas County (Toledo), Ohio. It included (a) an examination of administrative client data from the Lucas County Department of Children Services (LCCS) Independent Living Program; (b) focus groups with current and former foster youth; and, (c) a self-administered survey of public and private agency transitional and independent living service providers. Both the focus group participants and the service providers identified what they perceived to be the needs of emancipating foster youth. Focus group members also displayed a lack of awareness of existing independent living resources in the community, and limited interest in post-emancipation support services. The results were used to generate ten recommendations for LCCS, community service providers, and philanthropic funders.     

Home is where the help is: community-based care in Denmark.

Policy regarding long-term care has been an issue of rising national concern. In this paper we examine the transition of Danish long-term care policy with special attention to Skaevinge, the first community in Denmark to integrate institutional and community-based services for the elderly. Recent studies on the variation between costs and services in Danish communities and the results of U.S. studies on community-based care suggest that successful implementation of integrated institutional and community-based long-term care is feasible in the United States. Lessons from Denmark highlight conditions that will facilitate success in this endeavor.     

Reflections on experiential learning in evaluation capacity building with a community organization,Dancing With Parkinson’s

This paper discusses what was learned about evaluation capacity building with community organizations who deliver services to individuals with neurological disorders. Evaluation specialists engaged by the Ontario Brain Institute Evaluation Support Program were paired with community organizations, such as Dancing With Parkinson’s. Some of the learning included: relationship building is key for this model of capacity building; community organizations often have had negative experiences with evaluation and the idea that evaluations can be friendly tools in implementing meaningful programs is one key mechanism by which such an initiative can work; community organizations often need evaluation most to be able to demonstrate their value; a strength of this initiative was that the focus was not just on creating products but mostly on developing a learning process in which capacities would remain; evaluation tools and skills that organizations found useful were developing a theory of change and the concept of heterogeneous mechanisms (informed by a realist evaluation lens).     

The Program of All-Inclusive Care for the Elderly (PACE): an innovative long-term care model in the United States

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Attitudes Towards Gambling,Gambling Problems,and Treatment Among Hispanics in Imperial County,CA

Gambling problems are associated with a wide range of serious negative personal, social, health, and mental health consequences and are an important public health concern. Some data suggest that gambling problems may be more prevalent among Hispanics, but few studies have been conducted in this community. The aim of the current study was to gather community-based, gambling-related data in order to increase understanding of gambling problems and their treatment in the Hispanic community. We conducted a mixed-methods study of gambling behavior and attitudes towards gambling, those with gambling problems, and professional treatment for gambling problems in a publicly funded health center serving a primarily Hispanic clientele. Study participants included clinic staff and clinic patients. All participants completed a brief, self-report survey; however, staff participated in a focus group on gambling issues and patients were interviewed individually about gambling issues. Nearly 80 % of patients had gambled in the past month, as compared to about 36 % of clinic staff. Survey data showed that patients had many risk factors for gambling problems. Focus group and interview information indicated that most viewed gambling problems as a form of addiction, the elderly were seen as being at increased risk for gambling problems, and gambling outings represented one of the few recreational opportunities in the region. The majority of both staff and patients believed that there was a need for gambling-related treatment services in the county; however, a notable minority of patients said that they would first seek help from a trusted relative or family member. Possible avenues to increase awareness of, screening for, and treatment for gambling problems may include collaborations with publicly funded health care centers and the training of promotoras to serve as an interface between health services and the community.     

The Program of All-Inclusive Care for the Elderly (PACE)

Summary

This article examines the long-term care service system in the United States, its problems, and an improved long-term care model. Problematic quality of care in institutional settings and fragmentation of service coordination in community-based settings are two major issues in the traditional long-term care system. The Program of All-Inclusive Care for the Elderly (PACE) has been emerging since the 1970s to address these issues, particularly because most frail elders prefer community-based to institutional care. The Balanced Budget Act of 1997 made PACE a permanent provider type under Medicare and granted states the option of paying a capitation rate for PACE services under Medicaid. The PACE model is a managed long-term care system that provides frail elders alternatives to nursing home life. The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system. In exchange for Medicare and Medicaid fixed monthly payments for each participating frail elder, PACE service systems provide a continuum of long-term care services, including hospital and nursing home care, and bear full financial risk. Integration of acute and long-term care services in the PACE model allows care of frail elders with multiple problems by a single service organization that can provide a full range of services. PACE's range of services and organizational features are discussed.     

Inclusion of caregiver supports and services in home- and community-based service programs: recent reports from state units on aging

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services-funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.     

Inclusion of Caregiver Supports and Services in Home- and Community-Based Service Programs: Recent Reports from State Units on Aging

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services–funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.     

Reframe your outlook on recidivism

1. Deinstitutionalization has placed many chronically mentally ill people in communities that are not prepared to care for them. A lack of fit between clients and the programs provided often results in repeated visits to psychiatric emergency services. 2. Repeated visits to a community program can be viewed positively: community services carry less stigma than hospital admissions, they are less expensive, and they are directly linked with the community. 3. By encouraging a return to a community program before decompensation necessitates a hospital admission, it becomes possible to focus on how a client can cope with, rather than simply react to, the illness.     

Problem Gambling in Non-English Speaking Background Communities in Queensland,Australia: A Qualitative Exploration

This paper provides an overview of qualitative research into problem gambling among non-English speaking background (NESB) communities in Queensland, Australia. The focus for this pilot study was the Chinese, Greek and Vietnamese communities. Using qualitative methodologies, this community-based research explored the motivations for gambling, and the impacts of problem gambling upon individuals and communities. Findings indicate that problem gambling is evident in each of the communities of study, but the issue is characterised by a pervasive sense of denial. Gambling is an issue of enormous shame and stigma, not only for the problem gambler but their entire family. As a result, most problem gamblers do not seek professional help but try to resolve the problem themselves or within the family unit. Research findings indicate that service access could be increased through a range of strategies including the provision of culturally appropriate community education and gambling help services, partnerships between NESB communities, gambling help services and community workers, and the development and implementation of preventative strategies.     

Home Is Where the Help Is

Abstract

Policy regarding long-term care has been an issue of rising national concern. In this paper we examine the transition of Danish long-term care policy with special attention to Skævinge, the first community in Denmark to integrate institutional and community-based services for the elderly. Recent studies on the variation between costs and services in Danish communities and the results of U.S. studies on community-based care suggest that successful implementation of integrated institutional and community-based long-term care is feasible in the United States. Lessons from Denmark highlight conditions that will facilitate success in this endeavor.