Coordinating health, extended care, and community support services: reforming aged care in Australia

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

Coordinating Health,Extended Care,and Community Support Services

Abstract

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

Organizational structure,leadership and readiness for change and the implementation of organizational cultural competence in addiction health services

Increasing representation of racial and ethnic minorities in the health care system and on-going concerns about existing health disparities have pressured addiction health services programs to enhance their cultural competence. This study examines the extent to which organizational factors, such as structure, leadership and readiness for change contribute to the implementation of community, policy and staffing domains representing organizational cultural competence. Analysis of a randomly selected sample of 122 organizations located in primarily Latino and African American communities showed that programs with public funding and Medicaid reimbursement were positively associated with implementing policies and procedures, while leadership was associated with staff having greater knowledge of minority communities and developing a diverse workforce. Moreover, program climate was positively associated with staff knowledge of communities and having supportive policies and procedures, while programs with graduate staff and parent organizations were negatively associated with knowledge of and involvement in these communities. By investing in funding, leadership skills and a strategic climate, addiction health services programs may develop greater understanding and responsiveness of the service needs of minority communities. Implications for future research and program planning in an era of health care reform in the United States are discussed.     

Facilitators and barriers to family engagement and retention of young children in mental health care: A qualitative study of caregivers’ perspectives

This study examines facilitators and barriers that influence family engagement and retention of children in mental healthcare from the parent and caregiver perspective. Researchers recruited and interviewed parents and caregivers (n=18) from urban community health and early childcare centers. The study team analyzed the data and identified barriers to retention in care, including stigma, lack of integrated health care services,and a shortage of providers with the expertise in early childhood mental health care. Social workers, case managers, parent peers, and community support groups helped facilitate parent and caregiver engagement and retention of children in care. Education,community support programs, and integrated healthcare systems would improve access to quality early childhood mental health care.     

Innovations in child protective services inservice training: commitment to excellence

The overwhelming obstacles to effective CPS intervention created by increasing reports of abuse and neglect, funding shortfalls, and the lack of qualified workers have prompted national efforts to reform the public child welfare system in the United States. Organizations such as the American Public Welfare Association, the Children's Defense Fund, the Child Welfare League of America, and the National Association of Social Workers are currently working closely with other national organizations to develop legislative proposals that will enable child welfare agencies to be more responsive to the needs of children and families. A critical component of this reform is the need to recruit, train, and retain qualified and competent CPS workers. The four training programs described in this article are examples of innovative programs seeking to enhance service delivery by enhancing the knowledge and skills of their staff members. Although the four programs were developed in very different political and social climates and within diverse organizational structures, they all provide useful lessons in how to develop efficient and effective training for workers delivering protective services for children. Any national, state, or local efforts to design and develop new CPS training programs should take into account the significant strides made by these agencies.     

The geriatric social worker and his self-awareness

Abstract

Hospice and palliative care services have become an established part of Australian health care in the last decade. Multi-disciplinary teams are usually a feature of such services and social workers are common members of such teams. Yet the exact extent of their use and role in these programs has not been investigated previously. The author conducted a survey of 53 social workers working in such programs and at the same time, another questionnaire was also sent to service directors in all 134 Australian programs about their utilisation and perception of social workers. This article reports the results of both surveys. The results show that a third of the programs employed social workers, but the social workers themselves reported a number of difficulties: nurses are often the dominant occupational group and role-blurring amongst team members is common. The findings are discussed in terms of their implications for the social work profession.     

Social Welfare Institutions: A Sociological Reader. Edited by Mayer N. Zald. New York: John Wiley & Sons, 1965. 671 pp. $8.95 Hardbound

Interdisciplinary approaches to mental health training comprise one form of innovation occurring in educational programs involving social workers. This paper supports the continued development of this educational format for the mental health and allied professions and offers a provisional definition of interdisciplinary training in a community mental health context. A review of the current status of interdisciplinary training precedes some assertions about its presumed values, obstacles to its implementation, and potential curricular content.     

Social work in mental health services: A survey of the field

Abstract

A survey of social workers employed in mental health services was conducted in Victoria in mid-1997. Approximately 300 social workers were identified as working in the sector. About half were employed in adult clinical services, 23% in psychiatric disability services, 12.4% in Child and Adolescent Mental Health Services, and the rest in a range of other services. More than 90% worked in a community based service or team. The number of entry-level (SW I) positions in clinical services was found to have declined over the last ten years from 61 to 14, resulting in a lack of opportunities for social workers to gain experience in base grade positions, and difficulty in recruiting to SW II positions. Major issues of concern reported by social workers included: the lack of accommodation and other community resources for consumers; diminished opportunities for professional development, supervision, and discipline-specific training; lack of professional recognition; increasing workloads; and organisational emphasis on throughput rather than quality.     

Diversity training for the community aged care workers: A conceptual framework for evaluation

Older Australians are an increasingly diverse population, with variable characteristics such as culture, sexual orientation, socioeconomic status, and physical capabilities potentially influencing their participation in healthcare. In response, community aged care workers may need to increase skills and uptake of knowledge into practice regarding diversity through appropriate training interventions. Diversity training (DT) programs have traditionally existed in the realm of business, with little research attention devoted to scientifically evaluating the outcomes of training directed at community aged care workers. A DT workshop has been developed for community aged care workers, and this paper focuses on the construction of a formative evaluative framework for the workshop. Key evaluation concepts and measures relating to DT have been identified in the literature and integrated into the framework, focusing on five categories: Training needs analysis; Reactions; Learning outcomes, Behavioural outcomes and Results The use of a mixed methods approach in the framework provides an additional strength, by evaluating long-term behavioural change and improvements in service delivery. As little is known about the effectiveness of DT programs for community aged care workers, the proposed framework will provide an empirical and consistent method of evaluation, to assess their impact on enhancing older people’s experience of healthcare.     

A case study in defining developmental costs for quality assurance in mental health center programs

Issues related to the state-of-the-art of ambulatory mental health care review as well as to the resources necessary for planning and operating a quality assurance program may be hampering development of such programs in community mental health centers nationwide. Faced with the problem of responsible and prudent program management, it has become increasingly difficult for CMHC directors to implement innovative, but unproven, and often unpriced programs which have the potential to draw scarce professional resources away from direct service delivery. Pressure to implement CMHC program requirements that are not ordinarily considered revenue-producing in nature, for example, consultation and education services and quality assurance activities, may further create anxiety for mental health program directors, especially during periods when they are ostensibly confronted with the need to maximize CMHC revenues. Before mental health professionals and administrators of mental health programs can be expected to introduce quality assurance programs, they need to have some idea how much the system costs. The figures reported from three North Carolina mental health centers may offer some indication of what other mental health centers might expect to spend in developing a quality assurance program. Salary expenses for multidisciplinary staff participation in quality assurance activities are presented.     

Pediatricians and foster children

The poor state of health and health care of foster children is well documented. The cure lies in the hands of the agencies that administer the foster care system and pay for medical services, and in those of the physicians who provide that care. This study suggests that much of the problem may be solvable. Adequate numbers of pediatricians in Connecticut seem to be committed to caring for foster children, but major impediments remain, including inadequate reimbursement for both primary and specialty health services. The institution of a medical passport can make needed information available and help to establish and promote standards of care. Pediatricians appear willing to take a leadership role in assisting other agencies in developing programs to improve the care of these children; despite the problems in providing medical care to foster children, most pediatricians view it as part of their responsibility to the community and to all children.     

Putting the “S” Back into Sexual and Reproductive Health

ABSTRACT

Sexuality is the most fundamental aspect of our lives and yet it has long been the silent partner in sexual and reproductive health (SRH). Growing awareness of the rights-based approach to health, the commitment of governments and international bodies to promote sexual health and well-being, and the failure of many of the interventions to combat the HIV/AIDS epidemic are helping the reproductive health community put the “S” back into SRH even as the Millennium Development Goals fail to address SRH directly. The disconnect is due to the fragmented, non-holistic approach to reproductive health, short-sightedness in neglecting violations like gender-based violence, a lack of training for students and health care professionals in sexuality, a dearth of indicators and sexuality research and discrimination against vulnerable groups like youth and sexually diverse populations. Recommendations include reaching consensus about the nexus between sexuality and reproductive health and strengthening the commitment to gender equity, empowerment, sexuality and sexual rights among policymakers. Ensuring that explicit and positive references to sexuality are universal, especially in comprehensive sexuality education, youth-focused programs and the integration of HIV and other SRH programs, and strengthening the ability of program managers and service providers to work on sexual health issues are key to successful integration and program sustainability. Strengthening understanding, acceptance and competence in serving sexually diverse populations and improving the research and evaluation specific to sexuality are longer processes, but equally important in the paradigm shift to non-stigmatizing, gender-equitable, rights-based, pleasurable sexual health services.     

Factors contributing to the subjective quality of life of the chronic mentally ill.

Although the deinstitutionalization of the seriously mentally ill has been severely criticized, the success of some model community programs shows that community care can enhance patients' quality of life. We lack specific knowledge, however, about the components that make these programs effective, and why. A theoretical framework for identifying these critical components is proposed. Services can enhance life satisfaction by increasing individuals' actual power through economic resources or status, thus enhancing their perceptions of mastery. An internal evaluation of a model program provides support for this hypothesis. One hundred and fifty-seven patients were interviewed about services, quality of life, and perceptions of mastery. Results show that services providing economic resources and an empowerment approach to service delivery are significantly related to overall quality of life. Furthermore, perceptions of mastery account for the impact of these components on life satisfaction. These findings suggest interventions that can be adopted by a wide range of mental health programs for the improvement of the quality of life of the chronic mentally ill.     

An interprofessional internship model for training master’s level social work and counseling students in higher education settings

ABSTRACT

The mental health needs of college students are steadily on the rise, which compels mental health service providers and educators to explore innovative ways to provide more collaborative, supportive, and interdisciplinary service models of practice and professional training. Graduate programs in social work and counseling are at the crux of producing internship training programs to help accommodate the influx of students with persistent mental health concerns across a variety of needs and cultures. This article describes an interprofessional internship program structured and designed to meet the clinical training needs of master’s level students matriculating in social work and counseling who aspire to provide mental health services in higher education settings. The interprofessional internship training model proposes an innovative interdisciplinary approach to field education which may result in positive training outcomes and learning experiences for social work and counseling students. This paper discusses the model’s emphasis on individual and interdisciplinary group supervision, objectives of the internship experience, internship site criteria, and professional and personal benefits to pre-service social workers and counselors. Recommendations for training and limitations of the model are provided.     

Teachers and health workers: partners in primary health care. Experiences from Papua New Guinea

Primary health care (PHC) involves community health education. When health priorities in rural communities are focused on the vulnerable under-5-years-of-age group then one has to examine who actually cares for this age group and what are the most appropriate means of reaching them through health education programs. In the context of rural communities in Papua New Guinea the linking of school and community health programs has been taking place. Examples and insights from programs where teachers and health workers attempted to find appropriate channels for integrating child and adult education in order to improve the health status of the very young child are described. The school programs used a child to child approach to develop in children a sense of shared responsibility with adults towards better health for themselves, younger children in their care and the environment of the community. The goal was a health program that applied to the whole community, where division between child and adult learning activities was not so sharply drawn, and where formal school programs and nonformal community education programs were to complement and contribute to each other. A campaign against infant diarrhea and death through dehydration was implemented. As a result of a 3-day planning workshop a program was drawn up for schools and communities. The workshop covered causes of diarrhea, fluid loss and dehydration, simple preventive and curative measures, essential hygiene habits and current community practices. Teachers, health workers and community leaders fashioned a program of activities for school children and adults. It was discovered that adults often feel a barrier between themselves and the child's school learning. Also, a gap often exists between what is taught in school and what is needed and can be applied to community health priorities. Thus, an effective community health education program that includes both children and adults in an integrated program will need to cover the varying ages and groups of community members who, with different degrees of responsibility, take care of themselves and others.     

Mental health service navigation: a scoping review of programmatic features and research evidence

ABSTRACT

Service navigation is a care coordination approach that is designed to resolve barriers and facilitate access to needed services. Originating within primary and specialty health care sectors, navigation models have recently emerged to support engagement with mental health services. Presently little is known about the nature, extent, and research evidence for mental health service navigation programs. To address this gap in knowledge, this study undertook a scoping review to identify, describe, and appraise current models of mental health service navigation. Data sources included PsychINFO, Medline, CINAHL, and Google Scholar. Inclusion eligibility required studies to describe a study design, recruitment strategy, navigation approach, sample characteristics, and study outcomes. Searches were constrained to English language and published after January 1, 2000. Twenty-five studies met the inclusion criteria. Navigation programs targeted diverse populations and were delivered in-person, by telephone, and online. Navigators included peers, paraprofessionals, clinicians, teams, and web applications. Eleven studies reported results from randomized trials, remaining programs employed program evaluation, qualitative, or CBPR methodologies. Common features of navigation programs included engagement, assessment, service identification, referral, and monitoring/follow-up. Current evidence for mental health service navigation is promising, although additional rigorous randomized controlled trials are needed.     

Young African American Males: Barriers to Access to Health Care

African American males continue to experience an unacceptable and disproportionate number of health disparities when compared with other racial and ethnic groups. Young African American males can expect to live the least amount of time when compared to any other ethnic minority or racial sub-group. Understanding the obstacles and barriers that impede access to health care and wellness services among young African American males is essential to begin the process of decreasing health disparities. The goal of this qualitative study was to explore and identify the barriers experienced by young African American males in accessing health care services while also creating a rare opportunity to give voice to young African American males. The study results indicate that young African American males have multiple perceptions of barriers to health care services. Their perceptions fell into three categories: the negative impact of environment or community, lack of finances or no insurance, and distrust of medical practices associated with race history resulting in accessing healthcare as a last resort. Additional research is needed to craft community-based programs to: a) educate young African American males on the importance of preventative strategies to maintain wellness; and b) ensure that the appropriate medical and wellness services are available and reaching young African American males in need.     

Community mobilization and health care in rural China

This study is based on interviews conducted in Xiao San Jiang Township, China. This article describes the health care system before and after the reforms of the late 1970s and the impact on community mobilization and health care provision. The success of the Chinese health care system is attributed to mass participation in disease prevention. There were the public health campaigns of the 1950s at the brigade level that mobilized people to adopt personal and environmental sanitation, pest control, and primary health education. There were organizations, such as the Youth Leagues and the Women's Federations. The large groups encouraged use of services, such as family planning services, gynecological screening, and immunization. The Barefoot Doctor and Cooperative Medical Care Insurance Schemes were introduced. Brigades became directly involved in health care delivery, and health workers increased access to primary health services. There was multisectoral collaboration between mass and government organizations. Each commune official had multiple roles and information flowed between sectors. The end result was community mobilization of resources in an organization-intensive social structure and increased hopes for improvements in health. The propaganda was effective in health promotion. In the late 1970s, township management districts and village committees replaced the brigades and communes. The responsibility system gave households responsibility for the productivity of specific plots of land in order to fulfill government quotas. Members of a health project funded by a Hong Kong-based primary health care organization discovered a number of problems. Community mobilization was waning, and mass organizations were not effective. The insurance system collapsed. People tired of political slogans. Although other countries are now adopting community health approaches, China is moving away from this approach.