The chain is never stronger than its weakest link: implementing a model of collaboration among agencies serving vulnerable children and adolescents

This article analyses agency collaboration to help vulnerable children and adolescents with complex social and psychological problems, examining the implementation of a formal collaboration model for these groups. This model, implemented in Västra Götaland, Sweden, involves five municipal agencies and five county council agencies in 49 different municipalities. Data were collected using two questionnaires sent to 355 lower managers and 424 professional representatives in the concerned organizations. The analysis demonstrates that there are differences in implementation results between the agencies, and that the differences are largely explainable by organizational self-interest and top management prioritization of collaboration model implementation. The main barriers to collaboration are factors modifiable by the agencies themselves, and perceived barriers decreased when the policy was working. The study suggests that managers of human service organizations must assume responsibility when implementing collaboratively, and that accountable professional and political leaders must rise above organizational interests to protect vulnerable citizens.     

Perceived Challenges to the Sustainability of Community-Based Aging Initiatives: Findings from a National Study of Villages

Concerns have been raised regarding the sustainability of Villages, a rapidly-expanding set of organizations that typically use a participant-directed approach to improve older adults’ quality of life and ability to age in place. Using online survey and telephone-interview data from a 2013 follow-up study of Villages across the United States, this study examined organizational leaders’ perceptions of the major challenges to sustainability. Major challenges identified included: (a) funding, (b) membership recruitment, (c) leadership development, (d) meeting members’ service needs, and (e) limitations of the Village model itself. Findings point to a number of important considerations for the development, implementation, and sustainability of the Village model, including the role of social workers in addressing these challenges.     

The Social Work Role in Reducing 30-Day Readmissions: The Effectiveness of the Bridge Model of Transitional Care

The hospital experience is taxing and confusing for patients and their families, particularly those with limited economic and social resources. This complexity often leads to disengagement, poor adherence to the plan of care, and high readmission rates. Novel approaches to addressing the complexities of transitional care are emerging as possible solutions. The Bridge Model is a person-centered, social work-led, interdisciplinary transitional care intervention that helps older adults safely transition from the hospital back to their homes and communities. The Bridge Model combines 3 key components—care coordination, case management, and patient engagement—which provide a seamless transition during this stressful time and improve the overall quality of transitional care for older adults, including reducing hospital readmissions. The post Affordable Care Act (ACA) and managed care environment’s emphasis on value and quality support further development and expansion of transitional care strategies, such as the Bridge Model, which offer promising avenues to fulfil the triple aim by improving the quality of individual patient care while also impacting population health and controlling per capita costs.     

Developing an aging prepared community: collaboration among counties, consumers, professionals and organizations

This paper reports on a collaborative process to create an "aging prepared community" in a four county region. The process benefited from a generous grant from the John A. Hartford Foundation that supported an 18 month planning period which included input from service providers and a vast array of aging persons and their families, including particular efforts to reach underserved populations from multicultural, inner- city and rural communities. Under the umbrella of the Elder Network of the Capital Region, the process is now beginning its implementation period with foci on the following: linking health, social service and faith communities; developing accessible health education and wellness programs; creating and implementing a regional system of information and assistance; and mounting a media campaign.     

政策执行与权力关系重构以S市2003年市级居委会直选政策的制订过程为个案

本文运用政策执行研究“自下而上模式”的一些有价值的观点与方法,以及组织决策分析的概念工具,根据个案调查取得的经验材料与文献资料,对S市2003年居委会直选政策的制订过程加以考察,得出如下结论：政策执行过程,既是一个连续不断的互动过程、一个行动者的决策过程,同时也是一个权力关系重构的过程;与科层组织中依职能分工和职位分层而产生的静态的、单向的权力关系完全不同,在政策执行过程中,行动者通过策略性互动重构的权力关系是动态的、多向的;居委会直选之所以能够在体制冲突的背景下得以实施,是政策执行过程中权力关系重构的结果。     

For the Sake of their Health: Older Service Users' Requirements for Social Care to Facilitate Access to Social Networks Following Hospital Discharge

Facilitating older service users’ requirements for accessto or re-engagement in social networks following hospital dischargeis recognized in social care analysis and policy as criticallyimportant. This is because of the associated benefits for restoringphysical health and psychological well-being. However, it tendsto be a neglected dimension of current social care/intermediatecare. Our paper draws on a qualitative study of voluntary sectorhospital aftercare social rehabilitation projects in five UKlocalities, which focused on addressing this issue. Throughexamining older service users’ feedback and experience,our study confirms the health benefits of social care facilitatingaccess to social networks at this crucial juncture. By providingsensitive interpersonal interaction, advocacy and ‘educational’assistance, social care workers supported older service users’re-engagement in a variety of networks. These included friendship,recreational and family groups, health care treatment programmesand locality based contacts and organizations. As a result,material, interpersonal and health care resources were accessed,which contributed to restoring and sustaining physical healthand psychological well-being. The process of such social carealso emerged as critical. This included ensuring that objectivesreflected service users’ priorities; integrating ‘low-level’home care; offering befriending; and challenging the pre-settime frame of intermediate care.     

Third Sector In Transition – A Question of Sustainability for Community Service Organizations and the Sector?

Third sector organizations are transitioning towards entrepreneurial and managerial models as a result of quasi‐market strategies. This paper reports on the research findings of a survey of nonprofit disability organizations in Queensland and Victoria impacted upon by quasi‐market reform. Enterprising organizations were found to have made substantial change to organizational structures and systems, whilst more traditional organizations made few changes. All organizations demonstrated commitment to a social justice ethos. However across the organizational archetypes there were reports of an organizational ‘fragility’. It is argued that the problems of sustainability of community service organizations that existed prior to quasi‐market reforms remain. This implies community service organizations will experience ongoing difficulties in the post‐market era without further rationalization and change. A conceptual framework for sustainability of the community service sector is presented at the policy and organizational level.     

医药卫生体制机制创新：特殊矛盾和路径选择

在市场经济条件下,医药卫生事业发展面临五大特殊矛盾。我国医疗卫生事业要解决的首要问题是体制机制创新问题。公立医院改革和医疗保险体制改革相结合,建立以公益性医院为主体的医疗保险职能和公共医疗服务职能相结合的制度统一、全民覆盖、统筹城乡的新型公共医疗服务保险制度,构建政事分开、管办分开、医保基金管用分开的医疗卫生管理体制,化解现行医药卫生体制蕴藏的内在矛盾,是破解我国医改难题可行的路径选择。     

Partnership and Performance of Community-Based Organizations: A Social Network Study of Taiwan

ABSTRACT

Community-based organizations (CBOs) generally face challenges of meeting clients’ complex needs with limited resources. Partnership development can be a strategy for the CBOs to expand capacity and improve performance. However, relevant evidence is scant and tends to lack a theoretical base. This study examines the relation between networking and performance of a CBO from the perspective of social network analysis. The sample consists of 15 CBOs relying on volunteers to provide primary care services for older adults in a suburban area of Taiwan. Data analyzed include an expert evaluation record, a sociomatrix data set denoting the CBOs’ relationships, and a focus group of the social workers supporting the CBOs’ services. The breadth, brokerage, and embeddedness of networking are measured by centrality indicators and are hypothesized as being beneficial for service performance in terms of effectiveness and innovation. The study reveals that brokerage and embeddedness of networking are positively associated with effectiveness. A CBO may enhance its performance by bridging less connected organizations that need the relationship or by partnering with other organizations that bring in information from many others, but a wide social network is not necessarily helpful. Future studies can strengthen the findings by employing large samples and advanced statistical methods.     

Finding the right connections: Peer support within a community‐based mental health service

Gray M., Davies K., Butcher L. Finding the right connections: Peer support within a community‐based mental health service This article reports on a qualitative study that examined the organisational enablers and barriers to implementing peer support work in an Australian, rural, community‐based mental health service. Interviews with 19 peer and non‐peer staff were conducted to identify attitudes towards peer support and whether there were organisational values, practices and strategies that might support the implementation of peer support. The findings revealed that peer support workers were valued for their ability to build trusting connections with clients and to accept client choice in a non‐judgemental way. However, peer support workers tended to ‘fill service gaps’ within intensive, administrative case‐management environments. These findings highlight the importance of an organisational‐wide approach to integrating peer support, where the responsibilities for adopting new ways of working fall to all staff, not just the peer support workers themselves. Key Practitioner Message: ? Practitioners placed high value on the peer support workers on their teams due to their unique personalised engagement with clients; ? The roles of peer support workers were poorly understood by team members; ? Organisational integration of peer support principles could improve the way all staff engage with clients to reflect a recovery orientation.     

Systematizing Knowledge of User Influence – A Study of User Advisory Boards in Substance Abuse and Mental Health Services

While there is a great deal of interest in, and literature describing user influence in mental health and substance abuse services at the individual level, there are fewer studies of collective user influence at the organizational level. This article presents the findings of a study of the development of user advisory councils in regional organizations providing substance abuse services, which were part of a national implementation project in Sweden. A survey of both users and professionals involved in the local projects, in addition to interviews with key actors at the national level, were completed and analyzed with reference to the results of a literature review. The overall aim of the study was to identify obstacles and success factors related to the development of collective user influence at the programme and system levels. The results indicated that there was an overwhelmingly positive attitude towards experience‐based knowledge and the potential for developing formal, collective user influence in these organizations. Users and professionals had common viewpoints regarding the obstacles and success factors, which included: addressing power relations, establishing legitimacy, assigning resources, investing in sustainability and planning for real participation. They were also substantially in agreement as to the strategies that would be needed in the future in order to move from ideology to action. These factors form the basis for a model that might be used to support the systematic implementation of this type of organized user influence.     

Improving Intimate Partner Violence Services in Home Visiting: A Multisite Learning Collaborative Approach

Abstract

To improve intimate partner violence (IPV) service delivery, the Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Initiative’s continuous quality improvement (CQI) team implemented a Breakthrough Series model Learning Collaborative with eight program sites. Using mixed-methods, we: examined post-Collaborative changes in Florida MIECHV home visitors’ knowledge, system awareness, and confidence; identified strategies to address challenges in supporting families with IPV; and assessed post-Collaborative program improvements. The Collaborative included three interactive 2-day sessions, six webinars, and testing strategies using the Model for Improvement (Plan-Do-Study-Act). Three online surveys assessed changes influencing IPV screening, referrals, and safety planning. Thematic content analysis of qualitative data revealed existing barriers and strategies to address challenges. Home visitors reported accurate knowledge (change: 2.3%-34.8%), confidence (change: 31.8%-37.9%), and system awareness (change: 22.7%-53.5%) for all items from baseline to final survey. There was also an increase in rates of IPV screening (change: 88.0%-91.0%) and referrals (change: 43.0%-100.0%). Strategies for addressing challenges in supporting families experiencing IPV were identified at the individual (self-care, continuous education); interpersonal (reflective supervision, trauma-informed approach); organizational (defining success, supportive agency/program, policies); and community (collaboration with IPV service providers) levels. Lessons learned from the MIECHV IPV Learning Collaborative informed future CQI projects.     

Into the Community: A Comparison of Care Management and Traditional Approaches to Resettlement1

The resettlement of people with learning disabilities (mental handicap) from long-stay hospitals has been under way for a number of years in England. This process has generally been dominated by the exigencies of the available services. A needs-led approach, emphasized in recent community care legislation, in which new services are sought on the basis of the specific requirements of service users, has been used infrequently for this purpose. This paper compares the process of implementing a needs-led care management approach to resettlement with the implementation of a more traditional service-led approach. It also suggests some important lessons for the application of a needs-led approach to hospital resettlement.     

The Care Programme Approach: Dimensions of Evaluation

Correspondence to Barbara Hatfield, Mental Health Social Work Research Unit, School of Psychiatry and Behavioural Sciences, University of Manchester, 12th Floor, Mathematics Building, Oxford Road, Manchester M13 9PL, UK. Summary The study examined the first six months of implementation ofthe Care Programme Approach (the CPA) at a psychiatric unitof a district general hospital. From an analysis of the researchliterature on case management, and from current policy, a frameworkwas developed which was used to analyse the implementation understudy. The framework included such features as: a keyworkeroffering a continuous relationship and co-ordinated care; assessmentand intervention over a range of ‘needs’; multidisciplinaryworking in the community; and involvement of user and carer.The objectives were to ensure continuity of care and reducehospital admission. The targeted service users were to be thosewith severe and enduring mental health problems. The study showsthat most of these features were achieved in the implementation,although there is no evidence that hospital admission was avoided.A number of factors were found to be associated with re-admission,and these are discussed in the light of the findings of otherstudies.     

Factors associated with provider self‐efficacy in delivery of evidence‐based programs for children,youth, and families

Investments in training real‐world behavioral health providers in evidence‐based programs (EBPs) can be costly; thus, it is important to understand which providers may be more or less likely to implement such approaches after training. Provider self‐efficacy is associated with implementation of EBPs, but research on factors associated with provider self‐efficacy is less common. An exploratory, cross‐sectional, quantitative survey examined factors associated with provider self‐efficacy among 150 real‐world service providers who reported delivering EBPs to children, youth, or families in one U.S. state. Factors found to be associated with higher self‐efficacy included profession, workplace support, and extent of training received; difficulty engaging families was associated with lower self‐efficacy. Self‐efficacy was found to be associated with program use but not fidelity. Several organization‐level variables were identified as both facilitators and barriers to implementation of EBPs. Implications for research and practice are discussed.     

Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK‐wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy. Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients. Methods: at the macro‐level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced. Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients. Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK.     

Lessons learned implementing community‐based comprehensive case management for families surviving homicide

Family members of homicide victims often experience a wide range of adverse reactions to the homicide. This study reports on the Traumatic Loss Response Team, a project conducted by a community‐based, mental‐health agency to provide comprehensive case‐management services to meet homicide survivors' complex needs. To conduct the study, we abstracted service/process data from open client cases in 2013 (most recent year with available data) and conducted interviews with the project's implementing agencies. Interviews revealed both initial challenges and factors facilitating successful implementation. Main challenges to overcome included gaining credibility and trust from police and issues around overlap of services provided to families by numerous agencies that may become involved in a homicide. Partners view the project providing a range of important services to families, including intermediary/buffer between families and police. Concerning service data, of the 131 cases open in 2013, most were referred directly by police and involved community violence, an adult victim and a firearm. Most of the 164 clients receiving services were female, adult, African‐American and parents of the deceased. Grief support was the most common of numerous services provided. We hope that this study will catalyse sharing of similar data and experiences among organizations providing services to homicide survivors.     

Overlooked and under‐served? Promoting service use and engagement among ‘hard‐to‐reach’ populations

Cortis N. Overlooked and under‐served? Promoting service use and engagement among ‘hard‐to‐reach’ populations Social service providers strive to meet the needs of those most marginalised from society and from service systems. Yet many people who might benefit from available help consistently miss out. Using qualitative data, this study developed a repertoire of actions that organisations and service personnel can employ to improve participation and outcomes for groups who may be eligible for and may benefit from services, but whom service providers find difficult to identify, reach and engage. Semi‐structured interviews with service managers and coordinators of child, family and youth services in Australia attest to the diversity and context specificity of those who are deemed to be ‘hard‐to‐reach’. The research data highlight ways to improve reach and engagement in a managerialist context by refining organisational action in four strategic domains: overcoming access barriers, building client relationships, utilising networks and partnerships, and ensuring staff capacity and sustainability.     

In the Eye of the Storm: Civil Servants and Managers in the UK Department of Health

In the wake of the 2008 financial crisis, the UK government faces some tough choices over public expenditure, and these choices will have important implications for both the future of health policy and the way in which health services are managed. In this article, we examine the organization and leadership of the UK Department of Health and weigh its suitability to meet such challenges. We find an organization that is culturally split between public servants and managers, highly reliant on the ability of its key personnel to bridge these divides, and extremely responsive to the political goals of government ministers. We explore the modern DH using three types of evidence. First, the history of the department shows clear political efforts to reduce civil service discretion and focus the DH on the management of the English NHS. Second, the recent organizational structures of the DH show a bifurcation between policy direction and NHS management tasks. Third, an analysis of the top ranks of the department since 2005 shows the implementation of political preferences that are consistent with managerialism but inconsistent with the perceived characteristics of traditional civil servants. The result is a department which has changed just as frequently as the health service it oversees – a department which has been moulded by successive ministers into one for the management of the NHS. Our findings raise important questions about the value and purpose of long‐term organizational knowledge in policy formulation.