Adjunct Services Research Articles

260 Barriers to the Delivery of Obstetric Care Within Primary Health Centres (PHC) in India- a Scoping Review

Abstract Aim This scoping review aimed aims to identify challenges in delivering obstetrics care within PHCs in India, using the 6 WHO healthcare building blocks. Method A literature search covered PubMed, MEDLINE databases, and Google Scholar. Studies published from 2012 to 2022, discussing PHC-based obstetrics care in India, were included based on predefined criteria. Title, , and full-text screenings were conducted using Covidence, involving 2 reviewers for screening and 1-2 reviewers for conflict resolution. Data extraction on the 6 WHO building blocks was performed by 4 reviewers. Results Twenty-two studies were included for final review, mostly cross-sectional (59%), mainly from the state of Bihar (23%). Service delivery (77%) and health workforce (73%) were the most extensively discussed building blocks. Leadership and governance were the least discussed (14%). Challenges in service delivery encompassed limited antenatal care uptake, inadequate emergency obstetrics care and adjunct services, inadequate infrastructure, equipment and space and poor transport, and onward referral services. Health workforce issues included staffing levels and competency and training deficiencies in existing staff. Conclusions This review highlights significant challenges in obstetrics care delivery within Indian PHCs in India, primarily related to service delivery and health workforce. Our scoping review identified literature gaps within the four building blocks outside service delivery and health workforce, and geographical literature gaps from the Northeast of India. PHCs play a crucial role in the equitable delivery of obstetrics services that can reach the most underserved population across India. It is imperative that surgical and obstetrics plan strategies include primary care within them.

Mobilising human resources to build a national communications network: the case of Japan before the Pacific War

Abstract This article analyses labour-intensive workforce strategies in Japan's government-run informational infrastructure (post, telegraph, and telephone) and in the adjunct services associated with their administration in the decades up to the Pacific War. It asks to what extent the growing scale of employment in Japan's communications infrastructure in this period confirms the existence of labour-intensive growth outside the manufacturing sector, and how far the growth of the labour force in post and telecommunications was facilitated by specific labour-absorbing institutions—that is, formal or informal institutions designed to mobilise or incentivise large numbers of employees. The discussion of these two associated questions shows not only that this area of infrastructure provision was highly labour-intensive in terms of the numbers employed and the diverse tasks undertaken, but also that the government-run postal system in effect depended for its growth and development on labour strategies and labour-absorbing institutions analogous to those usually associated with manufacturing development. The article also seeks to establish how far we can see in this sector the gradual improvement in the quality of labour normally associated with the labour-intensive industrialisation process, providing evidence that the evolving institutions were closely associated with a gradual improvement in the quality of labour and its ability to interact with rapidly changing needs and technologies.

Developing an Adjunct Services Approach to Identify the Use of Procedures Not Covered by Health Insurance: The Case of In Vitro Fertilization.

Health care claims have an inherent limitation in that noncovered services are unreported. This limitation is particularly problematic when researchers wish to study the effects of changes in the insurance coverage of a service. In prior work, we studied the change in the use of in vitro fertilization (IVF) after an employer added coverage. To estimate IVF use before coverage began, we developed and tested an Adjunct Services Approach that identified patterns of covered services cooccurring with IVF. Based on clinical expertise and guidelines, we developed a list of candidate adjunct services and used claims data after IVF coverage began to assess associations of those codes with known IVF cycles and whether any additional codes were also strongly associated with IVF. The algorithm was validated by primary chart review and was then used to infer IVF in the precoverage period. The selected algorithm included pelvic ultrasounds and either menotropin or ganirelix, yielding a sensitivity of 93.0% and specificity of >99.9%. The Adjunct Services Approach effectively assessed the change in IVF use postinsurance coverage. Our approach can be adapted to study IVF in other settings or to study other medical services experiencing coverage changes (eg, fertility preservation, bariatric surgery, and sex confirmation surgery). Overall, we find that an Adjunct Services Approach can be useful when (1) clinical pathways exist to define services delivered adjunct to the noncovered service, (2) those pathways are followed for most patients receiving the service, and (3) similar patterns of adjunct services occur infrequently with other procedures.

PDG68 TO EXAMINE DIFFERENCES IN OPIOID PRESCRIBING AND ADJUNCT PAIN SERVICES BY CONCENTRATION OF OPIOID PRESCRIBING PATTERNS IN VETERANS' ADMINISTRATION MEDICAL CENTERS IN THE U.S.

Geographic variation in opioid use has been well documented however it is unknown if this variability is driven by few prescribers or reflects variability in local practicing norms. To address this, we describe the geographic variability in opioid prescribing (any, chronic, high-risk) and the dispersion (Gini Coefficient (GC)) of those measures across 130 medical center areas in the U.S. Nationwide data from Veterans’ Health Administration was used to calculate physician prescribing rates for any opioid, high-risk opioid (dose ≥ 100 MME or concomitant benzodiazepine) and chronic opioid prescribing (≥ 90 days’ continuous use) among chronic pain patients. GC for each of the 130 VAMCs were calculated. System-level factors included adjunct services like acupuncture, kinesiotherapy, mental health biomedical intervention (MHBI), chiropractor, chronic pain program (CPP) and adult day healthcare services (ADHC). Unadjusted analyses were carried out using student’s t-test. 729,213 patients were identified with chronic pain, of which 53.34% were prescribed an opioid. The average GC for any, chronic, and high-risk opioid prescribing among VAMCs was 0.33 (SD=0.07), 0.56 (SD=0.10) and 0.58 (SD=0.09) respectively. VAMCs with the highest GC had on average lower opioid prescribing (32.65 (SD=33.86) vs 51.82 (SD=31.49), chronic (6.34 (SD=16.58) vs 20.10 (SD=24.05) and high-risk opioid prescribing (8.62 (SD=19.09) vs 17.83 (SD=22.93). Unadjusted analysis showed significantly higher GC for chronic opioid prescribing for VAMCs offering acupuncture (-0.05(-0.08 - -0.01)), kinesiotherapy (-0.02(-0.06 - -0.02)), MHBI (-0.06(-0.10 - -0.02)), CPP (-0.05(-0.09 - -0.001)) and ADHC (-0.07(-0.10 - -0.03)). Similarly, VAMCs offering acupuncture (-0.02(-0.05 - -0.01)), MHBI (-0.05(-0.08 - -0.02)), CPP (-0.05(-0.09 - -0.01)) and ADHC (-0.05(-0.08 - -0.02)) showed significantly higher GC for high-risk opioid prescribing. Opioid prescribing shows considerable geographic variability and is concentrated across relatively few prescribers for chronic and high-risk prescribing. Medical centers offering adjunct pain services were found to have more unevenly distributed opioid prescribing patterns.

Collaborative care in real-world settings: barriers and opportunities for sustainability.

Patient-centered care and self-management of chronic disease are optimally characterized by distinct adjunct services such as education, and support for the behavioral and psychosocial elements of managing disease. The collaborative care model for the treatment of depression and anxiety in primary care includes the integration of a behavioral health specialist, in collaboration with the primary care provider, and psychiatric consultation to effectively screen and treat common mental health problems. Dissemination and sustainability of the model have encountered numerous barriers across systems of care. This article represents a discussion of the key barriers to collaborative care and offers a discussion of opportunities for dissemination and sustainability of the model.

A Survey of Domestic Violence Perpetrator Programs in the United States and Canada: Findings and Implications for Policy and Intervention

A 15-page questionnaire, the North American Domestic Violence Intervention Program Survey, was sent to directors of 3,246 domestic violence perpetrator programs (also known as batterer intervention programs, or BIPs) in the United States and Canada. Respondent contact information was obtained from state Coalitions Against Domestic Violence and from various government agencies (e.g., Attorney General) available on the Internet. Two hundred thirty-eight programs completed and returned the questionnaire, a response rate of 20%. The survey yielded descriptive data on respondent characteristics; program philosophy, structure, content, and service; client characteristics; treatment approach and adjunct services; and group facilitator views on intervention approaches and domestic violence policy and treatment standards. The programs varied in the extent to which they adhere to treatment approaches suggested by the empirical research literature. In addition, chi-square analyses were conducted on the associations between several factors. Significant correlations were found between respondent low level of education and adherence to a feminist-gendered program philosophy; respondent low level of education and use of a shorter assessment protocol; feminist-gendered program philosophy and incorrect facilitator knowledge about domestic violence; and feminist-gendered program philosophy and a program focus on power and control as the primary cause of domestic violence.

Erratum to: Trauma-Focused Treatment in a State System of Care: Is It Worth the Cost?

1. Wraparound services with outliers reads $7,746.05, but it should be $72,022.50 2. Wraparound services without outliers reads $64,987.50, but it should be $67,207.50 (adjunct services were excluded) 3. As a result, the total cost for controls reads $378,686.10, but it should be $442,962.55 4. Additionally, the sentence in the first paragraph of the Results section reads, ‘‘The two groups combined (N = 180) utilized a total of $653,697.45...’’ but should read ‘‘...a total of $717,973.90’’.

Cognitive impairment as barrier to engagement in vocational services among veterans with severe mental illness

Vocational services (VS), particularly supported employment models, have clear advantages for assisting adults with severe mental illness (SMI) in returning to the workplace, but a majority of eligible individuals with SMI do not receive any type of VS. The reasons for nonparticipation in VS remain poorly understood, and the potential contribution of cognitive impairment as a barrier to entry has not been explored. The present study uses a pathways-to-care design to examine the specific contribution of cognitive functioning to entry into VS among veterans with SMI. We examined 179 veterans with both SMI and un- or underemployment who completed a work history, the Pathways To Care Inventory, and the Trail-Making Test, Part B. Analysis revealed that veterans with SMI and moderate to severe cognitive impairment took significantly longer to progress through pathways-to-care than those with SMI and mild or no cognitive impairment. These results suggest that identifying veterans with SMI and cognitive impairment early and providing them with integrated and adjunct services may help them navigate VS.

A Comparison of Counselling Students' Needs in the United States and Nigeria

AbstractKnowledge of the needs of graduate counselling students can assist counsellor education faculty in understanding the unique concerns of this student population and thus assist in the development of adjunct services to address these important issues. This study compared the needs of graduate counselling students from the United States (U.S.) and Nigeria and found that they shared many of the same concerns, with time management as the highest-ranked concern. The implications of these results may help guide all counsellor education faculty in planning to assist students.

A Manual-Based Intervention to Address Clinical Crises and Retain Patients in the Treatment of Adolescents With Depression Study (TADS)

To describe a manual-based intervention to address clinical crises and retain participants in the Treatment for Adolescents With Depression Study (TADS). The use of adjunct services for attrition prevention (ASAP) is described for adolescents (ages 12-17 years) during the 12-week acute treatment in TADS, from 2000 to 2003. Logistic regression, controlling for site, was used to predict use. Of 439 enrolled participants, 17.8% (n = 78) used ASAP primarily for suicidality or worsening of depression. Of these, 46.2% continued in their assigned treatment through week 12, 47.4% received out-of-protocol treatment but continued participating in assessments, and 10.3% withdrew consent, including 3 who terminated treatment and withdrew consent on the same date. ASAP use did not differ between treatments (p =.97) and typically occurred early in treatment. At the end of the 12 weeks, 37.2% of participants using ASAP remained in their assigned treatment, although 80.8% continued participating in assessments. ASAP was associated with, at baseline, a higher severity of depression (p <.01), substance use (p <.01), and precontemplation level of change (p <.02). ASAP may be useful to retain adolescent participants and as a safety intervention in placebo-controlled trials. In clinical practice ASAP-like procedures may be useful to encourage adherence in patients engaging in long-term treatment. Clinical trial registration information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006286.

Treatment Engagement with Caregivers of At-risk Children: Gaps in Research and Conceptualization

The high rates of dropping out and other engagement problems are significant concerns in the delivery of mental health and adjunct services to the families of at-risk children. Consequently, researchers have examined the correlates of attrition and have developed interventions to increase engagement and retention. However, the lack of a clear definition of engagement and gaps in theory about the relationship of engagement to other treatment processes hinder knowledge development. In this paper the behavioral and attitudinal aspects of engagement are disentangled. Current knowledge about treatment barriers and interventions to increase appointment keeping is summarized. A preliminary conceptualization of the engagement process is presented and research needs and practice implications are discussed.

Relationship of impaired processing speed and flexibility of abstract thought to improvements in work performance over time in schizophrenia

Vocational impairments in schizophrenia have been widely linked to deficits in neurocognition. This study examined the possibility that deficits in visuomotor processing speed and flexibility in abstract thought may in combination be an especially potent risk factor for poorer levels of work performance in rehabilitation. Fifty-seven participants with confirmed diagnoses of schizophrenia spectrum disorders were administered the Digit Symbol Subtest and the Wisconsin Card Sorting Test and then offered work placements in a vocational rehabilitation program. Work performance was assessed biweekly over two months using the Work Behavior Inventory. Multivariate and univariate repeated ANOVA revealed that participants classified as having no impairments in either visuomotor processing speed and flexibility in abstract thought ( n=14) had superior work performance compared to participants with deficits in either one area ( n=20) or both areas ( n=23). Additionally, participants with no impairments were the only group to show significant improvement in work performance over 7 weeks of rehabilitation. Participants with only one deficit had significantly better work performance than participants with both deficits but showed no statistically significant improvement in work performance. Results suggest assessments of these domains of neurocognition may provide important information about individual needs for adjunct services.

Emergency/Adjunct Services and Attrition Prevention for Randomized Clinical Trials in Children: The MTA Manual-Based Solution

Treatment studies in child and adolescent psychiatry are increasingly characterized by long-term, multisite, randomized clinical trials (RCTs). During the course of these RCTs it is common for clinical exigencies to emerge that require rapid, direct intervention. The challenge is to provide clinically appropriate responses that do not contaminate the delivery, distinctness, and interpretation of the treatments under investigation. In multisite studies, the problem is compounded by the need to minimize cross-site differences in the delivery of adjunct treatments. Such minimization requires fully operationalized and manual-based procedures for clinically mandated intervention. The NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (ADHD)--"the MTA"--is a long-term multisite collaborative study in which children with ADHD were randomly assigned to either medication management, behavioral treatment, the combination, or community-comparison assessment and referral. In designing its study, the MTA developed a manual-based set of procedures (the MTA Adjunct Services and Attrition Prevention [ASAP] Manual) for situations not covered by the protocol treatments. The majority of cases requiring adjunct services fell into two major categories: (1) crisis/emergent situations and (2) imminent risk of attrition. This report describes the ASAP guidelines for dealing with cases that required adjunct services that the MTA Steering Committee adopted before initiating the trial. Although the manual-based guidelines are especially applicable to multisite RCTs, many of the procedures in the ASAP Manual can apply to any treatment study in children.

Selecting Effective Treatments: A Comprehensive, Systematic Guide to Treating Mental Disorders (Revised Edition)

Selecting Effective Treatments: A Comprehensive, Systematic Guide to Treating Mental Disorders (Revised Edition) L. Seligman. San Francisco: Jossey-Bass, 1998, 502 pp. Treatment planning based on empirically supported research and including structured shorter-term treatment approaches has become increasingly important during the past several years as the mental health field has evolved in response to managed care and to other requirements for greater accountability. Seligman's book provides a thorough guide to treatment planning in the current healthcare environment. It includes pragmatic, research-based suggestions for treatment planning for all of the major mental disorders in the DSMIV. It can be read through as a comprehensive overview of treatment strategies for the various mental disorders, or it can be used selectively as a guide when deciding on a treatment plan for a specific disorder. This book is intended for use by nonmedical mental health practitioners, including psychologists, counselors, and social workers. It is appropriate for both graduate students, who are likely to find it to be a valuable introduction to treatment planning, and for more experienced clinicians who may find it more useful as a reference tool. Although the focus is on describing the most effective approaches to psychotherapy, the need for medication and the most commonly prescribed medications for each of the major mental disorders is also addressed. The first chapter provides a thorough introduction to treatment planning and differential therapeutics. It includes an overview of the research on the effectiveness of psychotherapy and a discussion of the determinants of treatment outcome. The determinants of treatment outcome are described in terms of therapist-related variables, client-related variables, treatment variables, and the therapeutic alliance. The acronym "DO A CLIENT MAP" is presented as a framework for organizing the elements of a treatment plan. These elements are as follows: Diagnosis, Objectives of treatment, Assessments, Clinician characteristics, Location of treatment, Interventions to be used, Emphasis of treatment (e.g., insight-oriented vs. action-oriented), Numbers (individual, family, or group), Timing (frequency, pace, duration), Medications, Adjunct services, and Prognosis. This acronym is used throughout the rest of the book to present recommendations for treatment planning. Chapters 2 through 9 systematically describe and then provide suggestions for the treatment of most of the disorders in the DSM-IV. In fact, this book is so thorough and so well organized that it may be used as a companion to the DSM-IV. Each chapter covers a related group of disorders (e.g., Mood Disorders, Disorders of Behavior and Impulse Control) and includes the following types of information for each disorder: Description of the Disorder, Typical Client Characteristics, Preferred Therapist Characteristics, Intervention Strategies, and Prognosis. Each chapter also presents a case illustration and includes a treatment plan ("Client Map") for both the group of disorders in general and for the clinical example. …

Treatment setting and treatment outcome in alcohol dependency: residential and day-care options compared.

When empowered to select either a residential or a day care treatment programme for problem drinking, more patients favour the latter option. Those completing the full programme, which was similar in content in both settings, were followed up at approximately 9 months after initial engagement in treatment. Attrition was a major problem, particularly in the day-patient sample. Of the 103 patients who began each programme, 91 completed the residential option but only 23 completed all sessions in the day-patient course. Day-care completers tended to have less severe alcohol-related problems than in-patient completers. They were also older, had experienced fewer episodes of alcohol-related admissions in the past and were less likely to show biochemical evidence of alcohol-related physical damage. Both groups showed positive changes in drinking intake, drink-related problems, the use of adjunct services and the self-ratings of improvement throughout the follow-up period. Outcome in the day programme completers group was, however, generally better than that shown by the in-patients. The results should be interpreted with caution owing to the significant inter-group differences at the start of treatment and the considerably higher non-attendance and attrition rates for the day-care programme. A cognitive-behavioural in-patient programme for alcohol dependent patients can be provided in a day-care setting. For some patients, this option is both attractive and effective.

Reports of child sexual abuse in the schools

Few studies have examined the problem of child sexual abuse (CSA) as it relates to the role of the school psychologist. The purpose of this study was to examine the incidence of CSA reports to school psychologists, to examine the perceived quality of service to child victims, and to survey the usage of CSA prevention and screening programs as adjunct services in managing this problem. Of the 171 respondents, 498 child sexual abuse cases were reported. Respondents with prior CSA training rated their performance significantly higher than those without training in handling these cases. Those respondents reporting use of CSA prevention and screening programs generally rated their effectiveness as average or above. The results of this study suggested a need for training of school psychologists in the assessment of child sexual abuse. The results also implicated the use of prevention and screening programs as part of a service delivery program to all students in the public schools.

Staff Development

The dramatic increase in the number of mothers of young children currently in the work force has resulted in an increased demand for child care outside the home, including care for handicapped children. To meet this need, we propose the integration of handicapped children into community child care centers as adjunct services to specialized early intervention programs. The successful integration of handicapped children into day care settings requires a planned program of staff development. Several models of staff development are presented that have been found effective for teachers of school-age children in mainstreamed settings. Several features of these models are incorporated in the special education consultation model described here. This model provides on-site consultation to day care providers as they acquire the skills to adapt and modify activities to facilitate the social integration of handicapped children in all activities of the center. And, finally, case studies are presented that document the staff development process.

Communication Camps for Communicatively Impaired Children and their Families

A communication orientated camping experience which is available in Australia for communicatively impaired children and their families is described. These camps are presented as adjunct or support services which are often not available to families of communicatively impaired children.