Availability Of Community-based Services Research Articles

BARRIERS AND SOCIETAL FACTORS SURROUNDING LONG-STAY RESIDENT DISCHARGE TO THE COMMUNITY IN LOUISIANA

Abstract The focus of this study is to determine the resident characteristics and societal factors that prevent long-stay residents (LSR) from discharging to the community based on the LSR in Louisiana (LA) compared to the United States (US). This study will also explore solutions that can assist LSR in successfully discharging to the community. Discharge to the community from a skilled nursing facility is influenced by functional status, health of the resident, and the availability of community-based services. About 20% of LSR (>100 days) discharge to the community from skilled nursing facilities (SNF), while that number is more than doubled for short-stay residents. Current data provides little information about the odds of a LSR returning to the community. CMS data shows that LSR in LA have higher rates of Activities of Daily Living Decline (ADL) (LA-18.83%/US-14.68%), Antipsychotic Use (LA-16.9%/US-14.58%), and Pressure Ulcers (LA-9.4%/US-2.4%) than the national average. LSR exhibiting these characteristics are less likely to be discharged to the community. Additional characteristics of this population include high levels of comorbid chronic conditions that are difficult to manage outside of the facility, and having Medicaid (LA-71.5%/US-61.1%) as their payer status, a known barrier to community discharge. States should increase the availability of home health and community-based services that cater to the Medicaid population. Assisted living facilities are a great alternative to living “at home”. Additional research should be conducted to examine affordable assisted living options in more states for long-stay Medicaid residents who desire to live independently in the community.

Multidisciplinary partnership: Targeting aggression and mental health problems of adolescents in detention.

Justice-involved adolescents meet diagnostic criteria for mental health disorders at much higher rates than their counterparts, and this increased risk persists into young adulthood (Abram et al., 2015; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002). Despite growing recognition of this problem, there remains a dearth of adequate therapeutic services in juvenile detention and marked variation in the quality and availability of community-based services (Kretschmar, Butcher, Flannery, & Singer, 2016). This article presents the development of a multidisciplinary partnership among clinical research psychologists and court professionals to address aggressive behaviors and unmet mental health needs of adolescents in the juvenile justice system. We describe the early stages of collaboration, in which experts from disparate disciplines joined forces to address a mounting problem in the juvenile justice system that represented both a gap in the research-practice continuum and a lack of vital mental health resources in the local community. We delineate the team composition, outline key players' roles and contributions, and describe the principles that guided our collaboration across disciplines and agencies. We were effective in developing a sustainable multidisciplinary team, developing a new intervention, and implementing this new intervention in a challenging setting. The challenges we encountered throughout the process as well as the solutions that were generated and the lessons learned are discussed in detail. We discuss the substantive outcomes of our research and conclude with recommendations for readers interested in organizing similar academic-research/community partnerships. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Rebalance Without the Balance: A Research Note on the Availability of Community-Based Services in Areas Where Nursing Homes Have Closed.

Policies to "rebalance" funding away from nursing homes and toward home and community-based services (HCBS) have encouraged national trends of nursing home closure and an expansion of the HCBS industry. These changes are unfolding without a clear understanding of what services are available at the local level. The purpose of this study was: (1) to describe the current distribution of community-based services (CBS) in areas where nursing homes have closed and (2) to examine differences in availability of CBS using local market and population characteristics as regressors in a multinomial logistic model. We collected data on and geocoded CBS facilities and then used ArcGIS to define a 5-mile radius around all nursing homes that closed between 2006 and 2010 and compared these local market areas. In rural areas, availability of CBS does not appear to compensate for nursing home closures. Policies encouraging HCBS may be outpacing availability of CBS, especially in rural areas.

Characteristics of Inpatient Psychiatric Units in Small Rural Hospitals

This study investigated inpatient psychiatric units in small rural hospitals to determine their characteristics, the availability of community-based services after discharge, and the impact of the new Medicare payment system on these units. Unit managers in all rural hospitals with fewer than 50 beds that had a psychiatric unit in 2006 (N=74) were surveyed on the telephone. On average these units had ten beds and 230 admissions per year. Medicare was the major payer (median of 84%). Typical staffing includes no more than one staff member from each category: psychiatrist, psychologist, social worker, counselor or therapist, and nurse practitioner. Common diagnoses reported were depression (74% of units), schizophrenia or other psychoses (42% of units), and dementia or Alzheimer's disease (57% of units). Hospital staff reported little difficulty obtaining postdischarge care, and most staff clinicians provided outpatient services locally. Thus mental health services infrastructure appears better in these communities than in most rural communities, but it may be weakened by recent closures reported by some units, caused, in part, by changes in Medicare reimbursement.

THE AMERICAN ACADEMY OF PEDIATRICS I-CATCH PROGRAM: IMPROVING CHILDREN'S ACCESS TO COMMUNITY-BASED CARE IN RESOURCE-LIMITED SETTINGS

INTRODUCTION: The great disparities in children's access to health care depend on many factors. Expanding the availability of community-based services through programs designed to decrease these disparities is imperative. METHODS: In 2006, the American Academy of Pediatrics Section on International Child Health implemented a new program to address these disparities, the International Community Access to Child Health (I-CATCH) program, which offers mentorship in grant preparation and project execution and provides 3-year funding to support project development and implementation. Projects are community-based initiatives that increase children's access to health care or services not otherwise available. Project initiatives will decrease health disparities and will develop sustainable community-based child health programs that may be replicated in other communities. RESULTS: During the first grant cycle, innovative proposals were received from colleagues in 16 countries. A great variety of opportunities were described to improve children's access to health. Four projects were funded, each of which focused on community education and development: (1) improve children's nutrition and decrease gastrointestinal and respiratory disease (El Salvador); (2) train community health care workers (Pakistan); (3) identify and serve high-risk pregnancies and neonates (Philippines); and (4) promote essential newborn care (Uganda). CONCLUSIONS: The first grant cycle illuminated the impressive creativity of colleagues, who outlined many opportunities to improve children's access to care through community-based programs with the expectation of decreasing health disparities. The tremendous potential of the I-CATCH program was validated. Although assessment of the long-term impact of the I-CATCH program is needed, the initial year showed great promise.

Diverting Mentally Ill Women Away from Prison in New South Wales: Building on the Existing System

Women in prison suffer from mental illness at a rate significantly higher than their male counterparts. Many avenues for diversion exist in current New South Wales (NSW) law, but judges and magistrates have demonstrated a reluctance to utilise them. This article outlines the diversionary mechanisms available to female mentally ill offenders and speculates on why they are under-utilised. Some recommendations for reform will be made, including the use of imprisonment as a last resort, creative use of probation, bonds and conditional release orders, and the expansion of the existing court liaison service. However, it will be concluded that the availability of community-based services to which judges and magistrates may refer offenders is central to the effective operation of this area of law. Since judges and magistrates will not release mentally ill offenders into a “void”, adequately funded social services must be available to provide necessary support, treatment and supervision.

Families' recommendations for improving services for children with chronic conditions.

Little research has been done on services and programs for children with chronic conditions and their families from the perspective of family caregivers from diverse cultural backgrounds. To identify recommendations that urban caregiving families from 3 major ethnocultural backgrounds have for improving the care of children with chronic conditions (ie, chronic illnesses and disabilities involving physical health impairments). Qualitative, community-based study. General community. The volunteer convenience sample included 21 African American, 20 Hispanic, and 22 European American families from 2 midwestern cities who care for school-aged children with chronic conditions. In-home semistructured interviews were conducted with each child's family caregivers. Content analytic techniques were used to identify and classify 275 recommendations from 63 families. Families focused on the following 4 topics: (1) improving the quality of health care services; (2) decreasing barriers to services and programs; (3) improving the training that health care professionals, families, and the public receive about chronic conditions and their management; and (4) improving the quality and availability of community-based services. Families from all 3 ethnic groups had similar recommendations for improving services and programs; however, several African American and Hispanic families also suggested making information more culturally relevant and resources more accessible to families from diverse cultural backgrounds. The findings indicate that further work needs to be done to deliver care that is, indeed, family centered and culturally sensitive. Families' recommendations provide information that health care professionals and policymakers can use to transform rhetoric about family-centered care into action.