Broad Partnerships Research Articles

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre

BackgroundAcross many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto’s local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation.MethodsWe purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis.ResultsFindings revealed wide-ranging endorsement for the two team-based models’ success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions.ConclusionsFindings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.

Is the Death of the TPP Good News for Brazil? Mega-Regional Agreements and the Quest for Development ‘Policy Space’

Beyond the controversy between supporters and critics of the Trans-pacific Partnership (TPP), the agreement has generated broad scholarly interest as the first twenty-first century ‘mega-regional’ accord ever concluded. This article seeks to contribute to the debate, analysing the potential regulatory impact of a TPP-like agreement on Brazil and developing countries in general, arguing that third-generation broad economic partnerships may be incompatible with the foreign policy stance of keeping ‘policy space’ for development. The article compares the TPP legal text with previous free trade agreements (FTAs), and analyses provisions in various TPP chapters that contrast with Brazil’s traditional stance in key issues relating to market access, services, investments, intellectual property, electronic commerce and regulatory convergence. Evidence from this exercise outlined that Brazil has not acceded to various international agreements which participation is required under the TPP, and Brazil still lacks modern domestic regulations in crucial areas that would be demanded in a third generation agreement. The recent withdrawal of the United States from the TPP and the uncertainties surrounding trade global governance suggests that Brazil has a window of opportunity to revamp its domestic institutions and decision-making process to become a ‘rule maker’ instead of ‘rule-taker’ in international trade.

The Civic Informatics of FracTracker Alliance: Working with Communities to Understand the Unconventional Oil and Gas Industry

Unconventional oil and gas extraction is fueling a wave of resource development often touted as a new era in US energy independence. However, assessing the true costs of extraction is made difficult by the vastness of the industry and lack of regulatory transparency. This paper addresses efforts to fill knowledge gaps taken up by civil society groups, where the resources produced in these efforts are used to make informed critiques of extraction processes and governance. We focus on one civil society organization, called FracTracker Alliance, which works to enhance public understanding by collecting, interpreting, and visualizing oil and gas data in broad partnerships. Drawing on the concepts of civic science, we suggest that the informational practices of civil society research organizations facilitate critical knowledge flows that we term “civic informatics.” We offer three case studies illustrating how different characteristics of civic informatics enable public-minded research as well as build capacity for political mobilizations. Finally, we suggest that empirical studies of civic informatics and its facilitators offer insights for the study of “engaged” Science and Technologies Studies (STS) that seek to generate new models of science at the intersection of praxis and theory.

The evolution of multiagency partnerships for safety over the course of research engagement: experiences from the NoGAPS project

ObjectiveImplementation of effective population-level injury prevention interventions requires broad multiagency partnerships. Different stakeholders address this from varying perspectives, and potential conflicts in priorities need to be addressed for such partnerships...

Sexual and Reproductive Health at 2015 and Beyond: A Global Perspective.

The International Conference on Population and Development and Millennium Development Goals propelled reproductive health into priorities for international development through declarations, statements, and frameworks. However, key indicators demonstrate that progress in both service provision and clinical outcomes has not been optimal, especially for certain disadvantaged groups. With the Sustainable Development Goals, efforts over the next two decades will focus on access to and quality of health services. Advocacy for mobilizing resources will be complemented by accountability, especially monitoring and evaluation, for utilization of these resources during the life cycle. Stakeholders should emphasize national commitments, with broad partnerships, to ensure long-term sustainability.

Strategic transformation of population studies: recommendations of the working group on epidemiology and population sciences from the National Heart, Lung, and Blood Advisory Council and Board of External Experts.

In 2013, the National Heart, Lung, and Blood Institute assembled a working group on epidemiology and population sciences from its Advisory Council and Board of External Experts. The working group was charged with making recommendations to the National Heart, Lung, and Blood Advisory Council about how the National Heart, Lung, and Blood Institute could take advantage of new scientific opportunities and delineate future directions for the epidemiology of heart, lung, blood, and sleep diseases. Seven actionable recommendations were proposed for consideration. The themes included 1) defining the compelling scientific questions and challenges in population sciences and epidemiology of heart, lung, blood, and sleep diseases; 2) developing methods and training mechanisms to integrate "big data" science into the practice of epidemiology; 3) creating a cohort consortium and inventory of major studies to optimize the efficient use of data and specimens; and 4) fostering a more open, competitive approach to evaluating large-scale longitudinal epidemiology and population studies. By building on the track record of success of the heart, lung, blood, and sleep cohorts to leverage new data science opportunities and encourage broad research and training partnerships, these recommendations lay a strong foundation for the transformation of heart, lung, blood, and sleep epidemiology.

Book Review: Fifty state systems of community colleges: Mission, governance, funding, and accountability by Friedel, J. N., Killacky, J., Miller, E., & Katsinas, S.

Friedel, J. N., Killacky, J., Miller, E. & Katsinas, S. (Eds.). (2014). Fifty state systems of community colleges: Mission, governance, funding and accountability (4th ed.). johnson City, TN: The Overmountain Press. 384 pp. US$29.95 (paper), ISBN 978-1-57072-339-1.The fourth edition of Fifty State Systems of Community Colleges: Mission, Governance, Funding, and Accountability is an invaluable reference for community college scholars, practitioners, and policy makers. A unique feature of the American community college sector is that there is no national system regulating these colleges, and not all states have formal systems in place. As a result, there are numerous approaches that colleges and systems take toward finance and governance, while serving similar missions. This volume is organized so that each chapter provides the following information about community and technical college systems in each state: a broad overview, history, mission, governance, funding, major partnerships, accountability measures, and major challenges and opportunities. The result is a comprehensive survey that provides state-specific information relevant to those researching, working within, or creating policy for community colleges.Each of the 50 states has its own chapter, and most chapters were written by practitioners, thus providing insight as to the most important issues at the ground level. The preface notes that the majority of chapters were written by the chief state-level community college system officers or their designees, with other chapters penned by current or retired executive directors or staff of state community college associations, professors in university-based community college leadership programs within the state, or doctoral students in community college leadership programs. Chapters in the book are relatively short, ranging from 3 to 10 pages each. Although most chapters provide information about their states using the predefined categories listed above, the quality and depth of that information varies from state to state. Some states present a historical picture that illustrates the growth and evolution of their system and/or colleges, whereas others merely present a snapshot. However, enough information is included to allow the reader to perceive the trends that shaped missions, funding, and governance over time, and to view developing trends that present challenges and future opportunities for colleges and state systems.Fifty State Systems provides a state-level view of community colleges and, to a lesser extent, a national-level examination of economic and accountability trends that are heavily influencing the work of community colleges, making this a nice complement to The American Community College (Cohen, Brawer, & Kisker, 2014). Where The American Community College defines the comprehensive role of the community college in American society through data, literature, and an analysis of the issues, Fifty State Systems enhances that picture by presenting information specific to each state and, in many cases, the reason behind changes that have occurred at the state level. It also provides a real-world glimpse at the way community colleges continue to struggle with the tensions between academic, economic, and workforce values (Levin, 2007; Levin, Kater, & Wagoner, 2006). …

Reducing racial and ethnic disparities in hypertension prevention and control: what will it take to translate research into practice and policy?

Despite available, effective therapies, racial and ethnic disparities in care and outcomes of hypertension persist. Several interventions have been tested to reduce disparities; however, their translation into practice and policy is hampered by knowledge gaps and limited collaboration among stakeholders. We characterized factors influencing disparities in blood pressure (BP) control by levels of an ecological model. We then conducted a literature search using PubMed, Scopus, and CINAHL databases to identify interventions targeted toward reducing disparities in BP control, categorized them by the levels of the model at which they were primarily targeted, and summarized the evidence regarding their effectiveness. We identified 39 interventions and several state and national policy initiatives targeted toward reducing racial and ethnic disparities in BP control, 5 of which are ongoing. Most had patient populations that were majority African-American. Of completed interventions, 27 demonstrated some improvement in BP control or related process measures, and 7 did not; of the 6 studies examining disparities, 3 reduced, 2 increased, and 1 had no effect on disparities. Several effective interventions exist to improve BP in racial and ethnic minorities; however, evidence that they reduce disparities is limited, and many groups are understudied. To strengthen the evidence and translate it into practice and policy, we recommend rigorous evaluation of pragmatic, sustainable, multilevel interventions; institutional support for training implementation researchers and creating broad partnerships among payers, patients, providers, researchers, policymakers, and community-based organizations; and balance and alignment in the priorities and incentives of each stakeholder group.

National and State-Specific Health Insurance Disparities for Adults in Same-Sex Relationships

We examined national and state-specific disparities in health insurance coverage, specifically employer-sponsored insurance (ESI) coverage, for adults in same-sex relationships. We used data from the American Community Survey to identify adults (aged 25-64 years) in same-sex relationships (n = 31,947), married opposite-sex relationships (n = 3,060,711), and unmarried opposite-sex relationships (n = 259,147). We estimated multinomial logistic regression models and state-specific relative differences in ESI coverage with predictive margins. Men and women in same-sex relationships were less likely to have ESI than were their married counterparts in opposite-sex relationships. We found ESI disparities among adults in same-sex relationships in every region, but we found the largest ESI gaps for men in the South and for women in the Midwest. ESI disparities were narrower in states that had extended legal same-sex marriage, civil unions, and broad domestic partnerships. Men and women in same-sex relationships experience disparities in health insurance coverage across the country, but residing in a state that recognizes legal same-sex marriage, civil unions, or broad domestic partnerships may improve access to ESI for same-sex spouses and domestic partners.

1.4.3 The Open Academic Model and the Impact of the Stevens Systems Engineering Program

AbstractThe Open Academic Model (OAM) is the research and education concept adopted by the Systems Engineering Program at Stevens Institute of Technology. Applying OAM principles, the Stevens program has grown from inception in 2001 into one of the largest in the U.S. in terms of education and research. The Stevens Systems Engineering program performance and consequent impact is characterized with respect to the OAM, which is based on five principles: (1) Broad Partnerships, (2) Blurred Boundaries, (3) Agile Environment, (4) Community Sharing; and (5) Second‐Career Faculty. The individual aspects of the OAM are not unique to Stevens, but the combination is novel and has underpinned Stevens' impact when the program is measured against the four general criteria of size, quality, publication record, and faculty leadership. The OAM has been implemented via a number of strategies that correlate with the performance of the program.

Introduction to the Special Issue

Although geographers have always been eclectic in their approach, the need for broad perspectives and partnerships with other disciplines has never been as important as it is in confronting contemporary environmental problems. This special issue explores a particularly active area of debate concerning the notion of ecosystem services. It looks at new dialogues that are now developing with economists and political scientists, and considers how an understanding of the biophysical characteristics of ecosystems is essential as we seek to bridge the science-policy divide. It has been suggested that we have now entered the Anthropocene, an epoch in which we have seen a ‘quantitative shift in the relationship between humans and the global environment’ (Steffen et al., 2011: 843). Part of this shift involves recognition that while we continue to depend on the integrity of ecosystems for our well-being, we have to confront the fact that people are now one of the dominant drivers of environmental change. As a consequence our thinking about nature, and the way societies interact with it, must be transformed. If we are to solve the problems posed by global environmental change it has been argued that we need better coordinated international research that places equal emphasis on the social and natural sciences (Perrings et al., 2011). A focus on ecosystem services is potentially one way in which a balanced perspective might be achieved. Given the interest that the idea of ecosystem services has attracted in the policy arena (ten Brink, 2011) it may also provide a focus for integrated, cross-sectoral forms of decision-making. The rapid expansion of the literature dealing with ecosystem services is traced in the first paper in this special issue (Potschin and Haines-Young), which suggests that the idea has taken on many of the characteristics of a classic ‘Kuhnian’ paradigm. The relatively limited contribution that geographers have made to current debates is noted, and it is argued that this is unfortunate, in the light of our traditional disciplinary concerns. Although much of the current work surrounding ecosystem services is being driven by the possibility of making estimates of the economic value of the benefits ecosystems generate, such assessments depend on a good understanding of the sensitivity of ecosystem outputs to the different drivers of change in biophysical terms; and it is here where physical geographers can make a particular contribution. These sensitivities need to be understood if we are to estimate the marginal changes in value between different policy options or management strategies. More especially, they also need to be

Mental health system in China: history, recent service reform and future challenges

This paper summarizes the history of the development of Chinese mental health system; the current situation in the mental health field that China has to face in its effort to reform the system, including mental health burden, workforce and resources, as well as structural issues; the process of national mental health service reform, including how it was included into the national public health program, how it began as a training program and then became a treatment and intervention program, its unique training and capacity building model, and its outcomes and impacts; the barriers and challenges of the reform process; future suggestions for policy; and Chinese experiences as response to the international advocacy for the development of mental health.

Sidebar: Peer-to-Peer Learning in the Self-Management of Chronic Disease

The North Carolina Department of Health and Human Services, through the Division of Public Health and the Division of Aging and Adult Services, has adopted an evidence-based self-management curriculum called Living Healthy in NC that uses peer-to-peer learning to improve the ability of persons to manage their diseases, including diabetes, and to prevent or slow the progression of chronic conditions. The program is based on Stanford University’s Chronic Disease Self-Management Program (CDSMP) and is being implemented in North Carolina through broad and diverse partnerships within and between multiple systems. Kate Lorig and colleagues at the Stanford Patient Education Research Center created and evaluated the CDSMP in the early 1990s, recognizing that physician care is only part of the disease-management process and that persons with chronic conditions must be good self-managers 24 hours a day, 7 days a week. Workshop sessions with a duration of 2.5 hours take place in community settings once each week for 6 weeks and provide tools and support for becoming positive self-managers. The CDSMP is based on years of research addressing patient self-efficacy and is built on several underlying assumptions, including the following: (1) people can learn skills needed to better manage their diseases; (2) people with chronic conditions have similar challenges, regardless of the type of condition; (3) people with chronic conditions deal not only with their disease(s), but also the impact it has on their lives; (4) laypeople with chronic conditions can, when given a detailed leader’s manual, teach the CDSMP as and perhaps more effectively than can health professionals; and (5) the way in which the CDSMP is taught is as important as the subject matter being conveyed. Research has shown the CDSMP to be effective across socioeconomic and education levels, settings, populations, and chronic conditions. The CDSMP results in statistically significant and measurable improvements in physical and emotional outcomes and in self-rated overall health and health-related quality of life. Whereas people with chronic illnesses are generally expected to make more trips to the emergency department and to have more hospital admissions as their condition worsens, this is not the case for those who have participated in the CDSMP. Participation in CDSMP has been shown to result in reductions in health care expenditures. Many of these health benefits persist over a 3-year period [1]. One or preferably both of the peer leaders who facilitate each workshop have chronic conditions and act as “models” for participants, because participants tend to have a greater sense of trust and understanding when workshops are led by people facing similar challenges and problems. Topics covered include techniques to deal with problems such as frustration, fatigue, pain, and isolation; appropriate exercise for maintaining and improving strength, flexibility, and endurance; appropriate use of medications; communicating effectively with family, friends, and health professionals; nutrition; and how to evaluate new treatments. The peer-to-peer characteristic of the CDSMP was one of the primary reasons the Division of Public Health adopted the program in 2005 as part of an effort to improve disease self-management. At that time, the CDSMP complemented existing programs that used community health workers through the Division of Public Health’s Diabetes Prevention and Control Program. In 2007 and 2010, the Division of Aging and Adult Services received grants from the US Administration on Aging to further disseminate the CDSMP statewide. These grants also made it possible to expand Stanford University’s Diabetes Self-Management Program (known in North Carolina as Living Healthy with Diabetes), the CDSMP’s “sister” program that targets individuals with type 2 diabetes. Together, Living Healthy and Living Healthy with Diabetes are the leading providers of chronic disease self-management services in North Carolina. These programs are supported by 17 regional coordinators in the state’s Area Agencies on Aging, local health departments, Community Care of North Carolina, the North Carolina Cooperative Extension, the University of North Carolina–Chapel Hill Institute on Aging, the American Association of Retired Persons, faith-based organizations, the Associations of the General Baptist State Convention of North Carolina, Strengthening the Black Family, the Eastern Band of Cherokee Indians, and dozens of local community-based organizations. Since 2005, >3,000 people have taken part in one or both of the programs, and >1,500 of those persons have participated in the past 15 months.

The Science of Eliminating Health Disparities: Summary and Analysis of the NIH Summit Recommendations

In December 2008, the National Institutes of Health (NIH) sponsored the first NIH Summit showcasing its investment and contribution to health disparities research and unveiling a framework for moving this important field forward. The Summit, titled "The Science of Eliminating Health Disparities," drew on extensive experience of experts leading health disparities research transformation in diverse fields. The Summit also provided a historic educational opportunity to contribute to health care reform. The theme, addressing disparities through integration of science, practice, and policy, introduced a paradigm for advancing research through transformational, translational, and transdisciplinary research. Engaging active participation throughout the Summit generated recommendations bridging science, practice, and policy, including action on social determinants of health, community engagement, broad partnerships, capacity-building, and media outreach.

A school nursing approach to childhood obesity: an early chronic inflammatory disease

Childhood obesity is widespread in all industrialized European countries and it contributes significantly to population morbidity and mortality.Moreover, obesity is a chronic disease with a multifactorial etiology including genetics, environment, metabolism, lifestyle and behavioral components. This article addresses the school nursing approach thought: education of children and their families, participation in policy-making process to improve nutrition and activities for children. The future policies surrounding pediatric obesity must include continued focus on prevention and treatment. Forming broad partnerships that include the government, communities, professional organizations, industries, schools, preschools, day care, and family will improve the likelihood for successful implementation.

Children as a zone of peace: A framework for promoting child health and welfare in developing countries

Children as a Zone of Peace (CZOP) is a strategy that aims to provide humanitarian aid during conflict by prioritising the rights of children. This desk review considers CZOP implementation in countries across five regions of the world. The strategy is found to have achieved results both in terms of stated objectives, such as immunisation coverage and disease control, and other benefits, such as a break from violence and a sense of national purpose. Implementation challenges relate to the political and logistical realities of conflict. Five elements are identified for successful execution of CZOP: (1) an initial proposal from a respected third party; (2) high level negotiations; (3) resourceful planning; (4) targeted communication; and (5) broad partnerships among diverse stakeholders. The CZOP is found to have proven value as a basis for negotiation and humanitarian intervention. Further potential is suggested, both in conflict settings and non-conflict environments, where children's rights are not being met.

Ocean acidification: An emerging Australian environmental security challenge

Ocean acidification refers to the natural process whereby carbon dioxide dissolves in the sea, forming a weak carbonic acid. The ocean is a major sink for atmospheric carbon dioxide and has absorbed about 48 per cent of the CO2 emitted by human activities since the pre-industrial age. Under conditions of increasing acidification, parts of the oceans will deteriorate and progressively become uninhabitable for certain types of plankton, central to the ocean food chain, and coral structures. Australia has a direct stake in the ocean acidification problem: it will affect every part of our marine environment.In the absence of any clear preventive solutions, and with so much at stake, Australia needs to understand how best to adapt to the problem of acidic seas. We need a more collaborative national research effort to enable broad partnerships to develop across the research community with marine-focused agencies, increasing Australia’s capacity and readiness to adapt to global oceanic changes. We need to address our marine research capability. Merchant vessels could be utilised to collect water samples needed to measure the rate of change in ocean acidity. Australia should become a lead nation in monitoring acidification levels in regional waters and raise the issue of sustaining our oceans at every opportunity in regional and international bodies concerned with global environmental change. As the debate about who wins and who loses in the future Australian emissions trading regime intensifies, we should remember that with ocean acidification there will only be losers.

Time for chronic disease care and management

To manage the future costs and quality of care, a health strategy must move beyond the individual, acute care model and address the care of older people with chronic, and often multiple, diseases. This strategy must address the issue of care gaps, ie, the differences between best care and usual care. It should also embrace broad partnerships in which providers may be a cross-disciplinary team of nurses, physicians and pharmacists; the patient partners may include all patients in the community with a disease or group of diseases; and the system managers should work with all to seek improved long-term care and share the governance of interventions and resources. This partnership is activated by repeated and widely communicated measurements of actual practices and outcomes, facilitating rapid knowledge gain and translation, including unmasking the invisible wait list of unmeasured care gaps. It drives continuous improvement in practices and outcomes. The time is right for such care models. There is increasing evidence of their clinical and financial benefits. There is a clear and immediate opportunity to evaluate them as part of a health strategy for effective chronic care in our aging society. Things can be better.

New water supply technology and development of water utility management in Japan

The Japanese government published “The Water and Sanitation Broad Partnership Initiative (WASABI)” in March 2006. This initiative was based on the policies that Japan will support the self-help efforts of developing countries on water and sanitation, establishing broad partnerships with international organizations, and the other donor agencies, etc. Because water resources are very limited, there are many areas and regions which have to use a heavily polluted water source. Therefore, it is necessary to develop the emergent water treatment technology which can supply safe drinking water from polluted source water at a reasonable cost. In order to anticipate a sustainable development of water service the Japanese Ministry of Health, Labor and Welfare published “The Water Works Vision” so as to restructure the water utility management system in 2004. The vision asks to reform the water utility management system so as to mobilize every resource including public private partnership. Therefore, it is necessary to develop an audit system by a third party for risk communication among the stakeholders.

Fruit and vegetable promotion programs in the European Union

Promoting fruit and vegetable consumption is one of the main objectives of food and nutrition policy interventions worldwide. Public institutions, non-governmental organizations, research and health agencies together with market stakeholders undertake integrated initiatives to inform consumers about the health benefits of everyday fruit and vegetable intake. In the European Union several campaigns aimed at increasing produce demand have been launched in the nineties to improve the dietary patterns of the general population or specific consumer groups, such as children. However statistics show that fruit and vegetable intake in most EU states including new members is much below the recommended level. School-aged children, women and employees are currently the main target groups of “5 a day’ information and promotion activities aimed at increasing f&v consumption. In order to secure long-term effectiveness of such programs the main determinants of consumer choice in the food market should be monitored. Broad public-private partnerships, including producers and distributors seem to be the key to strengthening the efforts at “pushing’ market demand. Some of the campaigns developed and implemented in the European Union countries can be described as “5 a day’ best practices. The involvement of fruit and vegetable chain participants, cooperation and evaluation of undertaken interventions are further needed in order for the programs to become more efficient and widespread.