Community-based Service Model Research Articles

The nature and impact of collaboration and integrated service delivery for pregnant women, children and families

This paper explores the impact of models of integrated services for pregnant women, children and families and the nature of collaboration between midwives, child and family health nurses and general practitioners. Increasingly, maternity and child health services are establishing integrated service models to meet the needs of pregnant women, children and families particularly those vulnerable to poor outcomes. Little is known about the nature of collaboration between professionals or the impact of service integration across universal health services. Discursive paper. A literature search was conducted using a range of databases and combinations of relevant keywords to identify papers reporting the process, and/or outcomes of collaboration and integrated models of care. There is limited literature describing models of collaboration or reporting outcomes. Several whole-of-government and community-based integrated service models have been trialled with varying success. Effective communication mechanisms and professional relationships and boundaries are key concerns. Liaison positions, multidisciplinary teams and service co-location have been adopted to communicate information, facilitate transition of care from one service or professional to another and to build working relationships. Currently, collaboration between universal health services predominantly reflects initiatives to move services from the level of coexistence to models of cooperation and coordination. Integrated service models are changing the way professionals are working. Collaboration requires knowledge of the roles and responsibilities of colleagues and skill in communicating effectively with a diverse range of professionals to establish care pathways with referral and feedback mechanisms that generate collegial respect and trust.

It Takes a Community to Create a Library

Over the course of four years, Working Together Community Development Librarians in Vancouver, Regina, Toronto and Halifax worked in diverse urban neighbourhoods and with diverse communities, traditionally considered marginalized or socially excluded. This practitioner-community based project allowed community voice to drive the projects process, not librarian generated beliefs, literature or other professional discourse. Community members identified barriers which impacted their ability to enter and use public libraries, and expressed that public libraries were not playing an important role addressing their daily needs. Socially excluded community members stay away from public libraries because traditional library service planning and delivery is based upon middle class values and worldviews. In response, based upon long-term work in diverse and socially excluded communities, the Working Together Project conceptualized and reviewed the traditional library service planning model and developed a new community based service model: the Community-Led Service Planning Model. Community-led service planning builds upon the traditional library service planning model and provides a new method that brings library staff together with community members in an effort to identify and meet community needs. Socially excluded community members are involved in each step of the community-led service development process, from needs assessment to evaluation. This non-prescriptive model is flexible and can be applied in all library settings, by all librarians, and to all program and service development. This paper, a synopsis of a 2008 CLA conference presentation, presents weaknesses associated with only using the traditional service model and provides examples, from each of the four sites, of the benefits of using the newly developed service model. It establishes that the Community-Led Service Planning Model provides libraries with a sustainable approach to working with socially excluded community members.

Innovations on a shoestring: a study of a collaborative community-based Aboriginal mental health service model in rural Canada

BackgroundCollaborative, culturally safe services that integrate clinical approaches with traditional Aboriginal healing have been hailed as promising approaches to ameliorate the high rates of mental health problems in Aboriginal communities in Canada. Overcoming significant financial and human resources barriers, a mental health team in northern Ontario is beginning to realize this ideal. We studied the strategies, strengths and challenges related to collaborative Aboriginal mental health care.MethodsA participatory action research approach was employed to evaluate the Knaw Chi Ge Win services and their place in the broader mental health system. Qualitative methods were used as the primary source of data collection and included document review, ethnographic interviews with 15 providers and 23 clients; and 3 focus groups with community workers and managers.ResultsThe Knaw Chi Ge Win model is an innovative, community-based Aboriginal mental health care model that has led to various improvements in care in a challenging rural, high needs environment. Formal opportunities to share information, shared protocols and ongoing education support this model of collaborative care. Positive outcomes associated with this model include improved quality of care, cultural safety, and integration of traditional Aboriginal healing with clinical approaches. Ongoing challenges include chronic lack of resources, health information and the still cursory understanding of Aboriginal healing and outcomes.ConclusionsThis model can serve to inform collaborative care in other rural and Indigenous mental health systems. Further research into traditional Aboriginal approaches to mental health is needed to continue advances in collaborative practice in a clinical setting.

Schizophrenia treatment in the developing world: an interregional and multinational cost-effectiveness analysis.

Schizophrenia is a highly disabling disease and is costly to treat. We set out to establish what are the most cost-effective interventions applicable to developing regions and countries. Analysis was undertaken at the level of three WHO subregions spanning the Americas, Africa and South-East Asia, and subsequently in three member states (Chile, Nigeria and Sri Lanka). A state transition model was used to estimate the population-level health impact of older and newer antipsychotic drugs, alone or in combination with psychosocial intervention. Total population-level costs (in international dollars or local currencies) and effectiveness (measured in disability-adjusted life years averted) were combined to form cost-effectiveness ratios. The most cost-effective interventions were those using older antipsychotic drugs combined with psychosocial treatment, delivered via a community-based service model (I$ 2350-7158 per disability-adjusted life year averted across the three subregions, I$ 1670-3400 following country-level contextualisation within each of these subregions). The relative cost-effectiveness of interventions making use of newer, "atypical" antipsychotic drugs is estimated to be much less favourable. By moving to a community-based service model and selecting efficient treatment options, the cost of substantially increasing treatment coverage is not high (less than I$ 1 investment per capita). Taken together with other priority-setting criteria such as disease severity, vulnerability and human rights protection, this study suggests that a great deal more could be done for persons and families living under the spectre of this disorder.

Psychopathology in Adults with Mental Retardation Before and After Deinstitutionalization

In a pilot study, the presence of psychopathology in 47 individuals with co-occurring mental retardation and psychiatric disturbance was examined before and after their move from the last remaining state institution for persons with mental retardation in Vermont. These persons, identified in previous literature as the least likely to succeed in community placements, experienced reduced psychopathological symptomatology and appeared to be served equally well in a variety of small-scale community residences irrespective of their care providers' prior experience. Individuals under 50 years of age showed significant psychiatric improvement while those older tended to remain unchanged. These preliminary findings appear to support the viability of a community-based service model using small residences for all persons with mental retardation regardless of their need for mental health care.