Community Care Teams Research Articles

Developing a Community Care Team: Lessons Learned From the Community Connections Program, a Health Care Home–Community Care Team Partnership

This article describes the development of the Community Connections Program (CCP), a community care team, within a health care home (HCH), as a short-term, intensive, team-based service planning and coordination program for older adults with multiple chronic health conditions. Three proven approaches were combined to support patient's self-management, nurse care coordination, the Wraparound process, and use of community services. Particzpants'responses to the CCP demonstrated the success of the community care team in connecting patients and nurse care coordinators (NCCs) with community service providers, thus supplying primary care providers with important information regarding the development of a community care team to support patient-centered care within a HCH.

A multicenter randomized controlled trial of aftercare services for severe mental illness: study protocol

BackgroundSevere mental illness is responsible for a significant proportion of burden of diseases in Iranian population. People with severe mental illnesses are more likely to have high rates of non-attendance at follow-up visits, and lack of an active follow-up system, particularly in the country’s urban areas that has resulted in the revolving door phenomenon of rehospitalizations. Therefore, there is an increasing need for implementation of effective and cost-effective aftercare services.Method/DesignThis is a randomized control trial with the primary hypothesis that aftercare services delivered to patients with severe mental illnesses in outpatient department and patient's home by a community care team would be more effective when compared to treatment as usual (TAU) in reducing length of hospital stay and any psychiatric hospitalization. Patients were recruited from three psychiatric hospitals in Iran. After obtaining informed written consent, they were randomly allocated into aftercare intervention and control (TAU) groups. Aftercare services included treatment follow-up (through either home care or telephone follow-up prompts for outpatient attendance), family psychoeducation, and patient social skills training that were provided by community mental health teams. Patients were followed for 12 months after discharge. The primary outcome measures were length of hospital stay and any hospitalization in the 12 month follow-up. Secondary outcome measures included patients' clinical global impression, global functioning, quality of life, and patient's satisfaction. The trial also allowed an assessment of direct cost-effectiveness of the aftercare services.DiscussionThis paper presents a protocol for an RCT of aftercare services delivered to patients with severe mental illnesses within patients' home or outpatient department. The findings of this study can influence policy and program planning for people with severe mental illnesses in Iran.Trial registrationIRCT201009052557N2

Regional primary care team to deliver best-practice diabetes care: a needs-driven health workforce model reflecting a biopsychosocial construct of health.

OBJECTIVEBest-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix. We applied a needs-driven evidence-based health workforce model to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations.RESEARCH DESIGN AND METHODSCare protocols, by number and duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with a previously estimated population profile of persons across 26 patient attributes (i.e., type of diabetes, complications, and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region.RESULTSA primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1,000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE, respectively (1 FTE/∼300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2,000 Australian dollars (∼2,090 USD) (2012) per person with diabetes.CONCLUSIONSA needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met, especially in disadvantaged groups.

Enhancing Patient-Centered Care

Health care reform focuses on primary care and development of Health Care Homes to improve patient-centered chronic illness care. This pilot study evaluated a community care team intervention that linked chronically ill older patients, support persons, and nurse care coordinators from a Health Care Home with community resources using an adaptation of the Wraparound process. A pragmatic clinical trial design was used. Patient-centered chronic illness care; physical, mental, and social health; service use; and study feasibility were evaluated. Differences between groups were compared using two-sample t, Wilcoxon rank sum, chi-square, or Fisher's exact tests. At 3 months, the intervention group reported higher patient-centered chronic illness care (mean total Patient Assessment of Chronic Illness Care change scores were 0.39 for the intervention group and -0.11 for the control group, p = .03). Results indicate that the integrated community care team intervention is a promising strategy to support patient-centered chronic illness care.

Do older patients' perceptions of safety highlight barriers that could make their care safer during organisational care transfers?

BackgroundHealthcare is a series of complex, interwoven systems in which any discontinuities of care may affect the safety of patients, who have been reported to perceive safety differently to clinicians....

Vermont’s Blueprint For Medical Homes, Community Health Teams, And Better Health At Lower Cost

written permission from the Publisher. All rights reserved. mechanical, including photocopying or by information storage or retrieval systems, without prior may be reproduced, displayed, or transmitted in any form or by any means, electronic or Affairs Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of by Project HOPE The People-to-People Health 2011 Bethesda, MD 20814-6133. Copyright © is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Health Affairs

Diabetes risk evaluation and microalbuminuria (DREAM) studies: ten years of participatory research with a First Nation’s home and community model for type 2 diabetes care in Northern Saskatchewan

OBJECTIVES: To review the DREAM studies and the role of participatory research using a Home and Community Care model in treating First Nations diabetes.STUDY DESIGN: Population survey, pilot and prospective randomized trial.METHODS: Review documented history of these studies since inception. Collation of all data from the DREAM studies from 1998 to the present, including interviews with all providers and many of the participants.RESULTS: The DREAM studies were a participatory process providing a needs assessment and became the foundation for this First Nation’s Home and Community Care team involvement in providing community-based chronic-disease management. The findings motivated the community to find a process that would lead to needed changes. This participatory research enabled a culturally tailored algorithm of evidence-based management of hypertension and disease management strategies for people with diabetes. These studies demonstrated that in this community the Home and Community Care team could work together with primary care physicians and specialists to prevent the complications of diabetes.CONCLUSIONS: The DREAM studies demonstrated in the first controlled trial that with participatory research a systems change is possible; a chronic-disease management model utilizing a trained multidisciplinary Home and Community Care team and informed patients can lead to lower blood pressure in a Canadian First Nations population with diabetes.

Concepts underlying continuity of care - the system of concepts described in ENV 13940a

In 1998, the Technical Committee 'Health Informatics' (TC 251) of CEN (European Committee for Standardisation) set up a specific project team to address aspects of sharing patient-related information needed in the process of care, in order to support continuity of care, giving way to a European pre-standard, numbered ENV 13940. The authors were both members of that project team. The system of concepts and the terms defined in this European pre-standard are designed to support the management of healthcare-related information over time, and the delivery of relevant health care by different agents, encompassing primary care professionals and teams, healthcare funding organisations, managers, patients, secondary and tertiary healthcare providers, and community care teams. Beyond the terms used in the standard, which have no actual value outside the framework of the document itself, the goal is to establish a common conceptual framework for continuity of care across national, cultural and professional barriers. It is neither to define how the processes should be performed in a particular healthcare framework, nor to have any regulatory impact on the actual delivery of care. The European pre-standard does not address other aspects of health care, such as security, the specific management of professional acts and their life cycle, terminology and classification, nor the financing mechanism for healthcare delivery.

White Pages misses important population segments

Australian and New Zealand Journal of Public HealthVolume 25, Issue 5 p. 472-472 Free to Read White Pages misses important population segments Sharon Lawn, Corresponding Author Sharon Lawn Division of Mental Health, Flinders Medical Centre, South Australia*Division of Mental Health, Flinders Medical Centre, Marion Community Care Team, 820 Marion Road, Marion, South Australia 5043. E-mail:Sharon.lawn@fmc.sa.gov.auSearch for more papers by this author Sharon Lawn, Corresponding Author Sharon Lawn Division of Mental Health, Flinders Medical Centre, South Australia*Division of Mental Health, Flinders Medical Centre, Marion Community Care Team, 820 Marion Road, Marion, South Australia 5043. E-mail:Sharon.lawn@fmc.sa.gov.auSearch for more papers by this author First published: 27 June 2009 https://doi.org/10.1111/j.1467-842X.2001.tb00299.xCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume25, Issue5October 2001Pages 472-472 RelatedInformation

The infant with Pierre Robin sequence: Review and implications for nursing practice

Pierre Robin sequence (PRS) is associated with long-term respiratory, nutritional, and developmental difficulties. Hypoxic complications, including cerebral impairment, cor pulmonale, and failure to thrive may be prevented or minimized with early detection and comprehensive care. This article reviews the embryological development of PRS and outlines the medical and nursing implications for treatment. Partnership with parents and a coordinated community care team are essential for successful management of infants and children with PRS. Copyright © 2001 by W.B. Saunders Company

Therapeutic limit setting in an assertive community treatment program.

The study examined the use of therapeutic limit-setting activities by members of assertive community treatment teams with clients who had serious mental illness. Case managers from 40 Veterans Affairs intensive psychiatric community care teams reported their use of 25 limit-setting activities with 1,564 veterans during the first six months of treatment. The 25-item measurement scale was factor analyzed, and a standard multiple regression procedure was used to regress scale scores on clients' characteristics, the frequency of case managers' contact with service providers and others, and clients' and case managers' perceptions about the therapeutic alliance. Case managers relied most frequently on informal verbal approaches to limit setting and relied least on formal legal restrictions. Factor analysis of the instrument, the Therapeutic Limit Setting (TLS) scale, reduced the number of items to 20 and resulted in a five-factor solution. The limit-setting factors were verbal guidance, money management, contingent withholding of services or support, enforced hospitalization, and invocation of external authorities. The TLS and its subscales were characterized by high internal consistency, modest intercorrelation, and unique relationships with variables related to clients' characteristics, the treatment process, and the therapeutic alliance. Case managers were more likely to set limits with clients who had more extensive hospitalization histories, a representative payee, recent alcohol or drug use, more arrests, and more severe symptoms. Case managers used a range of limit-setting strategies in assertive community treatment. Limit setting is a frequent and potentially important aspect of assertive community treatment that may be useful for comparing levels of assertiveness in assertive community treatment teams and other community-based rehabilitation services.

A community needs assessment: the care needs assessment pack for dementia (CarenapD)--its development, reliability and validity.

To develop and evaluate a multidisciplinary needs assessment tool for people with dementia living in the community and their carers. The measure was developed through applying a theory of need, generating content, consultation with potential users and refinement and evaluation. Validity was established incrementally through the development process. The development and evaluation was conducted in a variety of settings, including multidisciplinary dementia community care teams, social work departments, day hospitals, and inpatient and residential care. The evaluation included community patients with a formal diagnosis of dementia (N = 34) and consultation with a multidisciplinary group of potential users (N = 23). The development process included inpatients with a formal diagnosis of dementia (N = 157) and consultation with potential users (N = 170) from a range of professions including both health and social care. Interrater reliability was assessed using the kappa statistic. Social validity was estimated using a measure developed for this purpose as part of the development process. The evaluation of interrater reliability demonstrated that three-quarters of assessors agreed on at least 85% of items in the CarenapD. The kappa statistic demonstrated that agreement for 76.2% of items in the CarenapD was 'good' or better (ie kappa >0.75), for 12.4% of items it was 'fair' or 'moderate' (ie kappa 0.35-0.60) and for the remaining 12 (11.4%) items for which kappa could not be calculated there was low intra-item variance and high agreement (>90%). There was good evidence for social validity. The CarenapD is a reliable and valid multidisciplinary assessment of need for people with dementia living in the community and their carers.

Stress in community care teams: will it affect the sustainability of community care?

The study investigated whether community care is sustainable by examining the levels of stress and burnout that affect community mental health staff. Six teams from around Great Britain were chosen to take part, representing a number of different facets of care: the type of community model, whether it was in an inner city or suburban area and whether the team had been part of a scientific evaluation of care, in which case it may have contained more experienced and more highly trained staff. The results indicated that community care staff experienced high levels of burnout as a result of the work stressors. These levels were higher than those found in any published study of health professionals within hospitals, but are similar to those found in community teams recently. There was no evidence that any particular model of community care produced less burnout, but working in an inner city did seem to produce the highest levels. There did seem to be some benefit from a moderate staff turnover within teams. These results mirror those of other recent studies. Models of community care can only be sustained by reducing their toxicity on the staff who have to make them work. Therefore, levels of stress and burnout should be included in any evaluation of the cost-effectiveness of service models. The alleviation of these high levels through individual and organisational interventions should now be a high priority.

Care management: Information, access and older patients

This article analyses an attempt to challenge inadequate provision of information about services and restricted access to them. It presents the advantages of such an approach for users and provides evidence of some of the major constraints on such initiatives becoming routine. It draws on a small scale action research project carried out by a Community Care team and the author, in a rehabilitation hospital for older patients (aged 75 or over). The significance of the project for both hospital based and wider practice is discussed.

Needs for care from a demand led community psychiatric service: a study of patients with major mental illness.

OBJECTIVE--To measure needs for care of patients aged 18-65 years with major mental illness. Identification of everyone in one area seen by a health professional within the previous five years because of a psychotic disorder. Interview of a one in three sample of patients and their main carers with the cardinal needs schedule. SETTING--Hamilton, a socially deprived district of Scotland. SUBJECTS--71 subjects were interviewed from the original sample of 263 patients. MAIN OUTCOME MEASURES--"Cardinal problems" in seven clinical and eight social areas of functioning; these are defined as problems requiring action. "Needs"-cardinal problems for which suitable interventions exist but have not been tried recently. RESULTS--High levels of morbidity were found. 30 interviewed patients (42%; 95% confidence interval 31% to 54%) had one or more clinical needs. 35 (49%; 38% to 61%) had one or more social needs. Skills to deal with all but seven needs in the sample were available at the time of investigation. Patients not being seen by the community mental health team were similar in severity and levels of need to those who were on the community team's caseload. Care was unequivocally and severely inadequate for four patients. Shortcomings in service delivery usually arose from failure to monitor some patients at home. Problems were not due to shortage of acute psychiatric beds nor the absence of an elaborate assertive community care team. CONCLUSIONS--Systematic assessment of needs with research instruments can give valuable insights into the successes and failures of community care of people with major mental illness. Most needs could be dealt with in these patients but in our area (and probably most other parts of the United Kingdom) this would entail diversion of resources from people with less severe disorders.

The Mad Among Us: A History of the Care of America's Mentally Ill

Back to table of contents Previous article Next article ArticleNo AccessThe Mad Among Us: A History of the Care of America's Mentally IllWilliam H. FisherWilliam H. FisherSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.47.4.434AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "The Mad Among Us: A History of the Care of America's Mentally Ill." Psychiatric Services, 47(4), pp. 434–435 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byActa Psychiatrica Scandinavica, Vol. 103, No. 1Service Use and Cost in 2002 Among Clients in Community Settings Who Were Discharged From a State Hospital in 1989Aileen B. Rothbard, Sc.D.Sungeun Lee, Ph.D.Kenneth Culnan, M.Ed.Sandra Vasko, M.Ed.1 December 2007 | Psychiatric Services, Vol. 58, No. 12Special Section: A Memorial Tribute: Care of Patients With the Most Severe and Persistent Mental Illness in an Area Without a Psychiatric HospitalJean-François Trudel, M.D., M.Sc.Alain Lesage, M.D., M.Phil.1 December 2006 | Psychiatric Services, Vol. 57, No. 12Journal of Dual Diagnosis, Vol. 3, No. 1One-Year Follow-Up of Persons Discharged From a Locked Intermediate Care FacilityH. Richard Lamb, M.D., and Linda E. Weinberger, Ph.D.1 February 2005 | Psychiatric Services, Vol. 56, No. 2Journal of Social Work Practice in the Addictions, Vol. 5, No. 4Artikel12 April 2017 | Nordic Studies on Alcohol and Drugs, Vol. 21, No. 4-5Blood-Borne Infections and Persons With Mental Illness: Responding to Blood-Borne Infections Among Persons With Severe Mental IllnessMary F. Brunette, M.D., Robert E. Drake, M.D., Ph.D., Bryan J. Marsh, M.D., William C. Torrey, M.D., Stanley D. Rosenberg, Ph.D., and 1 June 2003 | Psychiatric Services, Vol. 54, No. 6Occupational therapy for people with dual diagnosis: a single case studyBritish Journal of Therapy and Rehabilitation, Vol. 10, No. 4Journal of Psychiatric Practice, Vol. 9, No. 3Out-patient behaviour therapy in alcoholism: treatment outcome after 2 years28 August 2002 | Acta Psychiatrica Scandinavica, Vol. 106, No. 3Journal of Addictive Diseases, Vol. 21, No. 3Long-Stay Patients in State Psychiatric Hospitals at the End of the 20th CenturyWilliam H. Fisher, Ph.D., Paul J. Barreira, M.D., Jeffrey L. Geller, M.D., M.P.H., Andrew W. White, M.A., Alisa K. Lincoln, Ph.D., and Marylou Sudders, M.S.W.1 August 2001 | Psychiatric Services, Vol. 52, No. 8Assaults on Staff by Psychiatric Patients in Community ResidencesRaymond B. FlanneryJr., Ph.D., William Fisher, Ph.D., Andrew Walker, Karolina Kolodziej, and Michael J. Spillane1 January 2000 | Psychiatric Services, Vol. 51, No. 1The Last Half-Century of Psychiatric Services as Reflected in Psychiatric ServicesJeffrey L. Geller, M.D., M.P.H.1 January 2000 | Psychiatric Services, Vol. 51, No. 1New Directions for Mental Health Services, Vol. 1999, No. 84New Directions for Mental Health Services, Vol. 1999, No. 84The Journal of Behavioral Health Services & Research, Vol. 26, No. 3The Journal of Behavioral Health Services & Research, Vol. 26, No. 3Symptoms, Cognitive Functioning, and Adaptive Skills in Geriatric Patients With Lifelong Schizophrenia: A Comparison Across Treatment SitesPhilip D. Harvey, Ph.D., Evelyn Howanitz, M.D., Michael Parrella, Ph.D., Leonard White, Ph.D., Michael Davidson, M.D., Richard C. Mohs, Ph.D., Jennifer Hoblyn, M.D., and Kenneth L. Davis, M.D.1 August 1998 | American Journal of Psychiatry, Vol. 155, No. 8Substance Abuse, Vol. 19, No. 1Current Opinion in Psychiatry, Vol. 11, No. 3Stress in community care teams: will it affect the sustainability of community care?Social Psychiatry and Psychiatric Epidemiology, Vol. 32, No. 7The state of the state mental hospital 1996 [published erratum appears in Psychiatr Serv 1997 Jan;48(1):99]1 April 2006 | Psychiatric Services, Vol. 47, No. 10 Volume 47Issue 4 April 1996Pages 434-435 Metrics PDF download History Published online 1 April 2006 Published in print 1 April 1996

All Change? The Role and Tasks of Community Occupational Therapists in Scotland

In November 1994, the Scottish Office commissioned a short study of occupational therapy in Scotland. It aimed to examine the structure, scale and outputs of the service and the role of occupational therapy in the context of community care. A variety of methods was employed. The total number of posts for occupational therapists has increased recently but a critical shortage of support posts remains. Staff recruitment and retention are not problematic, In contrast to the situation south of the border. Occupational therapists still spend most of their time on equipment and adaptations. Authorities have been developing a range of strategies for tackling this problem, but more are needed. The Involvement of occupational therapists in care management is at an early stage. Practitioners are working with a more diverse range of clients than before, and some have greater opportunities to utilise their wider skills. Most have compjex extended networks for collaboration, although links with home care and health colleagues are often underdeveloped. Hospital discharge is a problematic area. The findings Indicate the need for occupational therapists to become better Integrated within community care teams, for more authorities to consider developing a unitary workforce straddling social services and health agencies, and for the deployment of occupational therapists to a wider and more Imaginative range of settings.

Observations from community care for serious mental illness during a controlled study

A controlled study of community care in serious mental illness (SMI) was carried out. Patients with SMI were randomised to have hospital care or be looked after by a community psychiatric care team in a Daily Living Programme (DIP). The day-to-day work of a clinical team with the difficulties encountered in delivering community psychiatric care in an inner city is described. There were seven deaths from self-harm during the 45-month study. One DIP patient committed homicide. An ordeal by media following this and the suicides are described. Lessons learnt include the need for the community care team to be responsible for discharge from any in-patient phases and for attention to team morale, especially during adversity, and to time spent working under pressure.

Two HIV/AIDS community support teams: patient characteristics, problems at referral and during the last 6 weeks of life.

Following the debate over the role and funding of specialist HIV/AIDS services there has been a call for more information about the needs of people with advanced HIV/AIDS and the processes and outcomes of care. This study describes the characteristics and problems of patients referred to two HIV/AIDS community teams in central London: Home Support Team (HST) and Community Care Team (CCT). Data was collected prospectively for consecutive referrals. A validated outcome measure of palliative care assessed 17 items (e.g. symptoms and anxieties), each rated 0 (best = no problem) to 4 (worst = severe problems). In total 234 patients (HST 116, CCT 118) were referred. Of these 215 died in care (HST 109, CCT 106). Most (232) were male (197 homosexual), mean age 37.8 years and 199 had AIDS at referral. Main sources of referral to HST were hospital ward rounds or nurses (51%); and to CCT genito-urinary medicine clinic staff (59%). Patients were referred to CCT much later in the course of their disease and spent a significantly shorter time in care (median time: HST 42 weeks, CCT 9.5 weeks). Symptom control, family anxiety and patient anxiety were identified as severe problems for 11%-58% of patients in the care of both teams. During the last 6 weeks of life HST patients' ratings for symptom control and family anxiety became more severe compared with CCT, where patients' ratings for four items improved. These findings suggest that staff referring patients may need further training in the recognition and management of the needs of patients and their carers and families. The similarity of problems between these patients and those reported for cancer patients suggests that the transfer of principles of good practice between services caring for these patient groups would be beneficial.

The management and development of continence services within the framework of the NHS and Community Care Act (1990)

The current context of community health care is described and the main issues concerning the development of continuity of care for the handicapped and elderly raised. Changes in philosophical and governmental approaches have coincided at a time of demographic changes that is resulting in increased numbers of elderly. Continence services are used as a vehicle in order to demonstrate the need for protocols, systems and evaluation measures across community care team boundaries. Current government decisions and reports are interwoven within the text with professional considerations and other requirements for decision making. The proactive approach offered in this paper for continence services, is also seen as important to other specialist services, such as stoma and diabetes care so that standards of patient care are improved--these being evaluated by approved quality care tools.