Use Of Community Services Research Articles

Linking Employed Caregivers' Perceptions of Long-Term Community Services With Health Care Legislation

Many Americans experience the daily struggle of combining employment with long-term caregiving of an older adult in their family. This study examined factors affecting employed informal caregivers use and nonuse of long-term community services and the influence on their employment. Using a mixed-methods approach, the study had a convenience sample of 50 employed informal caregivers. Three major factors were identified as facilitating the use of long-term community care services, whereas 9 others were described as barriers. The study participants also suggested 12 changes in long-term community services that could have allowed them to continue both employment and informal caregiving. Information from this study may help advance the discussion regarding the linkage of employed informal caregivers' needs, perceptions of community support services, and their employment.

Is use of formal community services by older women related to changes in their informal care arrangements?

ABSTRACTThis paper examines how the relationships between the factors (predisposing, enabling and illness) of the 1973 Andersen framework and service use are influenced by changes in the caring role in older women of the 1921–26 cohort of the Australian Longitudinal Study on Women's Health. Outcome variables were the use of three formal community support services: (a) nursing or community health services, (b) home-making services and (c) home maintenance services. Predictor variables were survey wave and the following carer characteristics: level of education, country of birth, age, area of residence, ability to manage on income, need for care, sleep difficulty and changes in caring role. Carer changes were a significant predictor of formal service use. Their inclusion did not attenuate the relationship between the Andersen framework factors and service use, but instead provided a more complete representation of carers' situations. Women were more likely to have used support services if they had changed into or out of co-resident caring or continued to provide co-resident care for a frail, ill or disabled person, needed care themselves, and reported sleep difficulties compared with women who did not provide care. These findings are important because they indicate that support services are particularly relevant to women who are changing their caring role and who are themselves in need of care.

Inclusion of adults with disability in Australia: outcomes, legislation and issues

This paper focuses on adults with disability and their inclusion in Australian society by examining various outcomes: community living, community participation and inclusive social roles such as open (competitive) employment, participation in university education, as well as use of generic community services like public transport. Australian disability services legislation provides clear support for inclusion, but implementation is inconsistent and segregated services remain common. Available outcomes data indicate that Australian disability service users are more to likely experience greater inclusion if they live in more normalised and less segregated settings. Australia has a history of segregated disability services and inaccessible community services that it is working to overcome. There is a growing but still a limited inclusion for adults in key adult roles such as open employment and university education. Significant progress has been made in areas as diverse as deinstitutionalisation and increased accessibility to public transport, but much remains to be done.

Does Risk Assessment Make a Difference? Results of Implementing the SAVRY in Juvenile Probation

An effective approach to reducing recidivism is, first, to identify a youth's risk of reoffending and then to match the intensity of interventions to that risk level. This pre-post quasi-experimental, prospective study compared 247 (pre) with 217 (post) adjudicated youths to examine the implementation of the Structured Assessment of Violence Risk in Youth (SAVRY) and its effects on case management practices in Louisiana's Caddo parish probation office. The results indicated that placement rates dropped by 50%, use of maximum levels of supervision dropped by almost 30%, and use of community services decreased except for high-risk youths, but only after the SAVRY was properly implemented. This shift towards more appropriate allocation of resources that are matched to risk level occurred without a significant increase in reoffending. The implications for implementation and for use of risk/needs assessment in juvenile probation are discussed.

Use of Community and School Mental Health Services by Custodial Grandchildren

We examined patterns and predictors of the perceived need, use, and unmet need for mental health services by custodial grandchildren within both the school-based and community-based delivery sectors. Data were self-reported by a national sample of 610 custodial grandmothers providing full-time care to grandchildren ages 6 to 17 in the absence of biological parents. Although overlapping use of services across both sectors was common, the overall use of school-based services (51%) was higher than that of community-based services (37%). Using theAndersen Social and Behavioral Model (1995) the following shared predictors of mental health service use across both sectors by custodial grand-families emerged: grandchildren's externalizing symptoms, having other grandchildren in the household with medical or psychiatric diagnoses and corresponding use of services in the other sector. Predictors were largely the same regardless of whether analyses were conducted with families recruited by probability or convenience based sampling methods. Findings suggest the necessity to coordinate and integrate the availability and implementation of mental health services for custodial grandchildren across different delivery sectors.

Burden of a Multiple Sclerosis Relapse

Relapses are a common feature of relapsing-remitting multiple sclerosis (RRMS) and increasing severity has been shown to be associated with higher healthcare costs, and to result in transient increases in disability. Increasing disability likely impacts work and leisure productivity, and lowers quality of life. The objective of this study was to characterize from the patient's perspective the impact of a multiple sclerosis (MS) relapse in terms of the economic cost, work and leisure productivity, functional ability, and health-related quality of life (HR-QOL), for a sample of patients with RRMS in the US treated with immunomodulatory agents. A cross-sectional, web-based, self-report survey was conducted among members of MSWatch.com, a patient support website now known as Copaxone.com. Qualified respondents in the US had been diagnosed with RRMS and were using an immunomodulatory agent. The survey captured costs of RRMS with questions about healthcare resource utilization, use of community services, and purchased alterations and assistive items related to MS. The Work and Leisure Impairment instrument and the EQ-5D were used to measure productivity losses and HR-QOL (health utility), respectively. The Goodin MS neurological impairment questionnaire was used to measure functional disability; questions were added about relapses in the past year. Of 711 qualified respondents, 67% reported having at least one relapse during the last year, with a mean of 2.2 ± 2.3 relapses/year. Respondents who experienced at least one relapse had significantly higher mean annual direct and indirect costs compared with those who did not experience a relapse ($US38 458 vs $US28 669; p = 0.0004) [year 2009 values]. Direct health-related costs accounted for the majority of the increased cost ($US5201; 53%) and were mainly due to increases in hospitalizations, medications, and ambulatory care. Indirect costs, including informal care and productivity loss, accounted for the additional 47% of increased cost ($US4588). Accounting for the mean number of relapses associated with these increased costs, the total economic cost of one relapse episode could be estimated at about $US4449, exclusive of intangible costs. The mean self-reported Expanded Disability Status Scale (EDSS) score, derived from the Goodin MS questionnaire, was significantly higher with relapse than with a clinically stable state (EDSS 4.3 vs 3.7; p < 0.0001), while the mean health utility score was significantly lower with relapse compared with a clinically stable state (0.66 vs 0.75; p = 0.0001). The value of these intangible costs of relapse can be estimated at $US5400. The overall burden (direct, indirect, and intangible costs) of one relapse in patients treated with immunomodulatory agents is therefore estimated conservatively at $US9849. This study shows that from a patient's perspective an MS relapse is associated with a significant increase in the economic costs as well as a decline in HR-QOL and functional ability.

Older people’s perception of their readiness for discharge and postdischarge use of community support and services

To examine older patients perception of their readiness for discharge from hospital to home and use of community supports postdischarge, including readmission. Early discharge leaves little time for older people, families and professionals to prepare. The perspectives of patients are essential to therapeutic caring; however, few studies have examined patient's perception of their readiness for discharge. A quantitative, descriptive and correlational design was used. Data were collected from older patients (n = 335) at discharge and postdischarge using the Readiness for Discharge Scale (Weiss & Piacentine; Journal of Nursing Measurement, 14, 2006, 163) and a Demographic and Community Resource Questionnaire. At 6 weeks postdischarge, almost one-quarter had been readmitted. Family support had increased, yet a minimal increase in formal services was found. At discharge, differences in readiness existed between the younger and older old. Significant relationships existed between lower perception of readiness at discharge and increased use of informal and formal support post-discharge. Lower perception of readiness had a significant relationship with readmission in the older old. Perceptions of readiness reflect the patient's reality and may be significant to discharge preparation and arrangements for support. Older patients' perspectives should be included in discharge decisions and in individualised approaches by nurses to discharge preparation.

Examining the Sociolinguistic Context in Schools and Neighborhoods of Pre-adolescent Latino Students: Implications for Ethnic Identity

This study examined the sociolinguistic contexts of neighborhoods and schools in two predominantly Latino communities in the United States. We used census data to assess social and ethnic composition and observational data to compare and contrast environmental print, language use, and availability of community services in Spanish in these schools and neighborhoods. Structured interviews with pre-adolescent (5th grade) students raised questions about how these sociolinguistic contexts might contribute to ways they viewed themselves as part of their ethnic community. Observational results revealed striking differences in the prevalence and use of Spanish across these two communities. Student interviews raised questions about how pre-adolescent Latino students in these two very different sociolinguistic contexts may see themselves in relation to their ethnic group. Implications for supporting ethnic-identity-development processes are discussed.

Assessing patterns of home and community care service use and client profiles in Australia: a cluster analysis approach using linked data

The planning and delivery of care systems require knowledge on the ways in which individuals access available services that are funded by a range of health and community services. The aims of this study were to identify distinct groups of Home and Community Care (HACC) clients in New South Wales, Australia, based on patterns of actual service use, and to understand the health and social needs and resources of client groups that access different mixes of services. Multiple data sets linked at the individual level - including the 45 and Up Study community survey, the HACC Minimum Data Set and the Admitted Patient Data Collection for hospitals - provide an innovative basis to investigate the complexity of access to service use. Data were collected between 2006 and 2008. A cluster analysis based on clients' type and volume of community service use was conducted on the 4890 HACC clients in the linked dataset and nine distinct clusters of clients were identified. Three of these clusters were considered 'complex', in terms of the range of community and hospital assistance received, while the others comprised mainly of one or two dominant service types. The analytical approach and findings developed here provide a client-centred approach to monitor and evaluate access to local service systems that are being reformed to better integrate the delivery of health and community services currently funded and managed separately by national and state governments.

Factors associated with use of community mental health services by schizophrenia patients using multilevel analysis

BackgroundPersons with schizophrenia and related disorders may be particularly sensitive to a number of determinants of service use, including those related with illness, socio-demographic characteristics and organizational factors. The objective of this study is to identify factors associated with outpatient contacts at community mental health services of patients with schizophrenia or related disorders.MethodsThis cross-sectional study analyzed 1097 patients. The main outcome measure was the total number of outpatient consultations during one year. Independent variables were related to socio-demographic, clinical and use of service factors. Data were collected from clinical records.ResultsThe multilevel linear regression model explained 46.35% of the variance. Patients with significantly more contacts with ambulatory services were not working and were receiving welfare benefits (p = 0.02), had no formal education (p = 0.02), had a global level of severity of two or three (four being the most severe) (p < 0.001), with one or more inpatient admissions (p < 0.001), and in contact with both types of professional (nurses and psychiatrists) (p < 0.001). The patients with the fewest ambulatory contacts were those with diagnoses of persistent delusional disorders (p = 0.04) and those who were attended by four of the 13 psychiatrists (p < 0.001).ConclusionsAs expected, the variables that explained the use of community service could be viewed as proxies for severity of illness. The most surprising finding, however, was that a group of four psychiatrists was also independently associated with use of ambulatory services by patients with schizophrenia or related disorders. More research is needed to carefully examine how professional support networks interact to affect use of mental health.

Correcting Community Service: From Work Crews to Community Work in a Juvenile Court

In 2001, the Clark County Juvenile Court in Washington State implemented the use of “restorative community service” (RCS) as part of its larger adoption of a restorative justice framework. This paper explores the court’s implementation and use of RCS, including: (1) the types of institutional changes made by the court in its development of RCS, (2) the types and qualities of social interactions observed by the researcher through participant observation at several RCS sites, (3) the practical implications of these findings for proponents of restorative justice in the use of community service in youth settings, and (4) the theoretical implications of these findings for sociological and criminological research on community service.

A systematic review of different models of home and community care services for older persons.

BackgroundCosts and consumer preference have led to a shift from the long-term institutional care of aged older people to home and community based care. The aim of this review is to evaluate the outcomes of case managed, integrated or consumer directed home and community care services for older persons, including those with dementia.MethodsA systematic review was conducted of non-medical home and community care services for frail older persons. MEDLINE, PsycINFO, CINAHL, AgeLine, Scopus and PubMed were searched from 1994 to May 2009. Two researchers independently reviewed search results.ResultsThirty five papers were included in this review. Evidence from randomized controlled trials showed that case management improves function and appropriate use of medications, increases use of community services and reduces nursing home admission. Evidence, mostly from non-randomized trials, showed that integrated care increases service use; randomized trials reported that integrated care does not improve clinical outcomes. The lowest quality evidence was for consumer directed care which appears to increase satisfaction with care and community service use but has little effect on clinical outcomes. Studies were heterogeneous in methodology and results were not consistent.ConclusionsThe outcomes of each model of care differ and correspond to the model's focus. Combining key elements of all three models may maximize outcomes.

Community Service Use by Older Adults: The Roles of Sociocultural Factors in Rural–Urban Differences

ABSTRACT This study examined the influence of sociocultural factors in explaining the rural–urban differences in home and community-based service (HCBS) use among older adults. Survey data of 228 older adults living in Alabama were analyzed. Sociocultural factors included participants’ perceptions of service availability, attitudes toward seeking formal help, informal support, and religious behaviors. Rural older adults were less likely to use HCBS than their urban counterparts (p < .05). An interaction effect between perceived service availability and church attendance was found. These findings suggest a need for collaborations between community aging services with religious organizations to ensure existing programs are accessible to older adults living in rural areas. Future research based upon large probability samples is needed to shed more light on the relation between church attendance and service use.

S17-01 - Assessing functionality in Schizophrenia: The psychosocial remission in Schizophrenia scale (PSRS)

BackgroundRemission, both symptomatic and psychosocial, is now an achievable goal in a substantial proportion of schizophrenia patients.Objectiveto develop a brief, clinician rated scale for the assessment of psychosocial remission in schizophrenia (the PSRS). The scale is to match the quantification of symptomatic remission as delineated by the American Psychiatric Association (APA) task force.Methoda “bank” of 124 questions pertaining to psychosocial remission was derived from published scales reflecting two domains: quality of life (QoL) and activities of daily living (ADL). Psychiatrists, residents, psychiatric nurses and community nurses were presented with the questions. All were asked to choose the 8 items they considered as reflecting the essence of psychosocial remission. Inter-rater reliability of the final scale version was assessed amongst psychiatrists.Resultsthe questions' “bank” was reviewed by 429 mental health professionals. The four items found to be most frequently sanctioned in the QoL domain were: a. familial relations (endorsed by 78% of participants), b. understanding and self-awareness (46%), c. energy (58%) and d. interest in every-day life (38%). The four items sanctioned in the I-ADL domain were: a. self-care (86%), b. activism (65%), c. responsibility for medications (54%) and d. use of community services (32%). Inter-rater reliability amongst 70 psychiatrists ranged from 0.67 to 0.83.Conclusionthe PSRS is an 8-item scale quantifying psychosocial remission in schizophrenia in a manner that complements symptomatic assessment of remission. The PSRS may be useful for both research and clinical evaluation.

The effect of patient characteristics upon uptake of the influenza vaccination: a study comparing community-based older adults in two healthcare systems

the uptake of influenza vaccination represents a simple marker of proactive care of older people. However, many still do not receive the vaccine. To understand this challenge better, we investigated the relationship between patient characteristics (demographic, physical and psychological health and health service use) and vaccination uptake in a sample of community-dwelling older people in two adjacent but differently structured healthcare systems (Northern Ireland (NI) and the Republic of Ireland (RoI)). a total of 2,033 randomly selected community-dwelling older adults (65 years and older) were interviewed in their homes. rates of uptake were 78% in NI and 72% in RoI. The uptake was greater with older age (odds ratio (OR) 1.6, 95% confidence interval (CI) = 1.3-2.1, P < 0.0005), widowhood (OR = 1.5, 95% CI = 1.1-2.3, P = 0.02), living in NI (OR = 0.77, 95% CI = 0.6-0.9, P = 0.04), greater functional impairment (OR RoI 2.0, 95% CI = 0.8-3.5, P = 0.03), more frequent use of family doctor (OR RoI 0.5, 95% CI = 0.3-0.6, P = 0.0001; NI 0.6, 95% CI = 0.4-0.9, P = 0.01) and greater use of services such as chiropody (OR NI 0.6, 95% CI = 0.4-0.9, P = 0.01), meals-on-wheels (OR RoI 1.3, 95% CI = 0.4-2.2, P = 0.03), social work (OR RoI 1.2, 95% CI = 0.3-1.9, P = 0.05) and occupational therapy (OR RoI 1.3, 95% CI = 0.5-2.5, P = 0.02). the uptake rates in both healthcare systems exceeded targets. Higher rates of vaccination were found among older people, those who were married and those who made greater use of hospital and community services. Increased exposure to health services may enhance trust in health care leading to higher vaccination uptake.

Preoperative factors prolonging the length of stay in elective colorectal surgery

In elective colorectal resections, the patient's preoperative social situation may play a significant role in delaying their discharge from hospital. The aim of this study was to identify which preoperative factors are associated with non-medical reasons for a delay in discharge and prolonged length of stay (LOS) in hospital after elective colorectal resections. A retrospective review of prospectively collected data was performed on all the elective colorectal resections done at Westmead Hospital for over 2 years between 2007 and 2008. LOS, whether there was a delay in discharge because of non-medical reasons, preoperative factors such as sex, age, marital status, country of birth, use of an interpreter, any children, type of residence, use of community services, American Society of Anaesthesiology (ASA) score, and whether the patient lives on their own, is a sole carer or requires help with activities of daily living were recorded. Overall median age was 66 years (58–75 years). Median post-operative LOS for patients not delayed in discharge was 8 days and 15 days for patients with an identifiable non-medical reason for delay (P < 0.0001). Preoperative factors significantly associated with a delay included advanced age (odds ratio (OR): 10.5; 95% confidence interval (CI): 3.0–37.7; P < 0.0001), being widowed (OR: 3.5; 95% CI: 1.2–10.2; P = 0.02) and living in a retirement village (OR 15.4; 95% CI: 1.6–150.3; P = 0.019). Higher ASA scores strongly correlated with longer LOS. This study confirms that preoperative factors are important in contributing to non-medical delays in discharge and longer post-operative LOS after elective colorectal resections.

Homelessness: patterns of emergency department use and risk factors for re-presentation

ObjectivesTo describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless.MethodsA retrospective cohort analysis was undertaken over...

Why carers of frail older people are not using available respite services: an Australian study

The purpose of this study was to explore the limiting and motivating factors that influence carers' use of respite services and the ability of currently available respite services to meet the needs of carers of frail older people. The development of community carer support services, their availability and usage and the common barriers that affect or impact on carers' use of community services in general and respite services in particular need to be examined to ensure they meet client needs. A qualitative descriptive approach informed by critical social theory was used to expose the inequities inherent in community services. A qualitative examination of carer relationships with respite services was informed and guided by critical theory. Sixteen carers took part in four focus groups. A purposeful sampling strategy was adopted to engage with carers not currently using respite services. Study participants were recruited from a state-wide carer support organisation and a community service organisation in Queensland, Australia. Three themes emerged from the data: 'Commitment' characterised by reciprocity, role definition and role frustration, 'Needing Help' discussed in terms of trust, confidence in service, fear and resistance, and 'Support' discussed in relation to informal networking, misinformation and lack of knowledge. This study improves our understanding of the caring role, its significance in carer's lives and how this shapes their formal service expectations and use. The findings suggest that further investigation of the factors involved in carers' service expectations and service-seeking is warranted to develop a deeper understanding of how care giving influences the ways carers seek help from formal services. Service delivery changes towards a model of care, which engages and promotes user control and fosters genuine participatory relations between informal and professional carers may improve uptake of respite services.

Anomaly detection for travelling individuals with cognitive impairments

Persons with mental impairments tend to be viewed as unemployable and systematically excluded from labor markets. However, this assumption has been challenged recently after the development of community rehabilitation, and supported employment services in particular. With sufficient and appropriate support on the job, many people with mental illness are capable of participating in the world of work to various levels, which not only provides them with financial support but also opportunity for social integration. Social integration includes community-based living, recreation and leisure pursuits, use of community services, and independent movement in and around the community through the use of public transportation. Coupled with this increased independence and integration is risk. With repeated training continued with daily practice, the individuals usually have no problems of getting lost or disoriented. However, there are occasions that individuals do forget how to travel to and from work. For example, part-timers with fewer shifts have more chances of running into transportation problems because they forget the routes. For places with many distractions, few landmarks that can help remain oriented, or surroundings that look similar, the situations can become worse. To decrease the risk for victimization of individuals with disabilities as they increasingly participate in their communities and seek social inclusion, mobile technology is used with a focus on increased autonomous functioning. Because individuals with disabilities are frequently dependent on others for support across environments, strategies and skills must be introduced that directly lead to access of those supports. Care providers are at the center of the support they have. Unfortunately, their care providers are often overloaded by too much work that results from pre-service training, coaching, escorting them to workplaces, and so on. To relieve their care providers from labor-intensive aids with traveling back and forth from work, we propose a PDA that is carried by the individual who has cognitive impairments. The PDA enables individuals to respond to unexpected situations such as being lost by effectively using the handheld device to alert themselves or call for assistance from the support system. In this article, we build a real-time anomaly detection system and conduct field experiments in communitybased settings for individuals with cognitive impairments. Deviation detection considers trajectories as input and tries to identify anomaly in following normal routes such as taking public transportation from the workplace to home or vice versa. Trajectory clustering is one of the methods of identifying normal routes from abnormal ones [9, 11]. However, trajectory clustering is performed only when trajectories of trips are completed. This makes the clustering algorithms less useful in identifying anomaly and discovering route deviation in the real time. Predicting personal destinations is the main principle behind most previous work in pervasive computing on modeling and predicting transportation routines. Many studies in this area share the trait that candidate destinations are extracted from GPS histories, i.e. places that subjects have actually visited [2, 8, 10]. In contrast, our work in anomaly detection is more focused on extracting anomaly at times users are trying to follow transportation routines, not necessarily inferring personal destinations.

Effective personalised housing support for people with disabilities – case study analysis

International policy trends favour personalised approaches to housing support for people with disabilities. Previous research is inconclusive about whether these approaches are effective compared to group home support in the way they use government resources and benefit clients, partly because it does not usually consider the experiences of people who use the support. In this research we compared six new, innovative case studies of personalised housing support to previous research about group home support. We included qualitative data about client experiences, in particular regarding social networks, decision making, community service use and participation in domestic tasks. We found that client outcomes were positive in all four categories, while the financial costs to clients and government were similar to group home support. The results offer evidence that current, personalised approaches to housing support can be an effective policy option that allows people with disabilities to make choices about how to live and participate in their communities, without increasing the cost to government.