Coordinated Service Provision Research Articles

Using the RE-AIM Framework to Evaluate Implementation of Male Involvement Strategies to Optimize the PMTCT Program in Malawi: A Mixed-Methods Study.

Involvement of male partners has been shown to be key for the prevention of mother-to-child HIV transmission (PMTCT). Despite the recorded success, uptake and implementation of strategies to involve men in PMTCT continues to be low in Malawi. In this study, we used the Reach Effectiveness Adoption Implementation and Maintenance (RE-AIM) implementation science framework to explore the implementation of male involvement (MI) strategies in Lilongwe, Malawi. We used a cross-sectional mixed-methods complementary-concurrent design from September to October 2020 in two health facilities. Qualitatively, we used a phenomenological approach and conducted seven focus group discussions (FGDs), three with women and four with men. We further conducted four key informant interviews (KIIs) among health care workers. Quantitatively, we conducted a cross-sectional study comprising 138 men presenting at an antenatal clinic (ANC). We used univariate analysis in Stata for the quantitative data, whereas a manual thematic analysis was applied to the qualitative data. Implementation and adoption of the strategies was high among health providers and there were indications of maintenance of the strategies. Provider's attitude, coordinated service provision, integrated training and service provision, information provision, and baby's HIV outcomes were driving factors in implementing the MI strategies. These factors have contributed to the sustained implementation of the strategies over time. In contrast, financial and time constraints, inadequate human resources, and male-friendly spaces impede the implementation of MI strategies. Improving MI will require a systems approach considering health system and individual-level factors for both providers and consumers.

Structural competency in the post-prison period for people who inject drugs: A qualitative case study

IntroductionAccess to services is key to successful community (re-)integration following release from prison. But many people experience disengagement from services, including people who inject drugs (PWID). We use a case study approach and the notion of structural competency to examine influences on access to services among a group of PWID recently released from prison. MethodsThis qualitative study recruited participants from SuperMIX, (a longitudinal cohort study in Victoria, Australia). Inclusion criteria: aged 18+; lifetime history of injecting drug use; incarcerated for > three months and released from custody < 12 months previously. From 48 participants, five case studies were selected as emblematic of the complex and intersecting factors occurring at the time participants missed an appointment at a service. ResultsNumerous, concurrent, and interdependent structural influences in participants’ lives coincided with their difficulty accessing and maintaining contact with services and resulted in missed appointments. The key factors involved in the cases presented here include policies around opioid agonist treatment, inadequate, unsuitable and unsafe housing, the management of mental health and side effects of treatment, the lack of social support or estrangement from family, and economic hardship. The support available from service workers to navigate these structural issues was inconsistent. One dissenting case is examined in which missing appointments is anticipated and accommodated. ConclusionsA case study approach enabled a holistic and in-depth examination of upstream structural elements that intersect with limited social and economic resources to exacerbate the challenges of community re-entry. These results highlight structural issues that have a disproportionate impact on the choices and opportunities for PWID. The incorporation of a structural competency framework in design of services and in staff training could support person-centred and coordinated service provision that take into account PWID's experiences post-release to overcome structural barriers to service engagement.

Issues affecting people with motor neurone disease and their carers: a literature review

Access to support for people with motor neurone disease (MND) is an area of concern for the person living with the condition as well as the carers supporting them. This review is an exploration of the key issues for people living with MND and their carers; it demonstrates the need for coordinated service provision that meets the complex holistic needs of those with MND—and their carers—throughout the disease trajectory. This literature review highlights several key themes in relation to these individuals and their carers. These include: specific needs of the carers; the service provision, including information and communication; hope and depression; and ethical decision-making.

Inadequate Communication Exacerbates the Support Needs of Current and Bereaved Caregivers in Advanced Heart Failure and Impedes Shared Decision-making.

Clinicians face considerable challenges in identifying patients with advanced heart failure who experience significant symptom burden at the end of life. Often, these patients are cared for in the community by a loved one who has limited access to support from specialist services, including palliative care. The aims of this study were to explore caregivers' experience when caring for a loved one with advanced heart failure at the end of life and to identify any unmet psychosocial needs. This article reports findings of a qualitative study, using semistructured, one-to-one interviews with current and bereaved caregivers, who participated in a larger mixed-methods study. Interviews were conducted by a trained researcher, digitally recorded, transcribed verbatim, and imported to NVivo 11 for data management and coding. Data were analyzed using thematic analysis and an inductive approach. The 30 interviews included 20 current caregivers and 10 bereaved caregivers. The central feature of the caregivers' experience was identified as being "a physical and emotional rollercoaster." There were 3 main themes identified: poor communication, living with uncertainty, and lack of service provision. These themes were supported by 6 subthemes: inadequate understanding of palliative care, a 24/7 physical burden, emotional burden, inability to plan, no care continuity, and dying lonely and unsupported. Caregivers in advanced heart failure need clearer communication regarding diagnosis and prognosis of their loved one's condition to help with the uncertainty of their situation. Improved identification of palliative care needs and more coordinated service provision are urgently required to address their physical and emotional challenges from diagnosis through bereavement.

Coordinating Service Provision in Dynamic Service Settings: A Position-practice Relations Perspective

How is continuity of service provision supported in dynamic service settings (DSS) when interactions span space and time, and are being increasingly infused by technology? We explored this question...

Coordinated service provision in payment for ecosystem service schemes through adaptive governance

In this paper, we look to the adaptive governance literature for insight into how payment schemes for the provision of ecosystem services might be designed to achieve multiple socially desirable objectives over different spatial scales instead of simply focusing on localised benefits for service providers. Using the principles of adaptive governance, we explore how the concepts of lateral information flows and incentive alignment might shape ecosystem service payment schemes and allow the coordination of ecosystem service priorities across different jurisdictions. We suggest that progressing from purely anthropocentric assessments of payment schemes towards biocentric evaluations may lead to improved design principles. We discuss specific advantages of adaptive governance approaches over traditional centralised governance models related to policy-experimentation at multiple spatial scales, institutional variety and deliberative decision-making processes that establish dialogue between service providers and beneficiaries that promote group learning.

Charting the trajectory of domestic violence policy change in the Republic of Ireland since the mid-1990s - a path towards integration?

This paper assesses the policy developments pertaining to the implementation of an integrated approach to domestic violence over the past 15 years. The contextual setting is outlined in terms of the international policy response to the problem of domestic violence based on an ecological perspective. Periods of core strategic policy and related structural developments are considered illustrating the Irish experience of domestic violence policy-making and service provision. The value of adopting an integrated approach to domestic violence based on the rationale of improving strategic policy formulation, coordinating service provision and facilitating joined-up governance is set out. The core facilitators and challenges associated with such an approach are described. The policy framework and restructured landscape of domestic violence in Ireland has undergone significant change over the past decade and a half. The paper uses a three-dimensional matrix of domestic violence policy development and service integration as a means of addressing horizontal, vertical and resource aspects of collaboration and integration. While the changes have been characterised by significant phases of fluctuation in terms of coordinated action and the situation currently appears promising, however it is too early to judge the outcomes of the most recent reforms.

European worlds of inclusive activation: The organisational challenges of coordinated service provision

For activation policies to succeed, the provision of social services in addition to labour‐market services is essential, as social services are a prerequisite for integrating groups with complex social problems into the labour market. Activation policies based on social services can be termed inclusive. They require not only a sufficient financial basis, but also governance structures that deal with the organisational challenges associated with coordinated service provision, including fragmented competences and conflicts between different political arenas and territorial levels. This article analyses the capacity of five countries − Germany, Italy, Poland, Sweden and the UK − to provide coordinated labour‐market and social services from a multidimensional, multilevel and multi‐stakeholder perspective. The findings show that coordinated service provision requires profound changes to national and local governance structures. Future research should take into account the organisational challenges of integrating social and employment services.Key Practitioner Message: ● The coordinated provision of employment and social services is an important precondition for integrating long‐term unemployed and other disadvantaged groups into the labour market.

Local status and power in area-based health improvement partnerships

Area-based initiatives have formed an important part of public policy towards more socio-economically deprived areas in many countries. Co-ordinating service provision within and across sectors has been a common feature of these initiatives. Despite sustained policy interest in area-based initiatives, little empirical work has explored relations between area-based initiative providers, and partnership development within this context remains under-theorised. This article addresses both of these gaps by exploring partnerships as a social and developmental process, drawing on concepts from figurational sociology to explain how provider relations develop within an area-based initiative. Qualitative methods were used to explore, prospectively, the development of an area-based initiative targeted at a town in the north west of England. A central finding was that although effective delivery of area-based initiatives is premised on a high level of co-ordination between service providers, the pattern of interdependencies between providers limits the frequency and effectiveness of co-operation. In particular, the interdependency of area-based initiative providers with others in their organisation (what is termed here as 'organisational pull') constrained the ways in which they worked with providers outside of their own organisations. 'Local' status, which could be earned over time, enabled some providers to exert greater control over the way in which provider relations developed during the course of the initiative. These findings demonstrate how historically constituted social networks, within which all providers are embedded, shape partnership development. The theoretical insight developed here suggests a need for more realistic expectations among policymakers about how and to what extent provider partnerships can be managed.

Engaging young people who misuse substances in treatment

The focus of this review is to examine service utilization, treatment effectiveness, and future directions for adolescents who misuse substances. Although the effectiveness of treatments has improved in the last two decades, young people's utilization of services has remained relatively stable. This is disconcerting because early intervention improves outcomes and deterioration is associated with physical, psychological, and social problems. The requirement for coordinated service provision across a wide range of treatment agencies cannot be emphasized enough, because young substance misusers come to services with a variety of symptoms and problems. It is encouraging that, to date, treatment studies indicate that adolescents in almost all types of treatment reduce their use of substances. The greatest reductions are shown for family therapy, followed by cognitive behavior therapy (CBT), motivational enhancement therapy (MET)/CBT, MET behavior therapy, and pharmacological treatment. Despite the developing treatment literature, important methodological limitations restrict comparability between studies. The requirement for holistic, systematic assessments should include adolescents' social contexts, trauma, and psychiatric and physical illnesses because they are the cornerstones to understanding engagement and retention. Our review shows the importance of coordinating primary healthcare, mental health, and substance abuse treatment facilities, and highlights networking between other providers as integral to providing an optimal response to this unpredictable, often marginalized, group.

A Multilevel Framework for Effective Interagency Collaboration in Mental Health

The difficulty of coordinating service provision in interagency programs is a challenge for many working in public policy. We reflect on lessons learned through evaluating two inter‐agency supported housing programs for people with mental illness and propose a framework outlining components needed for well co‐ordinated service provision. We specify collaborative mechanisms at the policy, agency, service and client level. The key component is the role of an ‘integration coordinator': a person who is able to facilitate relationships and ensure effective information flows. Relationships need to be actively maintained to meet the inevitable challenges that will arise in complex interagency systems. The framework is relevant to policymakers across the public sector, including mental health, drug and alcohol, aged care, and policing.

Super-peer-based coordinated service provision

Leveraging P2P technologies for Web service provision attracts considerable research interests. One of the challenges is how to enable the service providers to adapt themselves in response to dynamic service demand. More specifically, one interesting research issue is coordinating the service groups in order to enable inter-group collaboration and resource sharing. In this paper, we propose a super-peer-based coordinated service provision framework (SCSP), consisting of an S-labor-market model (super-peer-based labor-market model), a recruiting protocol based on a weighting mechanism, and an optimal dispatch algorithm. In the SCSP, the S-labor-market model is designed to build the coordination among service groups by employing the proposed recruiting protocol. The optimal dispatch algorithm is designed to select the optimal service peers within a service group to process service requests. Finally, we perform simulations to evaluate the SCSP with four application scenarios. The experimental results show that our SCSP is efficient in coordinating the service groups, and possess good scalability and robustness.

“I'm wondering if I am completely missing that”: Foster care case managers and supervisors report on their IPV training

The co-occurrence between child maltreatment and adult intimate partner violence (IPV) is estimated to range from 30% to 60%, and child welfare workers have tremendous potential to identify IPV when they are adequately trained. The purpose of this descriptive study is to assess whether any training on IPV is received by child welfare employees in three large geographic areas of one Midwestern state. The study includes survey data from 237 ( n = 133 public, n = 104 private) foster care case managers and supervisors. Data from three focus groups of case managers and supervisors are also used to uncover what topics should be included in IPV training provided to child welfare employees. Results revealed that 49% of the respondents received no training on IPV as part of their initial agency training and 32% have received no training on IPV during their current employment, although public employees reported IPV training more often than private employees. Fifty-eight percent of survey respondents report they are not sufficiently trained to address IPV in their caseload, and public employees discuss aspects of IPV with their supervisors more often than private employees. Focus group results show a wide range of IPV training received by the state's child welfare workers and highlight the need for collaborative training and coordinated service provision with domestic violence agencies.

From pillar to post – a study of younger people with dementia

AIMS and MethodA health needs assessment was undertaken to evaluate current provision and to help inform the future development of services for people under the age of 65 years with dementia in Leeds.ResultsThe prevalence rate for early onset dementia in Leeds was found to be 42 per 100 000 aged 30–64 years, and 78 per 100 000 aged 45–64 years. Four main gateways for specialist investigation and care were identified and 38 referral pathways were identified in total. Carers had difficulties accessing information and services and they, along with the patients, valued, in particular, both the coordinated service provided by the specialist early onset dementia team and the dedicated day care facility available in Leeds.Clinical ImplicationsYounger people with dementia can have very different needs to older people. The prevalence rate and the experiences of carers and patients clearly justifies the existence and further development of a specialist early onset dementia service. Such a service should provide a single gateway to coordinated service provision and ensure continuity of care. It should provide sufferers and carers with information, advice and expertise.

Working with parents with a serious mental illness: What do service providers think?

Parents with a history of serious mental illness are vulnerable in many ways and are therefore likely to be accessing services from a range of government and community agencies. The use of multiple services, sometimes with conflicting practice frameworks, can result in sub-optimal management of these families. This study surveyed 77 service providers from a range of government and non-government agencies targeting their views regarding parents with a serious mental illness (specified in this study as schizophrenia, bipolar disorder and psychotic depression). They were asked what they perceived were difficulties for this population, interventions required to meet the needs of this group and finally, barriers to effective service delivery. We found that service providers reported that current services were inadequate for these parents. Parent-based interventions were seen as being more beneficial than those targeting children. Lack of liaison between agencies and lack of coordinated service provision were seen as the greatest barrier to effective service delivery. The results highlight the need for policy planners and service providers to develop strategies to ensure effective coordination between services that work with this population.

Characteristics and activities of case managers in the RWJ Foundation Program on chronic mental illness.

Case management was seen as the major strategy for integrating mental health, housing, and social supports for clients in the Robert Wood Johnson Foundation Program on Chronic Mental Illness, a five-year multisite demonstration project designed to test the effects of reorganizing mental health systems in large urban areas. The authors assessed data on case management programs in the demonstration project to try to explain the lack of consistent improvement in clients' outcomes that was found in the national evaluation of the project. Data on case management programs from five demonstration sites-Baltimore; Cincinnati; Columbus, Ohio; Denver; and Toledo, Ohio-were reviewed. Data sources included onsite interviews, documentary material, studies of case managers' contact with community agencies that were conducted in 1989 and 1991, and telephone interviews with coordinators of case management programs. The characteristics and activities of case managers changed little between 1989 and 1991. Case managers tended to become the principal service providers for their clients rather than coordinating service provision among multiple service providers. Case managers reported that their clients received few services from other agencies in the local community support system. Although lack of change in case managers' activities during the demonstration project may help explain clients' lack of improvement over time, case management by itself does not constitute comprehensive treatment. More attention must be paid to the development and refinement of community-based medical-psychiatric and psychosocial treatments with a proven track record of improving clients' level of symptoms and quality of life.