Current Service Delivery System Research Articles

가정폭력 피해 이주여성 지원 제도 및 서비스에 대한 고찰: 문제점과 개선 방안을 중심으로

While public awareness on domestic violence has increased over the past few decades in Korea, little is known about domestic violence issues pertaining to immigrant women. This study is an attempt to provide an overview of domestic violence issues, legal and policy structures, and current social service system in place for battered immigrant women in Korea. The findings show that various sound legal and policy framework has been established over the past years, resulting in provisions added to the existing laws on domestic violence, policies developed specifying support for battered immigrant women and implementation of social service agencies to assist and protect the battered immigrant women and their families. Using the AAAQ framework by UN, we examined the current service delivery system. The result shows that service availability, accessibility, and acceptability are found to be quite compromised by gaps between the policy and practice. A large number of service providers are located in metropolitan areas, reducing the accessibility of battered women in other regions. A limited budget is also a barrier to provide comprehensive services to all in need. Lastly, a lack of translator and interpreter services limits accessibility and acceptability as both the service providers and the victims are unable to communicate with language barriers. Based on the findings, we suggested implications for policy and practice.

Comment for "The Importance of Health Management in Developing Countries; Choosing a Health Champion or a Slaughterhouse Executioner"

Improving population health is a challenge facing all countries, both developed and developing. As healthcare has become more complex and specialised, management faces serious governance gaps. The current service delivery system is not robust enough to apply knowledge and technology in a consistent, safe, effective, timely and efficient manner, as argued by authors Kalavani and Akhondzardainien in a recent article published in the Journal of Quality in Health Care & Economics

Barriers to mental health care for disadvantaged adolescents: perspectives of service providers

ABSTRACTObjective: To identify barriers and enablers to professional mental health service utilisation for disadvantaged adolescents from the perspective of mental health service providers.Method: This study incorporated qualitative research methods with eight semi-structured, face-to-face interviews completed with purposively recruited government, non-government and school mental health service providers. The data were collected from May to September 2015 in Perth, Western Australia. Data analysis was undertaken using content analysis.Results: Service providers identified multiple barriers and facilitators for disadvantaged adolescents accessing and using mental health services including: (1) pathways to mental health services; (2) how services listen to and interact with adolescents; (3) service environment, including youth-friendly locations and atmosphere; and (4) government and organisational policies.Discussion: These results highlight the need to simplify pathways and provide support for adolescents in negotiating the mental health system. Schools can be utilised as an important gatekeeper to mental health services. Legislation associated with adolescent mental health appears to be a barrier for adolescents in seeking or continuing with care. Service should place more emphasis on building trusted relationships with clients and developing capacity to perform outreach. Strategies to enable services to work collaboratively may reduce the risk that adolescents experience multiple referrals within the system. To reduce the impact on individuals and long-term costs, the State Government needs to make early intervention a priority and modifying the current service delivery system to be more inclusive of adolescents’ perspectives.

Improving antiretroviral therapy scale-up and effectiveness through service integration and decentralization

Current service delivery systems do not reach all people in need of antiretroviral therapy (ART). In order to inform the operational and service delivery section of the WHO 2013 consolidated antiretroviral guidelines, our objective was to summarize systematic reviews on integrating ART delivery into maternal, newborn, and child health (MNCH) care settings in countries with generalized epidemics, tuberculosis (TB) treatment settings in which the burden of HIV and TB is high, and settings providing opiate substitution therapy (OST); and decentralizing ART into primary health facilities and communities. A summary of systematic reviews. The reviewers searched PubMed, Embase, PsycINFO, Web of Science, CENTRAL, and the WHO Index Medicus databases. Randomized controlled trials and observational cohort studies were included if they compared ART coverage, retention in HIV care, and/or mortality in MNCH, TB, or OST facilities providing ART with MNCH, TB, or OST facilities providing ART services separately; or primary health facilities or communities providing ART with hospitals providing ART. The reviewers identified 28 studies on integration and decentralization. Antiretroviral therapy integration into MNCH facilities improved ART coverage (relative risk [RR] 1.37, 95% confidence interval [CI] 1.05-1.79) and led to comparable retention in care. ART integration into TB treatment settings improved ART coverage (RR 1.83, 95% CI 1.48-2.23) and led to a nonsignificant reduction in mortality (RR 0.55, 95% CI 0.29-1.05). The limited data on ART integration into OST services indicated comparable rates of ART coverage, retention, and mortality. Partial decentralization into primary health facilities improved retention (RR 1.05, 95% CI 1.01-1.09) and reduced mortality (RR 0.34, 95% CI 0.13-0.87). Full decentralization improved retention (RR 1.12, 95% CI 1.08-1.17) and led to comparable mortality. Community-based ART led to comparable rates of retention and mortality. Integrating ART into MNCH, TB, and OST services was often associated with improvements in ART coverage, and decentralization of ART into primary health facilities and communities was often associated with improved retention. Neither integration nor decentralization was associated with adverse outcomes. These data contributed to recommendations in the WHO 2013 consolidated antiretroviral guidelines to integrate ART delivery into MNCH, TB, and OST services and to decentralize ART.

Needs assessment: an Internet information system for Taiwan's professionals working with adult survivors of childhood sexual abuse

The problem of childhood sexual abuse (CSA) continues as a serious public health issue in Taiwan. However, the current service delivery systems in Taiwan are fragmented and fraught with a variety of problems, similar to those reported in Western society. Because of the sensitive nature of CSA, the development of an internet information system may be helpful in treatment efforts. The Delphi method was used to collect data from 15 professionals in the field of CSA in order to assess the need for such an information system. The needed resources, limitations, and implications of the study are discussed.

Ageing and Australian Disability Enterprises

Ageing and Australian Disability Enterprises

Veterans with history of mild traumatic brain injury and posttraumatic stress disorder: Challenges from provider perspective

The Department of Veterans Affairs (VA) has separate clinical structures and care processes for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). However, because veterans are returning from the wars in Iraq and Afghanistan with TBI (most frequently mild TBI [mTBI]) and PTSD, the VA needs to evaluate current service delivery systems. We conducted key informant interviews with 40 providers from across the United States who represented separate clinical teams providing specialized TBI or PTSD services. We identified challenges providers perceive in scheduling and engaging patients with co-occurring mTBI and PTSD (mTBI/PTSD) in treatment, determining the etiology of patients' presenting problems, coordinating services, and knowing whether or how to alter standard treatments. We found consensus that patients with mTBI/PTSD often have other morbidities requiring specialized treatment, including pain and sleep disturbance. Another important theme we found was the need for patient and family educational material on mTBI/PTSD or pain and mTBI/PTSD and provider education tailored to provider specialty. Together, findings point to the need for guidance for providers on best practices to assess and treat mTBI/PTSD given available information, a systematic approach toward patient and provider education, and research to build the evidence base for practice.

Disability and the Black Community

Back to table of contents Previous article Next article Book ReviewsFull AccessDisability and the Black CommunityAltha J. Stewart, M.D.Altha J. StewartSearch for more papers by this author, M.D.Published Online:1 Feb 2005https://doi.org/10.1176/appi.ps.56.2.227AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Although the literature related to the complex and diverse disability concerns and needs of the black community has increased in the past two decades, there are still gaps and inconsistencies in translating theory and knowledge into practice. An already marginalized population, black persons with disabilities are further disenfranchised by the stigma and discrimination related to their disability. Disability and the Black Community is relevant to all health and human service professionals, because it expands the focus beyond treatment and intervention to include other important cultural and socioeconomic stressors that influence disabilities and those adapting to disability in the black community. Sheila D. Miller and her contributors have diverse perspectives on the needs of black individuals with disabilities. As the national debate on reducing health care disparities continues, the topics discussed in this book are timely and relevant.The aim of the book is to motivate, influence, and empower communities, including providers and policy makers. Disability and the Black Community goes beyond a traditional review of health care services and reforms, with several authors providing an overview of the history of the development of current service delivery systems and the systemic deficiencies that account for the inadequate treatment of black people. The inclusion of such background and historical information makes the book useful for both beginning and veteran practitioners. Mental health and social service professionals at all levels should find this book helpful.Several authors describe the variables to be taken into account to ensure appropriate inclusion of a cultural perspective in dealing with black persons with disabilities and highlight the need to shift from crisis-oriented and reactive responses in the current system to a more proactive, fully integrated approach. In addition, several authors confront assumptions and stereotypes about blacks and the roles such biases play in response to disability by individuals, their communities, and the service delivery system. Several contributors offer specific, culturally appropriate strategies for effective interventions designed to improve quality of life for these individuals.Topics of importance to black individuals, such as mental health services for children, chronic medical illnesses (sickle cell anemia, arthritis, HIV infection and AIDS, and end-stage renal disease), domestic violence, foster care, housing, education and workforce training, and the cultural resiliency required to overcome the challenges they present are discussed. Adolescent males, a high-risk group, are the subject of three articles. One article describing the quality of life of black hemodialysis patients is especially thought provoking as we learn more about the metabolic and possible end-organ effects of newer psychotropic medications.No matter what their professional orientation, those who work with black persons with disabilities will find that Disability and the Black Community offers useful information to support the belief that culture, instead of being viewed as an "add-on," should be viewed as improving care for all those we serve.Dr. Stewart is president of the American Psychiatric Foundation and leads a minority health care firm based in Memphis, Tennessee, that provides consultative services to nonprofit health and behavioral health systems, governmental agencies, and private corporations.by Sheila D. Miller; New York, Haworth Press, 2002, 239 pages, $24.95 softcover FiguresReferencesCited byDetailsCited ByNone Volume 56Issue 2 February 2005Pages 227-227 Metrics History Published online 1 February 2005 Published in print 1 February 2005

A Public Health Approach to “Prevention With Positives”

Prevention of new HIV infections through meeting the prevention needs of HIV-infected persons, known as "prevention with positives," is a national priority. State health departments administer complex HIV/AIDS prevention, health care, and supportive service programs and shape the context for prevention services in their states. This larger context provides opportunities for development and enhancement of HIV prevention interventions. This article presents results of an assessment conducted by the New York State Department of Health of the extent to which the New York State HIV service delivery system, conceptualized as a continuum of services, supports prevention with positives and identifies opportunities for new initiatives. The New York State service continuum offers a comprehensive yet flexible framework into which effective HIV prevention interventions and services are embedded. It is mobilized in support of meeting individuals' HIV prevention needs. The service continuum continues to evolve and requires constant attention on the part of New York State Department of Health to keep pace with the ever-changing HIV epidemic. Additional features of New York State's comprehensive approach to prevention with positives are also discussed. This simple assessment, which can be adapted for use elsewhere, was effective in pinpointing how the current service delivery system supports prevention with positives. Approaches used by state health departments to advance prevention with positives warrant support and recognition.

Organization and Delivery of Long-Term Care in Taiwan

Summary Taiwan reached the World Health Organization (WHO) benchmark of7%aged 65and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan.

Navigating Systems of Care: Results From a National Survey of Families of Children With Special Health Care Needs

In this article we focus on the contemporary experiences of families of children with special health care needs (CSHCN) and illustrates the extent to which they are embedded in multiple systems of care that include health insurance plans, public supports, community-based programs, and a variety of specialized providers. Data are presented from the Family Partners Project, a national survey of 2,220 parents of CSHCN conducted from 1998 to 1999 in 20 states. We address 4 critical issues, including the complexity of current service delivery systems, the problems experienced in obtaining needed specialty services, the coordination of services and the role of case managers, and parental ratings of health plans.

Rural Mental Health and Elders: Historical Inequities

Although there have been unexpected and unintended consequences—and what many might consider inadequate care—America has consistently attempted to care for its mentally ill. This article provides a historical review of the pathways this care has taken, with particular focus on the persistent inequities older and rural adults experience with regard to mental health care. The care of people with mental illness has taken different forms as social, political, and economic environments have changed. The persistent social construction of myths about aging in rural areas and ageist biases necessitate greater advocacy if more equitable care is to be provided. This will unquestionably involve addressing the myths surrounding rural life, removing the stigma attached to mental illness, becoming aware of the biases inherent in current service delivery systems, and developing new and different models for the delivery of care that is appropriate to diverse, rural settings.

TBI State Demonstration Grants.

In July 1996, the Congress enacted Public Law 104-166, "to provide for the conduct of expanded studies and the establishment of innovative programs with respect to traumatic brain injury" (TBI). Under the Law, the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB) is charged with implementing a State Demonstration Grant Program to improve access to health and other services for individuals with TBI and their families. The National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) have also been delegated responsibilities in the areas of research, surveillance and prevention, respectively. Traumatic brain injury (TBI) is defined as an insult to the brain from some externally inflicted trauma to the head that results in significant impairment to an individual's physical, psychosocial, and/or cognitive functional abilities. Motor vehicle crashes, falls, violence, and sport-related injuries are the major causes of TBI; the number one killer and cause of disability for young people in the United States. The Centers for Disease Control and Prevention has identified that approximately 5.3 million Americans live with the effects of TBI. About half the estimated 1.9 million Americans who experience traumatic brain injuries each year incur at least short-term disability; 52,000 people die as a result of their injuries; and more than 90,000 people sustain severe brain injuries leading to debilitating loss of function. The direct medical costs for treatment of TBI have been estimated at more than $4 billion annually. There are two program categories in the TBI State Demonstration Grant Program: Planning and Implementation. The planning category provides support to those States that need assistance in developing an infrastructure for individuals with TBI in their families. The implementation category supports the development and expansion of activities that will improve or enhance access to services for individuals with TBI and their families, within the current service delivery system.

Special education in Macedonia

ABSTRACT This paper provides an overview of educational opportunities currently available for young people with disabilities in the (former Yugoslav) Republic of Macedonia. Information about Vygotsky's theory of defectology is presented, and its influence on the current service delivery system for persons with disabilities is described. Since independence in 1991, a series of reforms, some initiated by the signing of international declarations, have been introduced into mainstream and special education. The challenges posed by these reforms are discussed in the context of the need for East‐West partnerships based on mutual understanding and respect

Implementing the family preservation program: Feedback from focus groups with consumers and providers of services

There is a growing understanding that preventative child welfare efforts can be both more cost effective and are more desirable philosophically than strictly remedial programs. The Family Preservation Act provides funds to assist communities in strengthening and preserving at-risk families. In order to implement this program effectively, local communities must design new programs and procedures which will be both attractive to consumers and effective in meeting their needs. This study it identifies problems with contemporary child and family services and suggests solutions to those problems. This study uses a focus group format and presents ideas generated by those individuals who will be most directly affected by this legislation; front line service providers and service consumers. Several areas of weakness in the current service delivery system are identified, including bureaucratic barriers, limited resources, problematic consumer/provider relations and a range of collaborative issues, both within and between agencies and the communities they serve.

Homeless families: program responses and public policies.

Numerous programs have been developed nationwide to address the needs of homeless families but many of their policies and practices raise serious questions about the adequacy of the nation's response. Significant problems in the current service delivery system are examined and recommendations are offered for a comprehensive program response that emphasizes service-enriched housing, specialized approaches to meet the needs of homeless mothers, and preventive interventions.

Refining an aftercare program for New York state's outpatient insanity acquittees.

Non-secure state operated psychiatric centers and community based providers of mental health services have witnessed an increase in their caseloads of defendants adjudicated not responsible for criminal activity as a result of mental disease or defect (NGRIs). NGRIs receiving services in these traditionally non-forensic settings are subject to continued court supervision by virtue of Court Orders of Conditions that are designed to assure that NGRIs receive services in a manner that is consistent with the public safety. Several characteristics of the current service delivery system often impede the ability to fulfill statutory mandates and the effective delivery of services to NGRIs. The authors provide an overview of the statutory provisions governing the care of NGRIs, discuss obstacles to the implementation of integrated services to NGRIs and propose a model for the development of an effective community based monitoring and treatment program.

The Regular Education Initiative in the U.S.: What Is Its Relevance to the Integration Movement in Australia?

A NEW THRUST for the integration of students with a mild disability has been initiated by special education scholars and Federal government officials in the U.S. The “regular education initiative” is based upon the assumption that mildly disabled students’ educational and social needs can be better served in regular education settings. Proponents of the regular education initiative are seeking “waivers for performance” that would allow school districts to experiment with alternative service delivery models and the allocation of resources without being Financially penalized under the current funding systems. Critics argue that the strength of the research base used to support REI is insufficient to warrant wholesale changes in current service delivery systems. They are sceptical of the argument that REI type programs can eliminate the effects of labeling by better integrating students who need supplemental educational resources. An analysis of the REI proposals and their conceptual relevance to the Austral...

The myth of the multi-problem family.

It is suggested that the concept "multi-problem family" is a myth when viewed in the context of our current service delivery system. That system, itself fragmented, may do more to promote than relieve family distintegration, conflict, and personal anxiety. Continued professional training and tendencies that lead to viewing problems presented by individuals only as individual problems may result in overlooking opportunities for total family approaches to treatment and prevention.

Role of behavior modification in community mental health.

This paper briefly reviews the original concept of the community mental health movement; points to ways in which current service delivery systems deviate from this; offers and alternative framework for service delivery, that is, a behavioral model; and argues that its implementation would move community services closer to this conception. The implications of this model for intervention in the natural environment as well as for transitional and prosthetic facilities are described and examples given of its use. Emphasis is placed on working in the natural environment whenever possible via the use and cultivation of significant others as well as via provision of training in self-directed behavior change in addition to the blending of case management with careful evaluation of service.