Development Of Services For People Research Articles

A new model for general practice-led, regional, community-based, memory clinics

BackgroundDementia is a major international health issue with high impact on the patient, relatives, and broader society. Routine screening for dementia is limited, despite known benefit of early detection and intervention on quality of care and patient outcomes. Screening is particularly limited in rural and regional areas, despite high burden and projected growth of dementia in these populations. The current study aimed to implement a new general practitioner (GP) led, multidisciplinary, model of care providing dementia detection and referral pathway to a community-based specialist clinic across six regional general practices.MethodsCross-sectional analysis of dementia screening and referral characteristics in the St Anthony Family Medical Practices group based in the regional area of Loddon-Mallee, Victoria. Data were collected on demographics and relevant medical history. Cognitive state was assessed using the Mini-Mental State Examination (MMSE), GP Assessment of Cognition (GPCog), and Geriatric Depression Scale (GDS). Referrals and referral outcomes were recorded for geriatrician, psycho-geriatrician, or both.ResultsEight hundred and eighteenth patients over 65 years were screened, accounting for approximately 24.2% of 65 and over presentations for the practice network. Of those screened, 68.9% were indicated for referral and 30.3% of these were successfully referred. Of the indicated patients who received referrals, 34.2% declined. Many who declined referral had intermediate scores on the cognitive assessments utilized.ConclusionStandardised models of care, integrated within community services, are necessary to improve access to early detection, referral and quality management of dementia. The St Anthony Memory Service model will be invaluable in informing future service development, and in particular the development of services for people living with dementia in rural and regional communities.

Implementation of an Isolation Shelter for Individuals with COVID 19 Experiencing Homelessness.

The COVID-19 pandemic had a devastating impact on non-sheltered homeless and housing-insecure individuals. This report details the development of a Chicago-based isolation shelter designed for people experiencing homelessness and recovering from COVID-19. The model is informative concerning the rapid development of services for people marginalized by the health care system.

Pitfalls of integrated care pathways for high needs patients

Introduction: In the forthcoming extensive reform of social and health care in Finland these services will be fully integrated at all levels of care. One of the most challenging target groups of the reform are patients making much use of both social and health care services, i.e. ‘high needs patients’. This paper introduces a study addressing the problems identified by care professionals working in the field in implementing integrated care pathways for this patient group. The study is part of a research project entitled ‘Successful Integration in Health and Social Care’, coordinated by the University of Eastern Finland and funded by the Foundation for Municipal Development (KAKS). The research question of the sub-study presented here is: What are the pitfalls in implementing integration in the care pathways for high needs patients? Theory/Methods: The study draws on the theoretical approaches to care pathways (Campbell et al. 1998; Rosstad et al. 2013), integration of health and social care (Nolte & McKee 2008; Valentijn 2015); integration models (Sampalli et al. 2012; Grembowski 2015); development of care services for people with multimorbidity (Rijken et al. 2016); and collaboration among health and social care professionals (e.g. D’Amour 2005; Schepman et al. 2015). The data was gathered in Finland in spring 2016 from participants on the Better Everyday Life project. Twenty-two teams of composed of various care professionals (altogether 130 people) representing primary, specialized and social care conducted a problem analysis of the development challenges in pathways for high needs patients. The professionals used the LEAN-based ‘fishbone tool’ for analyzing the pathways. The data were analyzed by two researchers using content analysis and the ATLAS.ti qualitative data analysis software. Results: Four main categories of problems in the care pathways were identified: helpless professionals, tired patients, insufficient coordination of care between the ‘silos’ of health and social care and lack of support from management. Professionals often find patients with multiple needs burdensome and that they lack the capacity to solve their problems. The only way to deal with them is to pass them on to another professional or care provider. Patients suffer from fragmentation of services: they get lost in the jungle of separate services and wear themselves out. Nobody in the care system is responsible overall for a patient needing services from several separate actors. Management is unaware of the problems at the operative level and does not give enough support for the care professionals to improve the pathways through collaboration. Discussions and Conclusions: (comprising key findings) Successful implementation of care pathways for high needs patients requires multi-professional and inter-organizational collaboration beyond professional, organizational and sectoral silos. Lessons learned: Thorough consideration of state-of-the-art of care pathways by grassroots professionals is a fruitful starting point for development work. Limitations: The findings are based on a small-scale study in the health and social care context of a single country. However, the challenges of integrated care pathways may be quite similar in other European countries. Suggestions for future research: In addition to listening to grassroots professionals, high needs patients themselves as well as managers should be involved in the study.

A review of the availability and cost effectiveness of chronic obstructive pulmonary disease (COPD) management interventions in rural Australia and New Zealand.

Chronic obstructive pulmonary disease (COPD) is a chronic, progressive disease, which consumes a significant proportion of the Australian and New Zealand healthcare budget. Studies have shown that people living with COPD outside of urban areas have higher rates of hospitalisations. Two international reviews have demonstrated reduced hospital admissions and length of stay in people with COPD who participate in an integrated disease management program. However, most studies included in these reviews are in urban settings. The purpose of this review is to explore the type and cost-effectiveness of COPD management interventions located in rural or remote settings of Australia and New Zealand in order to inform planning and ongoing service development in the authors' local health district. Six databases and Google scholar were searched to find literature relating to the availability and cost-effectiveness of non-pharmaceutical interventions for the management of COPD in rural and remote areas of Australia and New Zealand. Two studies were found that met the inclusion criteria. Both studies had small sample sizes, were single intervention studies and showed a positive influence on variables such as number of hospital admissions and length of stay at 12 months post-intervention. However, because of the limited number of studies and the lack of homogeneity of interventions, no conclusions regarding availability and cost-effectiveness of COPD interventions in rural and remote areas of Australia and New Zealand could be drawn. Limited literature exists to inform planning and development of services for people with COPD living in rural and remote areas of Australia and New Zealand. Approximately 50% of pulmonary rehabilitation programs are situated in rural and remote locations in Australia and New Zealand. Outcomes from existing programs need to be reported in a consistent and coordinated manner to allow evaluation of health resource utilisation.

Communication disability in Fiji: Community self-help and help-seeking support

Purpose: To understand how a Fijian community supports people with communication disability (PWCD) and whether their support is associated with participant demographics.Method: Thematic analysis of 144 questionnaires that asked about participants’ actions to support a fictional child and adult with communication disability.Result: Participant responses fell into two categories: what they would do directly (self-help) and people and places where they would seek assistance (help-seeking). Self-help behaviours included: making a change to their own communication style or mode; trying to change their own and others’ behaviour; teaching new skills; praying; changing the physical environment; seeking information independently; assessing or observing; and, using traditional medicine, western medicine, or traditional belief practices. Help-seeking behaviours included seeking help from: other community members; education professionals; a professional in another country; spiritual leaders; traditional belief practitioners; traditional medicine practitioners; western health care practitioners; or, an alternative provider (e.g. home, orphanage, nursing home). Younger participants and those of iTaukei Fijian ethnicity were more likely to seek help from other community members.Conclusion: This Fijian community actively supports people with communication disability within available networks. Development of speech-language pathology services for people with communication disability living in similar communities should harness the informal knowledge within these networks.

Politics of geographic exclusion: deinstitutionalization, hegemony and persons with intellectual disability in Israel

Deinstitutionalization is a core policy for the development of services for people with intellectual disabilities (ID) in western countries. Nonetheless, although a western country, deinstitutionalization is not well advanced in Israel. In order to shed light on this phenomenon, we explore the hegemony of ID as reflected in Israeli legislation. The analysis shows a biomedical hegemony; ID is depicted as a form of medical and social deviance. Israel’s legislation reflects paternalistic views of persons with ID, who are largely seen as vulnerable objects of pity, to be cared for and protected.

Karl Koenig, Stanley Segal, and Herbert Gunzburg: pioneers in the field of intellectual disability in Britain

This paper seeks to examine the contribution of three pioneers — Karl Koenig, Stanley Segal, and Herbert Gunzburg — to the development of services for people with an intellectual disability in Britain. Their respective contributions are set within an historical context which examines events which took place in Europe before and during the Second World War. It also looks at the consequences of the eugenics legacy which coloured professional and popular perceptions of people with an intellectual disability in Britain. What sets these pioneers apart is the fact that they were all practitioners and had first-hand experience of creating and delivering innovative programmes and services. In identifying and celebrating their achievements, it is acknowledged that there is currently an absence of comparable figures providing leadership, inspiration, and direction at a time when the economic recession threatens the future of services for people with an intellectual disability.

Implementation of the World Report on Disability: Developing human resource capacity to meet the needs of people with communication disability in Uganda

The World Report on Disability makes nine recommendations to ensure the inclusion, participation, and emancipation of people with disabilities. As described by Wylie, McAllister, Marshall, and Davidson (2013), the recommendations present a challenge for the development of services for people with communication disability (PWCD) in the Majority World, particularly recommendation 5: “increasing human resource capacity”, since professionals with training in communication disability are often in extremely short supply. In partial answer to this situation in East Africa, a degree-level education programme for speech-language pathologists (SLPs) commenced in Uganda in 2008. This paper describes the establishment of that degree course, the current context of professional education, service development, and delivery, and describes how the World Report on Disability recommendation of increasing human resource capacity could be further addressed using culturally-appropriate, accessible, and innovative models of education. It highlights the need for a multi-strand and long-term approach to addressing communication disability at impairment, activity, and participation levels and offers a vision for the future of services in Uganda.

Human rights and intellectual disabilities: an emergent theoretical paradigm?

Human rights and intellectual disabilities: an emergent theoretical paradigm?

The Role of Library and Information Science Education in the Development of Community Health Information Services for People Living with HIV/AIDS: Perspectives of Directors and Managers of Public Libraries

This article identifies the role of library and information science (LIS) education in the development of community health information services for people living with HIV/AIDS (PLWHA). Preliminary findings are presented from semi- structured qualitative interviews that were conducted with eleven directors and managers of local branches in the Knox County Public Library (KCPL) System that is located in the East Tennessee region in the United States. Select feedback reported by research participants is summarized in the article about strategies in LIS education that can help local public librarians and others in their efforts to become more responsive information providers to PLWHA. Research findings help better understand the issues and concerns regarding the development of digital and non-digital health information services for PLWHA in local public library institutions.

Reconciling the perspective of practitioner and service user: findings from The Aphasia in Scotland study

It is widely accepted that service users should be actively involved in new service developments, but there remain issues about how best to consult with them and how to reconcile their views with those of service providers. This paper uses data from The Aphasia in Scotland study, set up by NHS Quality Improvement Scotland to identify the direction of the development of services for people with aphasia in Scotland. It examines the views both of those who provide and of those who receive those services. The study integrated findings from a questionnaire to all speech and language therapists treating people with aphasia across Scotland with findings from focus groups with service users and aphasia practitioners. Three themes were identified: (1) public and professional awareness of the impact of aphasia on the individual and their family; (2) current service provision and gaps in services; and (3) directions for the future development of services and barriers to change. Although the impact of aphasia is well recognized amongst most professionals (that is, not just speech and language therapists), considerable concern was expressed about the level of knowledge amongst professionals who do not specialize in stroke care and about public awareness of aphasia. Service providers indicated a shift in the model of service delivery of which the service users were largely unaware. Although the majority of speech and language therapists spend most of their time providing one-to-one therapy, and this is valued by service users, there is undoubtedly an emerging shift towards a focus on broader social function and the inclusion of the person with aphasia in supportive social networks. This creates tensions because of the existing pressure for individualized models of delivery. Concern was expressed by practitioners, although not echoed by patients, about the transition from the acute sector to primary care. Practitioners also expressed concern about the introduction of more recent services like NHS 24 and e-health initiatives, which rely on means of communication that may be particularly challenging for people with aphasia. The findings from this study indicate that although there are clearly common perspectives, the views of people with aphasia about services do not necessarily coincide with those of service providers. This is an important consideration when initiating consultation and highlights the need for clarity on the part of practitioners in identifying the aims and objectives of their services as far as people with aphasia are concerned.

Transition and people with learning disabilities

PurposeThe paper's purpose is to describe the information content of web sites developed by and for people with learning disabilities around the theme of transition from school to adulthood.Design/methodology/approachThe paper adopts a content analysis approach, in which subject experts evaluate user‐generated content produced as part of a project on inclusion and people with learning disabilities.FindingsDespite being only one theme of a number pertaining to transition, leisure, entertainment and hobby‐related information dominated the web sites. Other issues elicited included that of writing about one's personal experiences providing limited information of use to others, the key role of carers/supporters in information provision, and some material being too difficult for people with learning disabilities to understand.Practical implicationsThe paper shows that for the information service to be valuable and relevant to the target audience, much training and considerable time investment are required for both people with learning disabilities and their supporters. The practice of creating and uploading information on to the web site holds benefits to the creator beyond mere information provision.Originality/valueThe development of information services for people with learning disabilities by the service users themselves is an important innovation. This paper points out how such an inclusive approach could work in the future.

Good practice in transition services for young people with learning disabilities: a review

There is now a vast amount of available information, research and policy on the transition of young people with learning disabilities to adulthood. These sources are informed by different professional philosophies and practices, resulting in a heterogeneous mass of data that can be confusing, contradictory and repetitive. In this review we provide an overview of recent publications about services for young people with learning disabilities at the time of transition, with particular focus on those with mental disorders including neurodevelopment disorders and/or challenging behaviour. We discuss their relevance to good practice and the implications for the future development of services for people with learning disabilities in the UK. We argue that, despite the qualitative differences between the experience of transition to adulthood for young people with learning disabilities and that of other young people, the principles of service provision remain the same. Developments in research and clinical practice in this field ought to reflect good practice, as well as embracing new methodologies, and benefit from advances in adolescents without learning disabilities.

Service innovation: a virtual informal network of care to support a ‘lean’ therapeutic community in a new rural personality disorder service

This article presents a brief overview of service user-led informal networks of care in therapeutic community practice before discussing the design and evolution of a new kind of network in one of the pilot services of the Department of Health National Programme for the Development of Services for People with Personality Disorder (National Institute for Mental Health in England, 2003a). This network employs well-established internet messaging and chat room facilities uniquely structured and moderated to encompass therapeutic community principles and provide equality of access across a huge mixed urban and rural catchment area. Both hardware and software are inexpensive, easily transferable to similar services and could be modified to suit other applications. The success of this system in allowing challenging work to proceed in a much reduced therapeutic community programme may offer the prospect of many more community-based therapeutic communities at the heart of new personality disorder services.

Lessons from an Australian community dialectical behaviour therapy programme for borderline personality disorder

In 2003, the National Institute for Mental Health in England (NIMHE) published guidelines for the development of services for people with personality disorders (NIMHE, 2003), prompting community mental health teams (CMHTs) to reassess their service provision for this patient group. The guidelines did not recommend any particular treatment approach, but CMHTs were encouraged to develop specialist programmes. For many CMHTs the focus has been on borderline personality disorder, as it is one of the most prevalent personality disorders seen in adult mental health services and has high costs for both the patient and the service (Moran, 2002). The evidence base for which treatment may be most effective within the community remains small, however, and this has left many CMHTs unclear regarding a suitable programme. Here I will outline a CMHT-based dialectical behaviour therapy (DBT) programme operating in Western Australia and reflect on why I feel it is an option that CMHTs in the UK looking to develop their service should consider.

Standards of care in home care services: A comparison of generic and specialist services for older people with dementia

Current policy in England emphasises both the importance of caring for highly dependent older people for as long as possible in their own homes, and the development of specialist care services for people with dementia. However, the differences between specialist and generic home care services for people with dementia are poorly understood. This cross-sectional postal survey describes the standards of home care services for people with dementia in the North West of England, and investigates the differences in quality standards between specialist and generic home care services. Forty-six percent of identified services provided information on a range of quality indicators. Most services provided only a few of the indicators utilized by the study, and there was little evidence of services adopting national minimum standards. Few differences were found between the two service types, although generic services appeared to offer a greater degree of flexibility than specialist services. These results help to inform the understanding of home care service mix and provision, and the uptake of national minimum standards. They provide key material for shaping the future provision of home care for older people with dementia.

Development of a multi-agency experiential training course on personality disorder

Aims and MethodThe need for training in the management of personality disorder is now firmly established following publication of policy implementation guidance for the development of services for people with such disorders. We report on the development of a training course for people from a range of disciplines, which is group-based, psycho-analytically informed and experiential in nature.ResultsThose attending the course rated it highly. They showed marked changes in attitude towards, and greater confidence to work with, the client group, and were more willing to communicate their own difficulties openly both within and between agencies, to pass on their skills and to develop further the networks they had formed.Clinical ImplicationsGiven a containing structure and reflective space, professionals from a number of agencies rapidly become able to use difficult theory to develop a ‘feeling language’ to communicate about clients with personality disorder. User presentations can be important to these changes. Repeating such a course over a number of years might lead to a more therapeutic culture within mental health services and associated agencies. The course format is likely to be transferable.

Making the journey brighter: early diagnosis and support services for people with dementia and their carers Alzheimer Scotland Making the journey brighter: early diagnosis and support services for people with dementia and their carers £8 p&p free 0 948897 0948897.

This report is intended to help speed up the development of early intervention services for people with dementia. It describes the needs of people with early stage dementia and their families and explains why early intervention services are needed, what they are and the evidence for what they achieve. Tel: 0131 243 1453. www.alzscot.org.

Is training in psychosocial interventions worthwhile? Report of a psychosocial intervention trainee follow-up study

A follow-up study of psychosocial intervention (PSI) trainees from the Sheffield and Maudsley training centres was undertaken in three stages. In Stage 1, 141 students, at two PSI training centres, were sent a simple postal questionnaire to elicit career trajectory following PSI training. A response rate of 82% was achieved. The sub-group, who had been trained and who still engaged in clinical practice were identified and followed-up in more detail ( n=96). The effect of PSI training in a range of domains was investigated. The impact of training may not be to equip students with formal technical skills in CBT and family work. What is more likely is that trainees acquired proficiency in: working effectively using a case management model; conveying ‘therapeutic optimism’; enabling users to meet their own goals and helping them to develop better coping strategies; using ‘stress vulnerability’ and formal outcome measures as means of structuring this approach. The secondary aim of the study was to identify and prioritise the barriers that impede the effective implementation of PSI skills in routine service settings. For the second phase of the survey the response rate was again 82%. This group's service managers were identified and surveyed for the same information and 59% responded. The aim was to gather information about implementation issues from both the clinical and service perspectives. The results of the survey indicate that PSI training has a positive impact on the development of services for people with serious mental health problems although there are serious organisational hurdles for managers, trainees and organisations to overcome if PSI skills are to be properly implemented. Key factors that impact upon faithful implementation are related to resource issues (caseload size), organisational factors (the existence of an implementation plan and training strategy), and the extent to which the trainee's team is supportive.

Community Mental Health Services for Individuals with Intellectual Disabilities

This article describes the issues associated with the development of services for people with intellectual disabilities (ID) and mental disorders [including challenging behavior (CB)] and reviews the evidence for providing effective community mental health services. Despite the fact that deinstitutionalization has been on the forefront of policies to improve social care for individuals with ID in the community, there has not been an equivalent drive to offer appropriate and effective interventions for the treatment of mental illness in this population. Evidence-based practice is still in its infancy and mental health outcomes are just beginning to emerge. The mental health component of existing specialist services is not fully integrated in many localities and mental health input is even considered stigmatizing to people with ID. Yet, people with ID have a higher prevalence of mental disorders, including schizophrenia and CB, and are vulnerable to overmedication and abuse. Furthermore, there has been more research on service models for CB than for mental health services. However, there is a need for further investigations of outcomes and of the application of such well known examples of community care as assertive community treatment, intensive case management and crisis resolution. People with ID deserve robust services to manage mental illness in this population.