Flexible Service Delivery Research Articles

HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda.

BackgroundOral pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, but data are limited on HIV incidence among PrEP users in generalized epidemic settings, particularly outside of selected risk groups. We performed a population-based PrEP study in rural Kenya and Uganda and sought to evaluate both changes in HIV incidence and clinical and virologic outcomes following seroconversion on PrEP.Methods and findingsDuring population-level HIV testing of individuals ≥15 years in 16 communities in the Sustainable East Africa Research in Community Health (SEARCH) study (NCT01864603), we offered universal access to PrEP with enhanced counseling for persons at elevated HIV risk (based on serodifferent partnership, machine learning–based risk score, or self-identified HIV risk). We offered rapid or same-day PrEP initiation and flexible service delivery with follow-up visits at facilities or community-based sites at 4, 12, and every 12 weeks up to week 144. Among participants with incident HIV infection after PrEP initiation, we offered same-day antiretroviral therapy (ART) initiation and analyzed HIV RNA, tenofovir hair concentrations, drug resistance, and viral suppression (<1,000 c/ml based on available assays) after ART start. Using Poisson regression with cluster-robust standard errors, we compared HIV incidence among PrEP initiators to incidence among propensity score–matched recent historical controls (from the year before PrEP availability) in 8 of the 16 communities, adjusted for risk group. Among 74,541 individuals who tested negative for HIV, 15,632/74,541 (21%) were assessed to be at elevated HIV risk; 5,447/15,632 (35%) initiated PrEP (49% female; 29% 15–24 years; 19% in serodifferent partnerships), of whom 79% engaged in ≥1 follow-up visit and 61% self-reported PrEP adherence at ≥1 visit. Over 7,150 person-years of follow-up, HIV incidence was 0.35 per 100 person-years (95% confidence interval [CI] 0.22–0.49) among PrEP initiators. Among matched controls, HIV incidence was 0.92 per 100 person-years (95% CI 0.49–1.41), corresponding to 74% lower incidence among PrEP initiators compared to matched controls (adjusted incidence rate ratio [aIRR] 0.26, 95% CI 0.09–0.75; p = 0.013). Among women, HIV incidence was 76% lower among PrEP initiators versus matched controls (aIRR 0.24, 95% CI 0.07–0.79; p = 0.019); among men, HIV incidence was 40% lower, but not significantly so (aIRR 0.60, 95% CI 0.12–3.05; p = 0.54). Of 25 participants with incident HIV infection (68% women), 7/25 (28%) reported taking PrEP ≤30 days before HIV diagnosis, and 24/25 (96%) started ART. Of those with repeat HIV RNA after ART start, 18/19 (95%) had <1,000 c/ml. One participant with viral non-suppression was found to have transmitted viral resistance, as well as emtricitabine resistance possibly related to PrEP use. Limitations include the lack of contemporaneous controls to assess HIV incidence without PrEP and that plasma samples were not archived to assess for baseline acute infection.ConclusionsPopulation-level offer of PrEP with rapid start and flexible service delivery was associated with 74% lower HIV incidence among PrEP initiators compared to matched recent controls prior to PrEP availability. HIV infections were significantly lower among women who started PrEP. Universal HIV testing with linkage to treatment and prevention, including PrEP, is a promising approach to accelerate reductions in new infections in generalized epidemic settings.Trial registrationClinicalTrials.gov NCT01864603.

Sexual and reproductive health service utilisation of adolescents and young people from migrant and refugee backgrounds in high-income settings: a qualitative evidence synthesis (QES).

Young people with migrant or refugee backgrounds from low- and middle-income countries settle in high-income countries and tend to underutilise sexual and reproductive health (SRH) services. This review aimed to explore perceptions and experiences of SRH services and the factors that shape their use among migrant youth. It focuses on qualitative studies that examine SRH service use among young migrants living in high-income countries. Seven peer-review databases and web-based grey literature were searched using pre-determined search criteria. The review includes 16 articles that met the inclusion criteria. The qualitative evidence synthesis (QES) method was used to synthesise findings. Thematic analysis resulted in five main themes and 11 sub-themes. Findings suggest that despite diversity of countries of origin and host countries, there were considerable similarities in their perceptions of and experiences with SRH services. Some young migrants reported experiences of discrimination by service providers. Cost of care was a deterrent to SRH service use in countries without universal healthcare coverage. Lack of information about SRH services, concerns about confidentiality, community stigma around sexually transmitted infections and premarital sex were key barriers to SRH service use. Health systems should integrate flexible service delivery options to address access barriers of SRH service use in young migrants. Engagement with parents and communities can help to destigmatise sexual health problems, including STIs. Host countries need to equip young migrants with the knowledge required to make informed SRH decisions and access relevant SRH services and resources.

Home visiting and justice system collaborations: Two Programs’ approaches to advocating for justice system-involved parents

Justice system-involved parents and their children face many significant socioeconomic and psychosocial challenges; yet, parenting and family support for these families is scant. Home visiting is a voluntary and flexible service delivery strategy that may be well-suited to serving justice system-involved parents. The present study explored implementation features and practices among two home visiting programs in the United States that serve young parents (including expectant parents) with past and current justice system involvement, including a large statewide program that accommodates but does not target justice system-involved parents, and a small program that was designed for and is targeted to mothers in the juvenile justice system. Based on 13 in-depth interviews with parents, home visitors, and justice system representatives, our findings revealed the unique circumstances in the lives of system-involved parents to which home visitors working with these parents must adapt. We discuss home visitors’ techniques for drawing youth into the home visiting relationship and forming connections with them, for targeting program services to their role as parents and other specific needs, and for emphasizing parents’ strengths. Finally, we review each program’s relationship to the state criminal justice agency, and how it facilitates or hinders home visitors’ ability to maintain ongoing program relationships with system-involved parents. The study concludes with practical recommendations for home visiting programs considering working with parents involved in the criminal justice system.

Application-Driven Provisioning of Service Function Chains Over Heterogeneous NFV Platforms

Although network function virtualization (NFV) has been proven to be beneficial in terms of equipment cost, service delivery flexibility, and time-to-market, most of the studies in this area only addressed homogeneous NFV platforms (e.g., with virtual machines (VMs) only). In this work, we argue that by leveraging heterogeneous NFV platforms such as VMs, docker containers, and programmable hardware accelerators (e.g., SmartNICs), one could achieve better flexibility and cost-effectiveness to support virtual network function service chains (vNF-SCs) with various quality-of-service (QoS) requirements. Therefore, we study application-driven provisioning of vNF-SCs over heterogeneous NFV platforms, and design a polynomial-time approximation algorithm to tackle the problem for near-optimal solutions. We first introduce a layered auxiliary graph (LAG) based approach to model the problem of vNF-SC provisioning, and then formulate a novel integer linear programming (ILP) model based on it. Specifically, the ILP model minimizes the total cost of vNF-SC deployment while ensuring that the QoS requirements of all the vNF-SCs are satisfied. To solve the ILP time-efficiently, we propose an approximation algorithm based on linear programming (LP) relaxation and randomized rounding. Extensive simulations confirm that with significantly improved time-efficiency, our proposed algorithm can provide near-optimal solutions whose gaps to the exact ones are bounded.

Speech-language pathologists’ perceptions and experiences when working with Aboriginal and Torres Strait Islander children

Purpose This study explored the perceptions of speech-language pathologists with regards to culturally responsive service delivery, assessment practices, and confidence when working with Aboriginal and Torres Strait Islander children. Method An online survey was used. Descriptive statistics were analysed with SPSS. Themes were derived from text responses using Braun and Clarke’s thematic analysis method. Result The 48 respondents were almost all non-Indigenous, equally spread across metropolitan and non-metropolitan regions, and had varied levels of experience. Respondents reported moderate to high levels of confidence. Identified barriers included accessibility, policy, impacts of colonisation, awareness of services and expectations and speech pathologist knowledge, training and experience. Engagement emerged as a facilitator to provision of culturally responsive services. A variety of speech-language pathology assessment methods were reported, not all of which were consistent with current recommendations. Conclusion Identified barriers and facilitators were consistent with previous research exploring work with adults with acquired communication disorders. A need to explore the perspectives of Aboriginal and Torres Strait Islander communities as users of speech-language pathology services was identified. Clinical implications are described for future training, clinical guidelines, and flexible service delivery.

Barriersto accessing maternal health care services in the Chittagong Hill Tracts, Bangladesh: A qualitative descriptive study of Indigenous women's experiences.

Increased maternal health care (MHC) service utilisation in Bangladesh over the past decades has contributed to improvements in maternal health outcomes nationally, yet there is little understanding of Indigenous women's experiences of accessing MHC services in Bangladesh. Face-to-face semi-structured qualitative interviews with 21 Indigenous women (aged 15-49 years) within 36 months of delivery from three ethnic groups (Chakma, Marma and Tripura) were conducted between September 2017 and February 2018 in Khagrachhari district. Purposive sampling was used to recruit women representative of the population distribution in terms of age, ethnic community and service use experience. All interviews were conducted in Bangla language and audio-recorded with consent. Interviews were transcribed directly into English before being coded. Data were analysed thematically using a qualitative descriptive approach aided by NVivo12 software. Of the 21 women interviewed, 14 had accessed at least one MHC service during their last pregnancy or childbirth and were categorised as the User group. The remaining seven participants were categorised as 'Non-users' as they had not access antenatal care, facility delivery or postnatal care services. Women reported that they wanted culturally relevant, respectful, home-based and affordable care, and generally perceived formal MHC services as being only for complications and emergencies. Barriers to accessing MHC services included low levels of understanding about the importance of MHC services, concerns about service costs, limited transport and fears of intrusive practices. Experiences within health services that deterred women from accessing future MHC services included demands for unofficial payments and abusive treatment by public facility staff. Improving access to MHC services for the CHT Indigenous women requires improved understandings of cultural values, priorities and concerns. Multifaceted reform is needed at individual, community and health systems levels to offer culturally appropriate health education and flexible service delivery options.

Facilitators to Engagement in a Mother-Child Therapeutic Intervention Following Intimate Partner Violence.

Intimate partner violence (IPV) affects more than one in four children worldwide. Despite the growing evidence base for interventions addressing children's IPV exposure, little is known about what assists families to engage with services. The current study sought to explore women's perceptions of barriers and facilitators to accessing an intervention for their children following IPV. A total of 16 mothers who had engaged in a community-based, dyadic intervention for children exposed to IPV participated in the study. The Brief Relational Intervention and Screening (BRISC) is an evidenced informed program designed by Berry Street (Australia). A pilot of the intervention was implemented across one metropolitan and one regional site. In-depth semi-structured interviews were conducted with 16 mothers who had completed BRISC. Transcripts were analyzed in NVivo using thematic analysis. Key facilitators to initial engagement included strong referral pathways, clear information about the program, and initial phone contact from the service. Difficulty trusting services were identified as a key barrier to initial engagement. Facilitators of continued engagement included flexibility in service delivery, consistent and direct communication between sessions, and the therapeutic approach. Key barriers to sustained intervention engagement included children's continued contact with their father, mothers' experiences of guilt and blame, and the need for additional support for mothers' own mental health. These findings highlight how service and clinician factors such as flexibility, therapeutic approaches, and communication can facilitate engagement for families affected by IPV. In addition, the study highlights the importance of including the voices of women in research to improve the acceptability of services for consumers.

An Uncontrolled Trial of Flexibly Delivered Relationship Education with Low-Income, Unmarried Perinatal Couples.

To examine couple and parenting outcomes from an American version of Couple CARE for Parents (CCP) in low-income, unmarried couples. We adapted an evidence-based, flexibly delivered program for use with low-income, unmarried couples, for whom the outcome literature is scarce. Couples (n = 443) were recruited from maternity units and began CCP. They completed measures before, during, and immediately after the intervention, and 6 months later. Moderate psychological intimate partner violence (IPV) declined and perceived parenting efficacy increased over time; there was no change in severe psychological or physical IPV. Individuals with lower levels of relationship commitment than their partners showed improvement in relationship satisfaction, whereas those with similar or higher levels of commitment maintained their baseline levels despite being in a period of expected satisfaction decline. CCP showed some signs of helping low-income couples during a stressful period and its flexible service delivery model allowed these couples to participate by reducing the impediments of transportation challenges, conflicting work schedules, and overall time poverty. Practitioners interested in using CCP with low-income couples would likely maximize the impact by (a) focusing on pregnant, first-time parents; (b) integrating CCP within post-natal healthcare; and/or (c) assuming that a considerable minority of couples will avail themselves of only up to two sessions, and thus practitioners should front-load content, making other content optional or just-in-time. In addition, non-psychoeducational elements (e.g., gamification, easy computerized tasks to reduce angry responses, watching couple-themed movies) could enliven preventative offerings for perinatal couples.

Improving Exercise-Based Interventions for People Living with Both COPD and Frailty: A Realist Review.

BackgroundPeople living with both chronic obstructive pulmonary disease (COPD) and frailty have high potential to benefit from exercise-based interventions, including pulmonary rehabilitation, but face challenges completing them. Research to understand ways to optimise exercise-based interventions in this group is lacking. We aimed to understand how exercise-based interventions might improve outcomes for people living with both COPD and frailty.MethodsThis realist review used database searches and handsearching until October 2019 to identify articles of relevance to exercise-based interventions for people living with COPD and frailty. A scoping search explored what is important about the context of living with COPD and frailty, and what mechanisms might be important in how exercise-based interventions result in their intended outcomes. Through discussion with stakeholders, the review scope was refined to areas deemed pertinent to improving care. We retained articles within this refined scope and identified additional articles through targeted handsearching. Data were extracted and synthesised in a narrative, prioritised by relevance and rigour.ResultsOf 344 records identified, 35 were included in the review and 20 informed the final synthesis. Important contextual factors to consider included: negative beliefs about themselves and exercise-based interventions; heterogenous presentation and comorbidities; decreased reserves and multidimensional loss; and experiencing unpredictable health and disruptions. In these circumstances, mechanisms that may help maximise outcomes from exercise-based interventions included: trusting relationships; creating a shared understanding of needs; having the capacity to address multidimensional concerns; being able to individualise approaches to needs and priorities; and flexible approaches to intervention delivery. Mixed-methods research and explicit theorising were often absent.ConclusionBuilding trusting relationships, understanding priorities, using individualised and multidisciplinary approaches, and flexible service delivery can improve the value of exercise-based interventions for people living with both COPD and frailty. Development and evaluation of new and adapted interventions should consider these principles.

Exploring the barriers preventing Indigenous Australians from accessing cancer genetic counseling.

In Australia, individuals of Aboriginal and Torres Strait Islander descent (Indigenous Australians) have poorer health outcomes than the general population, including higher incidence of cancer and reduced life expectancy up to 14years compared to non-Indigenous Australians. Although differences in engagement with healthcare and beliefs about disease/cancer exist between Indigenous communities, a number of common barriers have been identified hindering attendance at mainstream health services. To inform exploration of barriers that may impact access to a cancer genetic counseling service, consultations with Aboriginal stakeholders were undertaken. Ethical principles for studies that engage Indigenous communities were followed throughout the research endeavor. Using a stakeholder-endorsed focus group approach, the views of an Aboriginal Elders group (n=9) were sought with additional semi-structured interviews with social science and genetics researchers working with Indigenous communities in Australia (n=7). Thematic analysis of the results identified three themes: explanatory models of illness, barriers to keeping well and attending services, and recommendations for improvements to access/attendance. Barriers common to accessing both mainstream health services and clinical genetic services were identified, including attributions of illness and cancer. Specific genetic counseling barriers included the cultural inclusivity and accessibility of services, and a lack of awareness of genetic counseling both in the community and by clinicians unfamiliar with genetics. Recommendations included developing flexible service delivery models and culturally appropriate resources for Indigenous patients. These findings may inform future studies to improve Indigenous health outcomes and promote a more accessible, culturally appropriate approach to provision of cancer genetics services for Australia's First Peoples.

Feasibility and acceptability of using telehealth for early intervention parent counselling

ABSTRACTObjective: With technology options for communication in healthcare becoming more widely available, families are increasingly able to access assistance regardless of location. Video conferencing (VC) is one means by which clients could access services remotely. A two-year pilot project was conducted with social workers, psychologists and parents to examine the feasibility and acceptability of the experience of VC for clinicians and clients undertaking parent counselling within child health services across Queensland.Method: The evaluation included pre and post questionnaires for parents and clinicians measuring their confidence, experience and satisfaction with using VC. Parents also completed the Parents Sense of Competence Questionnaire and a session feedback form after each appointment.Results: Clinicians showed increased confidence and skills in using technology. Most parents reported improved parenting satisfaction and improved feelings of self-efficacy. Despite half of the parents experiencing some technical issues, parents were satisfied with VC service delivery and their satisfaction with counselling via VC was comparable to the in-person appointments. Parents reported a preference for a hybrid approach combining VC and in-person counselling.Discussion: Parents and clinicians found the VC system easy to use and effective for counselling. Recommendations for the use of VC in parenting interventions are outlined, including the benefits of a flexible mixed service delivery model.

Service Packaging: A Pattern Based Approach Towards Service Delivery

Authentication, authorization, billing and monitoring are all common service delivery functions that are generally required to be added on to core business services in order for them to be delivered online commercially. Extending core services with these service delivery functions requires considerable effort if implemented ground-up and can be subject to limitations if outsourced to a service broker or a conventional middleware platform. Because of the ubiquitous nature of these service delivery functions, we see them as reusable patterns for service delivery. In this paper we have introduce an approach to implementing and applying these patterns in business to consumer e-commerce. We name the approach Service Packaging. Through the approach, generic implementations (or service packages) of the various service delivery patterns can be incrementally applied to core services, thus enabling flexible and systematic service delivery. A core service, regardless of its business domain does not require any structural or behavioral modifications in order to conform to a specific service delivery requirement and hence can be used out of the box. We also present a prototype middleware platform for the design-time modeling and implementation of service packages as well as their runtime execution.

Postsecondary students with psychiatric disabilities identify core services and key ingredients to supporting education goals.

Accessing and successfully completing postsecondary educational opportunities may be challenging for those living with psychiatric disabilities. This exploratory study highlights the experiences of individuals with psychiatric disabilities participating in postsecondary educational support initiatives. Investigators conducted case studies with 3 education support initiatives across the United States. Focus groups revealed what concrete supported education services were helpful and key ingredients in delivering education supports. Access to specialists, mindfulness techniques, help with time management and procrastination, and facilitating classroom accommodations were identified as critical. Developing authentic relationships with supported education staff, flexibility in service delivery and access to student peers living with psychiatric disabilities were noted as key ingredients in service delivery. Incorporating the voice of students with psychiatric disabilities into supported education services can increase access, involvement, and retention, therein providing more supports to students with psychiatric disabilities achieving their postsecondary education goals. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

STRATFram: A framework for describing and evaluating elasticity strategies for service-based business processes in the cloud

In the recent years, growing attention has been paid to the concept of Cloud Computing as a new computing paradigm for executing and handling operations/processes in an efficient and cost-effective way. Cloud Computing’s elasticity and its flexibility in service delivery have been the most important features behind this attention which encourage companies to migrate their operation/processes to the cloud to ensure the required QoS while using resources and reduce their expenses. Elasticity management has been considered as a pivotal issue among IT community that works on finding the right tradeoffs between QoS levels and operational costs by developing novel methods and mechanisms. However, controlling process elasticity and defining non-trivial elasticity strategies are challenging issues. Also, despite the growing attention paid to the cloud and its elasticity property in particular, there is still a lack of solutions that support the evaluation of elasticity strategies used to ensure the elasticity of processes at service-level. In this paper, we present a framework for describing and evaluating elasticity strategies for Service-based Business Processes (SBP), called StratFram. It is composed of a set of domain-specific languages designed to generalize the use of the framework and to facilitate the description of evaluation elements that are needed to evaluate elasticity strategies before using them in real cloud environment. Using StratFram, SBP holders are allowed to define: (i) an elasticity model with specific elasticity capabilities on which they want to define and evaluate their elasticity strategies, (ii) a SBP model for which the elasticity strategies will be defined and evaluated, (iii) a set of elasticity strategies based on the elasticity capabilities of the defined elasticity model and for the provided SBP model, and (iv) a simulation configuration which identifies simulation properties/elements. The evaluation of elasticity strategies consists in providing a set of plots that allows the analysis and the comparison of strategies. Our contributions and developments provide Cloud tenants with facilities to choose elasticity strategies that fit to their business processes and usage behaviors.

Career Services for Young Adults with Serious Mental Health Conditions: Innovations in the Field.

This study examined careers services provided to young adults with serious mental health conditions. Based on an internet survey and key informant telephone interview of 31 programs nominated for delivering innovative practices for young adults, the state of the field for career services was described. Most programs offered supported education and supported employment along with mental health services. Detailed and written planning was a key feature. Programs emphasized working closely with families, inter-agency collaboration, and use of normative community resources. Programs provided direct skills training for school and work and other life skills. Largely, existing models are being applied. However, providers described unique adaptations including greater flexibility in service delivery, attending to the turbulence and developmental changes characteristic of this age group, use of social media, and a heightened willingness to meet young people where "they are at" both literally and figuratively.

Enabling NFV Elasticity Control With Optimized Flow Migration

Network function virtualization (NFV) together with software defined networking (SDN) offers the potential for enhancing service delivery flexibility and reducing overall costs. Based on the capability of dynamic creation and destruction of network function (NF) instances, NFV provides great elasticity in NF control, such as NF scaling out, scaling in, and load balancing. To realize NFV elasticity control, network traffic flows need to be redistributed across NF instances. However, deciding which flows are suitable for migration is a critical problem for efficient NFV elasticity control. In this paper, we propose to build an innovative flow migration controller, OFM controller , to achieve optimized flow migration for NFV elasticity control. We identify the trigger conditions and control goals for different situations, and carefully design models and algorithms to address three major challenges including buffer overflow avoidance , migration cost calculation , and effective flow selection for migration . We implement the OFM controller on top of NFV and SDN environments. Our evaluation results show that OFM controller is efficient to support optimized flow migration in NFV elasticity control.

Households, fluidity, and HIV service delivery in Zambia and South Africa - an exploratory analysis of longitudinal qualitative data from the HPTN 071 (PopART) trial.

IntroductionPopulation distributions, family and household compositions, and people's sense of belonging and social stability in southern Africa have been shaped by tumultuous, continuing large‐scale historical disruptions. As a result, many people experience high levels of geographic and social fluidity, which intersect with individual and population‐level migration patterns. We describe the complexities of household fluidity and HIV service access in South Africa and Zambia to explore implications for health systems and service delivery in contexts of high household fluidity.MethodsHPTN 071 (PopART) is a three‐arm cluster randomized controlled trial implemented in 21 peri‐urban study communities in Zambia and South Africa between 2013 and 2018. A qualitative cohort nested in the trial included 148 purposively sampled households. Data collection was informed by ethnographic and participatory research principles. The analysis process was reflexive and findings are descriptive narrative summaries of emergent ideas.ResultsHouseholds in southern Africa are extremely fluid, with people having a tenuous sense of security in their social networks. This fluidity intersects with high individual and population mobility. To characterize fluidity, we describe thematic patterns of household membership and residence. We also identify reasons people give for moving around and shifting social ties, including economic survival, fostering interpersonal relationships, participating in cultural, traditional, religious, or familial gatherings, being institutionalized, and maintaining patterns of substance use. High fluidity disrupted HIV service access for some participants. Despite these challenges, many participants were able to regularly access HIV testing services and participants living with HIV were especially resourceful in maintaining continuity of antiretroviral therapy (ART). We identify three key features of health service interactions that facilitated care continuity: disclosure to family members, understanding attitudes among health services staff including flexibility to accommodate clients’ transient pressures, and participants’ agency in ART‐related decisions.ConclusionsChoices made to manage one's experiential sense of household fluidity are intentional responses to livelihood and social support constraints. To enhance retention in care for people living with HIV, policy makers and service providers should focus on creating responsive, flexible health service delivery systems designed to accommodate many shifts in client circumstances.

Evaluating a nurse-led community model of service for perinatal mental health

BackgroundPerinatal mental illness is prevalent in Australia. Accessible and affordable specialist perinatal mental health services are important in ensuring optimal maternal and infant outcomes, but remain scarce in some areas. AimThis paper describes the development and evaluation of a community model for perinatal mental health based on the practice principles of: nurse-led; partnership approach; individualised evidenced based treatments and accessible, flexible service delivery. MethodsData collected prospectively as part of routine care for two years was analysed. Data included Edinburgh Depression Scale, Parent Coping Scale and Health of the Nation Outcome scale scores, rates of attendance, diagnostic codes, nurse practitioner prescribing and the appointment locations. FindingsThere was a significant reduction in depressive and anxiety symptoms and for women parenting infants, an increase in their perception of coping with parenting. There were comparatively high rates of attendance once women attended once. Diagnostic codes indicated the service saw the target group with the majority of diagnoses consisting of adjustment disorders, depression and anxiety. The nurse practitioner role enhanced continuity of care for women requiring antidepressant treatment. DiscussionThe perinatal nurse-led community model of service has been shown to provide effective specialist perinatal mental health assessment and brief intervention and treatment services. ConclusionThe model offers the potential for replication in other areas where service gaps for perinatal women and families persist and resources remain scarce.

Role of Relational Case Management in Transitioning from Poverty

ABSTRACTOne-off financial assistance through emergency relief provides a short-term intervention to immediate material crisis. However, recurrent instances of clients accessing this type of assistance points to the ineffectiveness of managing financial hardship without addressing the causes of long-term poverty. This article presents findings from an external process evaluation of the Salvation Army relational case management model known as Doorways. A mixed-method design was implemented, consisting of semistructured interviews, observations, and document analysis, as well as Client Satisfaction and Wellbeing Survey. Across the seven research sites semistructured interviews were conducted with 45 clients and nine case managers, and 30 client surveys were completed. Three themes will be discussed: the Doorways philosophy; the flexible service delivery approach; and client capacity building and continuity of care. Findings illustrated the effectiveness of a relational case management approach and reaffirm the central role of relationships in transforming the lives of people experiencing poverty.IMPLICATIONSThe quality of relationship between case managers and their clients plays an integral role in transforming the lives of people experiencing long-term or situational financial disadvantage.Service delivery requires a relational and flexible approach to adequately tailor support to the individual and contextual needs of clients.

HYPER: A Hybrid High-Performance Framework for Network Function Virtualization

Network function virtualization (NFV) offers the potential for both enhancing service delivery flexibility and reducing overall costs by virtualizing network functions that are traditionally implemented in dedicated hardware. However, the flexibility of NFV comes with considerable compromises since virtual machine carried functions could introduce significant performance overhead. In this paper, we present a novel high-performance framework called HYPER, which combines programmable hardware infrastructure and traditional software infrastructure in NFV to achieve both high performance and flexibility for supporting virtualized network functions (VNFs). In HYPER, we design a mediator layer to hide underlying infrastructure heterogeneity from the NFV orchestrator to simplify VNF management. In addition, we design a SLA-aware service chaining algorithm in HYPER to leverage the benefits of the hybrid infrastructure to fulfill both functional and performance requirements from service subscribers (or tenants). To optimize resource utilization efficiency, we also introduce a performance-aware VNF placement algorithm in HYPER, which accommodates both resource and performance requirements in placing VNFs. We implement HYPER in a testbed based on OpenStack and ONetCard. Experimental results show that HYPER reduces the forwarding latency of a service chain by 40% to 67% compared with data plane development kit -based implementation, while maintaining the flexibility of VNF management.