Generalist Model Research Articles

The evolution of thermal performance curves in fungi farmed by attine ant mutualists in aboveground or belowground microclimates.

Fungi are abundant and ecologically important at a global scale, but little is known about whether their thermal adaptations are shaped by biochemical constraints (i.e. the Hotter is Better Model, HBM) or evolutionary tradeoffs (i.e., the Specialist Generalist Model, SGM). We tested these hypotheses by generating thermal performance curves (TPCs) of fungal cultivars farmed by six species of Panamanian fungus-farming 'attine' ants. These fungi represent evolutionary transitions in farming strategies as four cultivars are farmed by ants belowground at stable temperatures near 25°C and two cultivars are farmed aboveground at variable temperatures. We generated TPCs using a common garden experiment confining fungal isolates to different temperatures and then used a Bayesian hierarchical modeling approach to compare competing temperature sensitivity models. Some thermal performance traits differed consistently across farming strategies, with aboveground cultivars having: 1) higher tolerance to low temperatures (CTLmin) and 2) higher maximum growth rate at the optimal temperature (rmax). However, two core assumptions shared by the HBM or SGM were not supported as aboveground cultivars did not show systematic increases in either their optimal temperature (Topt) or thermal tolerance breadth. These results harness ant farming systems as long-term natural experiments to decouple the effects of environmental thermal variation and innate physiological temperature sensitivity on fungal thermal evolution. The results have clear implications for predicting climate warming induced breaking points in animal-microbe mutualisms.

Le « Good Psychiatric Management-Adolescents » (GPM-A) : un modèle généraliste et accessible de traitement du trouble de la personnalité borderline chez l’adolescent

The Good Psychiatric Management for Adolescents (GPM-A) is a generalist model of structured care for adolescents with borderline personality disorder. It is based on principles derived from several psychotherapies validated in the treatment of borderline personality disorder and on current good practice data. Borderline personality disorder is conceptualised as the result of a particular sensitivity to relationships (defined with the term interpersonal hypersensitivity). The GPM-A offers clinicians a pragmatic approach based on good practice in the care of adolescents with borderline personality disorder. Developed in the United States, it is currently being disseminated in the French-speaking world. This article provides a summary of the main components of the model and a discussion of the benefits expected from its implementation among French-speaking clinicians.

Defining the "ideal state": A primer on critical care pharmacy practice models.

Critical care pharmacists (CCPs) have been clearly established as value-added members of the interprofessional team, and their contributions positively impact patient outcomes in the intensive care unit (ICU). Despite this, not every critically ill patient in the US receives care from a CCP and the model through which CCPs practice is variable, which has important implications. The purpose of this primer is to review current CCP models and discuss elements of the optimal CCP practice model. Current CCP practice models are defined, including the drug processing and dispensing model, clinical pharmacy specialist model, integrated pharmacy generalist model, and hybrid model, as well as unit-based vs service-based models. The optimal CCP practice model considers the Triple Domain of CCP workload, which includes direct patient care, indirect patient care, and professional service. Elements of the ideal CCP practice model including 24/7/365 CCP services, unit- vs service-based models, prescriptive authority, operational support, and CCP-to-patient ratio are discussed. Other vital elements include dedicated offline time, use of appropriate workload metrics, development of career ladders, opportunities for professional development, and providing wellness resources. The ideal CCP practice model must also be considered through the lens of the patient and medical team, the CCP, the institution, and professional organizations. Strategies for optimizing current CCP practice models are provided, and application of optimal CCP practice model elements is explored through 5 case studies. The optimal CCP practice model includes multiple elements and incorporates the viewpoints of patients, providers, CCPs, institutions, and professional organizations; this model will increase access of all ICU patients to CCPs, enhance the scope of CCP cognitive services, and ensure the economic sustainability of CCP practice while establishing CCP involvement in activities outside of patient care and in professional service.

Improving Medical Entity Recognition in Spanish by Means of Biomedical Language Models

Named Entity Recognition (NER) is an important task used to extract relevant information from biomedical texts. Recently, pre-trained language models have made great progress in this task, particularly in English language. However, the performance of pre-trained models in the Spanish biomedical domain has not been evaluated in an experimentation framework designed specifically for the task. We present an approach for named entity recognition in Spanish medical texts that makes use of pre-trained models from the Spanish biomedical domain. We also use data augmentation techniques to improve the identification of less frequent entities in the dataset. The domain-specific models have improved the recognition of name entities in the domain, beating all the systems that were evaluated in the eHealth-KD challenge 2021. Language models from the biomedical domain seem to be more effective in characterizing the specific terminology involved in this task of named entity recognition, where most entities correspond to the "concept" type involving a great number of medical concepts. Regarding data augmentation, only back translation has slightly improved the results. Clearly, the most frequent types of entities in the dataset are better identified. Although the domain-specific language models have outperformed most of the other models, the multilingual generalist model mBERT obtained competitive results.

Will Affective Computing Emerge From Foundation Models and General Artificial Intelligence? A First Evaluation of ChatGPT

ChatGPT has shown the potential of emerging general artificial intelligence capabilities, as it has demonstrated competent performance across many natural language processing tasks. In this work, we evaluate the capabilities of ChatGPT to perform text classification on three affective computing problems, namely, big-five personality prediction, sentiment analysis, and suicide tendency detection. We utilize three baselines, a robust language model (RoBERTa-base), a legacy word model with pretrained embeddings (Word2Vec), and a simple bag-of-words (BoW) baseline. Results show that the RoBERTa model trained for a specific downstream task generally has a superior performance. On the other hand, ChatGPT provides decent results and is relatively comparable to the Word2Vec and BoW baselines. ChatGPT further shows robustness against noisy data, where the Word2Vec model achieves worse results due to noise. Results indicate that ChatGPT is a good generalist model that is capable of achieving good results across various problems without any specialized training; however, it is not as good as a specialized model for a downstream task.

A Realist Evaluation of Case Management Models for People with Complex Health Conditions Using Novel Methods and Tools-What Works, for Whom, and under What Circumstances?

Case management developed from a generalist model to a person-centred model aligned with the evidence-informed evolution of best practice people-centred integrated care. Case management is a multidimensional and collaborative integrated care strategy where the case manager performs a set of interventions/actions to support the person with a complex health condition to progress in their recovery pathway and participate in life roles. It is currently unknown what case management model works in real life for whom and under what circumstances. The purpose of this study was to answer these questions. The study methods used realistic evaluation framework, examined the patterns and associations between case manager actions (mechanisms), the person's characteristics and environment (context), and recovery (outcomes) over 10 years post severe injury. There was mixed methods secondary analysis of data extracted via in-depth retrospective file reviews (n = 107). We used international frameworks and a novel approach with multi-layered analysis including machine learning and expert guidance for pattern identification. The study results confirm that when provided, a person-centred case management model contributes to and enhances the person's recovery and progress towards participation in life roles and maintaining well-being after severe injury.Furthermore, the intensity of case management for people with traumatic brain injury, and the person-centred actions of advising, emotional and motivational support, and proactive coordination contribute to the person achieving their goals. The results provide learnings for case management services on the case management models, for quality appraisal, service planning, and informs further research on case management.

Rural social work: practices and organisation. A case study in Andalusia (Spain)

ABSTRACT The practice of social work in rural settings represent a specific challenge for the profession although this subject has received very little attention in the European literature. In contrast to urban settings, social work in rural areas is conditioned by organisational circumstances and specific socio-cultural contexts, which require reflection on the possible specificity of professional practice in these areas. The purpose of this article is to analyse the organisational models and practices of rural social work in order to explore that potential peculiarity and its implications in social intervention. This article presents part of the results of a broader research endeavour, focusing on an exploratory case study in Andalusia (Spain), where we carried out qualitative research in public social services centres to study in depth the characteristics of the organisation and practices of social workers. The conclusions reached point to the existence of an urbanormative bias in the organisation and practices of social work, which masks rural specificities (the relational social work and the generalist model of organisation) and could condition the response capacity of social workers to tackle the rural crisis.

Costs and Implementation Effectiveness of Generalist Versus Specialist Models for Adolescent Screening and Brief Intervention in Primary Care

This study analyzed the marginal service and program costs, and conducted a cost-effectiveness analysis (CEA) of two models of implementation of adolescent substance screening, brief intervention, and referral to treatment (SBIRT). SBIRT was implemented at seven clinics in a multisite, cluster-randomized trial, through a Specialist model (behavioral health counselor-delivered brief intervention), and a Generalist model (primary care provider-delivered brief intervention). The CEA calculated marginal costs using an activity-based costing methodology for direct SBIRT services, and effectiveness was measured by the proportion of brief interventions delivered among patients who screened positive for alcohol, tobacco, or other drugs. Site-level program costs comprised start-up and maintenance (training and technical assistance). Costs were estimated in 2017 U.S. dollars. The marginal cost of SBIRT per patient with a positive screen for brief intervention was $6.72 in the Specialist model and $6.05 in the Generalist model. Implementation effectiveness was 7.2% (SE = 2.9%) in the Specialist model and 37.7% (SE = 5.6%) in the Generalist model. The program costs to provide SBIRT for 1 year per site were $13,548 for the Specialist site and $12,081 for the Generalist. The Generalist model was more effective in implementing brief intervention and less expensive than the Specialist model. Results were robust to sensitivity analysis. Brief intervention delivered by primary care providers rather than by handoff to a behavioral health counselor may ensure greater penetration and a lower cost of these services in primary care settings.

Mutual Adversarial Training: Learning Together is Better Than Going Alone

Recent studies have shown that robustness to adversarial attacks can be transferred across deep neural networks. In other words, we can make a weak model more robust with the help of a strong teacher model. In this paper, we ask if models can &#x201C;learn together&#x201D; and &#x201C;teach each other&#x201D; to achieve better robustness instead of learning from a static teacher.We study how interactions among models affect robustness via knowledge distillation. We propose mutual adversarial training (MAT), in which multiple models are trained together and share the knowledge of adversarial examples to achieve improved robustness. MAT allows robust models to explore a larger space of adversarial samples and find more robust feature spaces and decision boundaries. Through extensive experiments on the CIFAR-10, CIFAR-100, and mini-ImageNet datasets, we demonstrate that MAT can effectively improve model robustness and outperform state-of-the-art methods under white-box attacks. In addition, we show that MAT can also mitigate the robustness trade-off among different perturbation types. Specially, we train specialist models that learn to defend a specific perturbation type and a generalist model that learns to defend multiple perturbation types by learning from the specialists, which brings as much as 13.4% accuracy gain to AT baselines against the union of <i>l</i>&#x221E;, <i>l</i>2, and <i>l</i>1 attacks. Our results show the superiority of the proposed method and demonstrate that collaborative learning is an effective strategy for designing robust models.

Multilayer perceptron applied to genotypes classification in diallel studies

In the last decades, a new trend to use more refined analytical procedures, such as artificial neural networks (ANN), has emerged to be most accurate, efficient, and extensively applied for mining and data prediction in different contexts, including plant breeding. Thus, this study was developed to establish a new classification proposal for targeting genotypes in breeding programs to approach classical models, such as a complete diallel and modern prediction techniques. The study was based on the standard deviation values of an interpopulation diallel and it also verified the possibility of training a neural network with the standardized genetic parameters for a discrete scale. We used 12 intercrossed maize populations in a complete diallel scheme (66 hybrids), evaluated during the 2005/2006 crop season in three different environments in southern Brazil. The implemented MLP architecture and other associated parameters allowed the development of a generalist model of genotype classification. The MLP neural network model was efficient in predicting parental and interpopulation hybrid classifications from average genetic components from a complete diallel, regardless of the evaluation environment.

What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales.

Under the generalist model of health care in rural Australia, general practitioners (GPs) are often the first point of contact for women seeking health services for unintended pregnancy, including pregnancy decision-making support and options advice, antenatal or abortion care. Rural women are more likely to experience unintended pregnancy in Australia, yet little is known about how well local rural primary healthcare services currently meet their needs. To address this gap, this qualitative study explores through in-depth semi-structured interviews, the experiences of 20 rural women managing an unintended pregnancy, and their expectations of, and satisfaction with, the quality of care they received. The Framework Method was used to organise data and conduct an inductive thematic analysis. Three themes related to management of unintended pregnancy in a rural primary care setting were identified: (1) women expect informed and efficient care once services are reached; (2) women desire greater choice and aftercare; and (3) comprehensive reproductive health should be part of rural primary care. Participants indicated an awareness of the limitations of the rural health system, yet a firm expectation that despite access delays, all of their reproductive health needs would be met. Choice, time efficiency, and aftercare were identified as gaps in the current primary care service experience. A desire for greater attention to rural reproductive health, including improved contraception, was also emphasised. Rural women with unintended pregnancy experienced gaps in service quality and described a lack of woman-centred care in their local rural health setting. This study offers insight into how rural primary care providers can better support women to make decisions about and reach their preferred services for unintended pregnancy.

Comparison of Palliative Care Delivery in the Last Year of Life Between Adults With Terminal Noncancer Illness or Cancer

Palliative care improves health outcomes, but studies of the differences in the delivery of palliative care to patients with different types of serious illness are lacking. To examine the delivery of palliative care among adults in their last year of life who died of terminal noncancer illness compared with those who died of cancer. This population-based cohort study used linked health administrative data of adults who received palliative care in their last year of life and died between January 1, 2010, and December 31, 2017, in Ontario, Canada. Cause of death (chronic organ failure, dementia, or cancer). Components of palliative care delivery, including timing and location of initiation, model of care, physician mix, care settings, and location of death. A total of 145 709 adults received palliative care (median age, 78 years; interquartile range, 67-86 years; 50.7% female); 21 054 died of chronic organ failure (4704 of heart failure, 5715 of chronic obstructive pulmonary disease, 3785 of end-stage kidney disease, 579 of cirrhosis, and 6271 of stroke), 14 033 died of dementia, and 110 622 died of cancer. Palliative care was initiated earlier (>90 days before death) in patients with cancer (32 010 [28.9%]) than in those with organ failure (3349 [15.9%]; absolute difference, 13.0%) or dementia (2148 [15.3%]; absolute difference, 13.6%). A lower proportion of patients with cancer had palliative care initiated in the home (16 088 [14.5%]) compared with patients with chronic organ failure (6904 [32.8%]; absolute difference, -18.3%) or dementia (3922 [27.9%]; absolute difference, -13.4%). Patients with cancer received palliative care across multiple care settings (92 107 [83.3%]) more often than patients with chronic organ failure (12 061 [57.3%]; absolute difference, 26.0%) or dementia (7553 [53.8%]; absolute difference, 29.5%). Palliative care was more often delivered to patients with cancer (80 615 [72.9%]) using a consultative or specialist instead of a generalist model compared with patients with chronic organ failure (9114 [43.3%]; absolute difference, 29.6%) or dementia (5634 [40.1%]; absolute difference, 32.8%). Patients with cancer (42 718 [38.6%]) received shared palliative care more often from general practitioners and physicians with subspecialty training, compared with patients with chronic organ failure (3599 [17.1%]; absolute difference, 21.5%) or dementia (1989 [14.2%]; absolute difference, 24.4%). In this cohort study, there were substantial patient- and practitioner-level differences in the delivery of palliative care across distinct types of serious illness. These patient- and practitioner-level differences have important implications for the organization and scaled implementation of palliative care programs, including enhancement of practitioner education and training and improvements in equitable access to care across all settings.

I never knew a librarian did that! : Exploring how faculty and librarian relationships support meaningful collaboration

This paper examines the relationships that developed over a 10+ year span at a comprehensive college in upstate New York. When the library was reorganized into a generalist model of library support, the faculty members felt unsupported. The paper explains the origin of the department-wide collaboration and then uses reflections to analyze ways in which the relationship with a liaison librarian support the faculty members work. Specific themes include overcoming library anxiety, online teaching support, and scholarship support with suggestions for librarian practice.

Testicular cancer management: Population-wide, rapid case ascertainment to drive early expert engagement and reduced practice variation.

39 Background: Research priorities in germ cell tumor (GCT) management have moved sharply from therapeutic improvements to cancer care delivery research and biomarker-based decision making. Early intervention with centralized decision support and oversight by expert teams result in best therapeutic outcomes and survivorship with decreased resource utilization. We describe Kaiser Permanente Northern California’s (KPNC) re-organization of care delivery through rapid case ascertainment and early expert input, as well as early results of reduction in practice variation and system-wide practice change. Methods: In 2016, KPNC reorganized oncology from a distributed generalist model to a model led by a centralized multidisciplinary expert team to share in initial and ongoing care delivery for all GCT patients in the system. Central to the re-organization was rapid ascertainment of the entire population of patients with GCT within the system and early expert engagement in treatment decision-making. Results: Between May 2016 and June 2018, 274 GCT patients were recorded in the tumor registry, of whom 69% were &lt; 40 years of age, 16% were non-white, 56% had seminoma and 63% had stage 1 disease. Rapid case ascertainment identified 89% (95% CI, 86-93%) of the cases, increasing from 79% in 2016 to 97% in 2018 as false negatives were identified and used to improve the case finding algorithm. The overall positive predictive value was 57% (52-62%) and number needed to detect was 1.75 (1.62-1.91). Of the 274 cases, 92% (89-95%) were engaged by the expert team. In addition, the team reviewed 61 testicular cancer patients who had recurrences or metastatic cancers. Among 177 patients with stage I seminoma, the preferred use of active surveillance over adjuvant chemotherapy or radiation therapy rose from 48% (95% CI, 35-62%) in 2015 to 87% (75-99%) in 2018 (p = 0.0005). For patients with nonseminoma, the rate of the preferred option of retroperitoneal lymphadenectomies being performed by a high volume urologic surgeon increased markedly from 62% in 2015 to 95% in 2018. Conclusions: To our knowledge, the KPNC re-organization of GCT care delivery with comprehensive rapid case ascertainment is unique for integrated health care delivery systems in the USA. While early, KPNC has a working platform for early, expert multidisciplinary review and bidirectional communication with local care teams for population-based care. Early evidence points to system-wide reductions in practice variation and improvements in practice.

Back to the Hospital for Chronic Care: a Hybrid Generalist Model

Singapore, like many countries, is attempting to meet the growing healthcare needs of an ageing population with a high burden of chronic diseases. Despite efforts to integrate and increase healthcare capacity, longstanding challenges remain difficult to overcome. Recently, policymakers have considered a new approach to building chronic and eldercare capacity-the Integrated General Hospital (IGH). The development of the IGH model is motivated by a combination of factors: the limit to which the primary care system can manage patients with increasingly complex chronic diseases, a longstanding preference of patients for hospital-based specialty services and patients experiencing fragmented care delivery. The IGH model links hospital care teams and community-based care providers, to facilitate the management of patients throughout the care continuum in a single integrated site. It is hoped that this hospital-led model for chronic care can meet patients' needs and preferences and reduce fragmentation of care.

(Invited) Mechanism of Formic Acid synthesis in low pH during CO2 Reduction via electrified plasma/liquid interface

Electrochemical discharger over liquid water enriched with dissolved carbon dioxide (CO2) is capable of synthesizes formate (HCO2 -) and oxalate (C2O4 2 -), although in very low faradaic selectivity toward organic molecules ca. 9% [1]. The efficient CO2 reduction (CO2-R) toward these organic molecules via electrochemical discharge remains a challenge. This contribution devotes to find possible ways to produce these products efficiently. In this context, the mechanism of electrosynthesis for both formate and oxalate is postulated and used from a theoretical perspective [2] to figure out which parameters are key to reach as maximum selectivity as possible.Figure 1a shows the chemical reaction network (CRN) postulated for CO2-R via electrochemical discharge over water. The discharge promotes a periodic perturbation on the local concentration of the solvated electron within the nanoreactor (volume of less than one nanoliter beneath the plasma liquid interface), firing the set of reaction displayed in this CRN. Three final products are formed, one volatile and two dissolved in the liquid phase. Gaseous hydrogen is a volatile product synthetized majorly via recombination of two solvated electrons, reaction (1); other two routes for hydrogen synthesis described in reference 2 are negligible over uninterrupted long lasting discharge. On the other hand, organic molecules requires the carboxyl radical anion {CO2 -∙ (aq)} as precursor. In view of this CRN, the generalist model in reference (2) were used for implement the algorithm related to the chemical dynamical system. The computational experiments employed Wolfram language, 10- 6 s step, a stationary current at level 9.5 mA (the same used by the researchers in ref 1) and the parameters displayed in table 1. The selectivity toward a given product is the ratio of its quantity of mole with respect to that of injected electrons. Figure 1b shows time evolution for the concentrations of the main reactants, the intermediate (carboxyl radical anion) and the final products. Figure 1c shows the selectivity toward each final product considering two span of continuous stationary discharge.The computational experiments demonstrated that the chemical dynamics driven by a stationary injection of electron (term qe in the model) in water is mostly governed by the formation reaction of CO2 -∙ (aq) within the early 43 ms span of time. Within this period, full content of CO2 in the nanoreactor depletes as result of the fastest reaction rate for the formation of CO2 -∙ (aq) . The large local concentration (“local” qualifies the concentration inside the nanoreactor) of CO2 -∙ (aq) favors the oxalate formation, being the oxalate the major final product. Formate is only synthetized at significant formation rate between 0.040 and 0.043 s, when the concentration of both solvated electrons and CO2 -∙ (aq) start to be less dissimilar as consequence of the depletions of the aqueous CO2 in the nanoreactor. Anytime thereafter, the solvated electrons has increased concentration, and the hydrogen passes to form majorly. Considering the 300,000 s (5 minutes used in reference 1), about 7.72% faradaic efficiency toward organic molecules is obtained, corroborating the low efficiency for experiments in real life.In conclusion, this work postulate the mechanism of CO2 reduction via electrochemical discharge, and it suggests the employment of short span of stationary discharge to obtain faradaic efficiency toward organic molecules of 98.46%, being 96.89% selective toward oxalate. Figure 1: (a) postulated chemical reaction network for CO2-R via electrochemical discharge over water, (b) time evolutions for the concentrations of either reactants or products , and (c) selectivity toward formate (yellow), oxalate (orange) and hydrogen (pink) at STP CO2 saturation. Table 1: parameters for solving the dynamical model [3] Parameter Value Unit Ref k1 6.0×109 L mol−1 s−1 3 k2 9.0×109 L mol−1 s−1 3 k3 1.0×1010 L mol−1 s−1 3 k4 1.26×109 L mol−1 s−1 3 qe (9.5 mA) 98.46×10-9 mol s- 1 1 V 2.36×10-9 L 2 [H+]0 1.00×10-7 mol L-1 [CO2]0 40.00×10-3 mol L-1 References [1]Rumbach, P., R. Xu, and D.B. Go, Electrochemical Production of Oxalate and Formate from CO2 by Solvated Electrons Produced Using an Atmospheric-Pressure Plasma. Journal of The Electrochemical Society, 2016. 163(10): p. F1157-F1161.[2] Mota-Lima, A., et al., Electrosynthesis via Plasma Electrochemistry: Generalist Dynamical Model To Explain Hydrogen Production Induced by a Discharge over Water. The Journal of Physical Chemistry C, 2019. 123(36): p. 21896-21912.[3] Neta, P., J. Grodkowski, and A.B. Ross, Rate Constants for Reactions of Aliphatic Carbon‐Centered Radicals in Aqueous Solution. Journal of Physical and Chemical Reference Data, 1996. 25(3): p. 709-1050. Figure 1

Relationship-Building as a Means to Navigating Genre in the Writing Center

The current literature on genre and best practices for writing center tutoring is mixed: some studies support a genre specialist model while others support a generalist model. However, these studies have not explicitly examined how the tutors handle different genres in their sessions, nor how relationships between the tutor and tutee can impact this navigation. This essay explores relationship-building and the use of empathy by tutors to better understand how tutors might negotiate genre during a tutoring session. A short survey was administered to tutors at the Goucher College Writing Center. Responses revealed that the tutors saw relationship-building as a higher priority in their sessions than the genre of the text. Specifically, when confronted with unfamiliar genres, tutors overwhelmingly communicated that they instead focus on the rapport they have with their tutees in order to work with them successfully. More detailed findings focused on the importance of the tutor-tutee relationship within the generalist tutoring model, and their implications are further discussed.

Adolescent SBIRT implementation: Generalist vs. Specialist models of service delivery in primary care

BackgroundDrug, alcohol, and tobacco use among adolescents pose significant short- and long-term health consequences and are associated with more severe use as adults. Screening, brief intervention, and referral to treatment in primary care settings has the potential to deliver preventive interventions to a diverse range of adolescents, but optimal implementation of these services needs to be determined. The purpose of this study was to compare implementation of two different SBIRT service delivery models in primary care settings. MethodsThis cluster-randomized trial assigned 7 primary care clinics of a federally qualified health center to implement brief interventions (BI) using a Generalist model (4 sites), in which BIs were delivered by the primary care provider (PCP), or a Specialist model (3 sites), in which BIs were delivered by a behavioral health counselor (BHC) for adolescent patients ages 12–17 years. Implementation was tracked through the clinic's electronic health record, spanning 9639 clinic visits over 20 months. Multilevel logistic regression modeling was used to compare Generalist and Specialist strategies on penetration of BI for patients scoring ≥2 on the CRAFFT substance use screen, delivered by the PCP in the Generalist sites, and via warm hand-off to a BHC in the Specialist sites. ResultsApproximately 62% of adolescent patient visits were screened with the CRAFFT (with <4% screening positive with a CRAFFT score ≥ 2). The Generalist Condition had significantly higher self-reported penetration of BI delivery than the Specialist Condition (38% vs. 8%; Adjusted Odds Ratio = 6.53; p = .005). DiscussionDespite having co-located behavioral health services at all sites, a Specialist approach to providing BI was less effectively implemented than a Generalist approach in this FQHC. BI delivered by PCPs rather than by hand-off to a BHC may ensure greater penetration of these services in primary care settings. Both implementation models provided a framework for identifying and intervening with adolescent primary care patients whose substance use might have otherwise gone undetected.

A Study on the Foundations for Continued Growth of French Social Housing and Recent Policy Dilemma

본 논문은 프랑스의 일반형 공공공임대주택 모델에 대해 탐구이다. 일반형 모델은 대상 계층을 달리하고 정부 지원 조건과 수혜 정도를 차등화한 공급 유형(PLAI, PLUS, PLS), 누구든 공적 역할을 할 수 있도록 개방된 정부 지원 구조, 지역기반에서 다양한 지역 수요에 차별적으로 대응해 온 공급 생태계가 특징이다. 이와 더불어 저축 예금인 Livret A라는 재원을 활용한 CDC의 금융 순환 회로의 역할, 기업의 ‘1% 주택기금’ 재원의 활용, 견고하게 잘 짜여진 거버넌스 구조는 프랑스 공공임대주택이 지속적으로 성장할 수 있는 주요 토대라 할 수 있다. 무엇보다 시대와 정권의 변화에도 거의 변함없이 공공임대주택에 대한 공급 확대 기조를 이어오고 있다는 것은 프랑스의 국민, 기업, 정치의 합의 형성의 성과이자 핵심 저력이라고 할 수 있다. 최근 공공임대주택 지원의 효과성, 효율성, 배분의 형평성 측면에서 제기되고 문제들에 대해 프랑스 정부는 2009년부터 입주자격 기준 강화, 절차와 방식 개선, 주거권 보장 및취약계층 보호 강화, 지역 격차 해소 등으로 풀어나가고 있다. 그러나 점차 늘어나는 저소 득층 입주, 줄어드는 재정 지원, 공급자의 자체자금 부담 증가 등은 향후 일반형 모델의 지속가능성을 위협하고 공급 확대의 저해 요소가 될 소지가 있다.The purpose of this study is to examine the characteristics of the generalist social housing model in France, factors behind the continued growth of French social housing, and how current social housing issues are being addressed by the French government. The generalist social housing model is primarily characterized by three ways of supplying social housing, which differentiate target beneficiaries, the government support structure that does not limit the participants in social housing supply initiatives, and the supply ecosystem that provides various solutions to meet the diverse needs of each local community. The continued growth of social housing is attributed to funds raised through savings accounts based on social solidarity, which are then redistributed by CDC, the 1% employer s housing fund and the well-structured governance system. Above all, the French government’s continued expansion of social housing despite changes in time and administration is an achievement and power of the consensus reached by the people, businesses, and political leaders of France. In response to recent issues raised about the effectiveness, efficiency, and distributive equity of social housing sector, the French government came up with various solutions, such as strengthening the qualification standards for beneficiaries, streamlining processes and methods, strengthening the right to housing, increasing protection of vulnerable groups, and narrowing regional gaps. However, a growing number of low-income households, dwindling financial support, and increasing self-financing burdens imposed on suppliers may threaten the sustainability of the generalist model and hamper the expansion of social housing supply.

A Study on Korea’s Public Rental Housing Policy Using Ghekière’s Social Housing System Typology

본고에서는 공공임대주택 정책이 지향하는 보편적 의의와 서민을 위한 저렴한 임대주택 공급정책이 유지된다는 전제하에 Gheki&egrave;re(2008)가 제시한 유형론(잔여주의, 일반주의, 보편주의)을 바탕으로 국내 공공임대주택 정책의 모델에 대해 탐구해 보았다. 국내 공공임대주택 정책은 일반적으로 전체 가구의 60%정도를 대상으로 하고 있어, 보편주의나 잔여주의로 보기 어렵다. 공급방식 측면에서, 민간과 공공으로 비교적 뚜렷하게 구분된 이원적 구조 속에서 작동되는 공급체계는 일반주의의 특성과 일치한다. 민간임대시장과 일부 수요층이 겹치는 동시에 공공임대주택 공급이 지속적으로 증가하며 거주율도 동시에 늘어나고 있는 점은 이를 일반주의 모델로 볼 수 있는 또 다른 이유다. 이런 점들을 종합적으로 고려하면, 한국의 공공임대주택 공급정책은 보편주의나 잔여주의보다는 일반주의 모델에 더 가깝다고 판단된다. 최근 추진되는 공적주택 공급 정책 등을 감안하면 이것이 보편주의나 잔여주의로 급격히 전환될 가능성은 현실적으로 낮아 보인다. 하지만 기존 공공임대주택 공급체계에 대한 내외적 변화의 요구와 필요성이 커지는 바, 정책의 목표와 대상, 공급주체 그리고 재정적, 기술적, 제도적 수단들의 재구조화에 대한 심도 있는 논의가 필요한 시점이 라고 보인다.This paper explored the model of public rental housing policy in Korea based on Gheki&egrave;re’s social housing typologies (universal model, generalist model, residual model) on the assumption that the universal significance of public rental housing policy and affordable rental housing supply policy for the common people would be maintained. The public rental housing policy in Korea is not intended for all households, instead it is generally for the lower 60% income households, so it is hard to be considered a residual or universal model. In terms of supply and distribution, it is characteristically a generalist model since it is a relatively distinct dualist rental housing system for private and public sectors (or non-profit). In terms of some demand groups’ overlap, competition in the public and private rental market is expected to increase gradually as public rental housing’s supply and residence rates increase. Considering these points, public rental housing policy in Korea seems to be more of a generalist model than a residual or universal model. Following the implementation of recent public housing supply policies, the system’s sudden transition would not appear. Considering the increasing requirements of the existing policy’s change, it is necessary to discuss restructuring of the policy’s purpose, target group, supplier and financial, technical and institutional means, among other issues.