Human Service Delivery Systems Research Articles

Understanding workplace violence against medical staff in China: a retrospective review of publicly available reports

BackgroundWorkplace violence against medical staff in China is a widespread problem that has negative impacts on medical service delivery. The study aimed to contribute to the prevention of workplace violence against medical staff in China by identifying patterns of workplace violence, key risk factors, and the interplay of risk factors that result in workplace violence.MethodsNinety-seven publicly reported Chinese healthcare violent incidents from late 2013 to 2017 were retrospectively collected from the internet and analysed using content analysis. A modified socio-ecological model guided analysis of the violent incidents focusing on risk.ResultsPhysical violence, yinao, or a combination of physical and verbal violence were the typical forms of violence reported. The findings identified risk at all levels. Individual level risk factors included service users’ unreasonable expectations, limited health literacy, mistrust towards medical staff, and inadequacy of medical staff’s communication during the medical encounter. Organisational level risk factors under the purview of hospital management included problems with job design and service provision system, inadequacies with environmental design, security measures, and violence response mechanisms within hospitals. Societal level risk factors included lack of established medical dispute-handling mechanisms, problems in legislation, lack of trust and basic health literacy among service users. Situational level risks were contingent on risk factors on the other levels: individual, organisational, and societal.ConclusionsInterventions at individual, situational, organisational, and societal levels are needed to systematically address workplace violence against medical staff in China. Specifically, improving health literacy can empower patients, increase trust in medical staff and lead to more positive user experiences. Organizational-level interventions include improving human resource management and service delivery systems, as well as providing training on de-escalation and violence response for medical staff. Addressing risks at the societal level through legislative changes and health reforms is also necessary to ensure medical staff safety and improve medical care in China.

Human Services and Behavioral Health Integration: A Model for Whole-Person Medicaid Managed Care.

A comprehensive, whole-person approach to individuals' health care can be achieved by aligning, integrating, and coordinating health services with other human services. HealthChoices, Pennsylvania's managed Medicaid program, delegates responsibility for Medicaid-funded behavioral health service management to individual counties or multicounty collaboratives. County administrators' programmatic and fiscal oversight of Medicaid-funded services allows them to create synergies between behavioral health and other human service delivery systems and to set priorities on the basis of local needs. This model supports access to community-based care, integration of general medical and behavioral health services, and programs that address social determinants of health.

Understanding the Conceptualization and Operationalization of Trauma-Informed Care Within and Across Systems: A Critical Interpretive Synthesis.

Increased recognition of the epidemiology of trauma and its impact on individuals within and across human service delivery systems has contributed to the development of trauma-informed care (TIC). How TIC can be conceptualized and implemented, however, remains unclear. This study seeks to review and analyze the TIC literature from within and across systems of care and to generate a conceptual framework regarding TIC. Our study followed a critical interpretive synthesis methodology. We searched multiple databases (Campbell Collaboration, Econlit, Health Systems Evidence, Embase, ERIC, HealthSTAR, IPSA, JSTOR, Medline, PsychINFO, Social Sciences Abstracts, Sociological Abstracts and Web of Science),as well as relevant gray literature and information-rich websites. We used a coding tool, adapted to the TIC literature, for data extraction. Electronic database searches yielded 2,439 results and after inclusion/exclusion criteria were applied, a purposive sample of 98 information-rich articles was generated. Conceptual clarity and definitional understanding of TIC is lacking in the literature, which has led to poor operationalization of TIC. Additionally, infrastructural and ideological barriers, such as insufficient funding and service provider "buy-in," have hindered TIC implementation. The resulting conceptual framework defines trauma and depicts critical elements of vertical TIC, including the bidirectional relationship between the trauma-affected individual and the system, and horizontal TIC, which requires intersectoral collaboration, an established referral network, and standardized TIC language. Successful operationalization of TIC requires policies that address current gaps in systems arrangements, such as the lack of funding structures for TIC, and political factors, such as the role of policy legacies. The emergent conceptual framework acknowledges critical factors affecting operationalization.

Barriers to an Effective Maternal Health Service Delivery Network: A Qualitative Study among Health Providers in Legazpi City, Albay

Objectives. To A functioning referral system is critical to the maternal health program, especially in the management of obstetric emergencies. This study explored supply-side barriers affecting the effective implementation of the said service delivery network (SDN) in Legazpi, Albay in the Bicol Region of the Philippines.
 Methods. Face-to-face in-depth interviews using semi-structured questionnaires were performed with health care providers involved in the SDN in Albay. Extensive note taking was done by the primary investigator while participants were observed during performance of duties from June - November 2018. Interviews were audio-recorded, transcribed, translated into English, and analyzed thematically along with the observation notes using NVivo. A deductive-dominant approach was utilized for the data content analysis.
 Results. Referral system barriers identified were cross-cutting across the different components of the health system such as governance, human health resource, service delivery and information systems. The barriers were further classified into individual, organizational and external-related factors in relation to the SDN. Examples of barriers included lack of knowledge of protocols and guidelines, lack of coordination between facilities, poor data management, inadequate capacity building opportunities, and constantly changing political landscape and policies.
 Conclusions. The study is the first to explore barriers to effective service delivery network in maternal health in the country. Findings from the study provide significant insight to areas of improvement in the SDN that must be addressed to strengthen local health systems, especially with the country’s movement towards Universal Health Care where local health systems play a key role.

Trauma care in Oman: A call for action

Many Arab countries have undergone the epidemiologic transition of diseases with increasing economic development and a proportionately decreasing prevalence of communicable diseases. With this transition, injuries have emerged as a major cause of mortality and morbidity in the Gulf Cooperation Council countries in addition to diseases of affluence. Injuries are the number one cause of years of life lost and disability-adjusted life-years in the Sultanate of Oman. The burden of injuries, which affects mostly young Omani males, has a unique geographic distribution that is in contrast to the trauma care capabilities of the country. The concentration of health care resources in the northern part of the country makes it difficult for the majority of Omanis who live elsewhere to access high-quality and time-sensitive care. A broader multisectorial national injury prevention strategy should be evidence based and must strengthen human resources, service delivery, and information systems to improve care of the injured and loss of life. This paper provides a unique overview of the Omani health system with the goal of examining its trauma care capabilities and injury control policies.

Evaluating and Measuring Quality and Outcomes

Annette C. Watson, RN-BC, CCM, MBA, is a past chair of the Commission for Case Manager Certification (CCMC), the first and largest nationally accredited organization that certifies case managers, and was the chair of the Program and Services Committee at the time the 2014–15 Role and Function Study and analysis were conducted. A national expert and thought leader in case management and health and human services delivery systems transformation and new models of care, she is President of Watson International Consulting, LLC. Address correspondence to Annette C. Watson, RN-BC, CCM, MBA, Commission for Case Manager Certification, 1120 Route 73, Suite 200, Mount Laurel, NJ 08054 ([email protected]). The author reports no conflicts of interest.

Community Readiness: Can the Human Services Delivery System Meet the Needs of Human Trafficking Victims

Community Readiness: Can the Human Services Delivery System Meet the Needs of Human Trafficking Victims

Integrated Health and Human Services Information Systems to Enhance Population-Based and Person-Centered Service

& 2013 Publ In this issue of the American Journal of Preventive Medicine, Vaithianathan and colleagues have made a valuable contribution in demonstrating how administrative data from human services systems can be used to develop a predictive risk model that identifies children at high risk of maltreatment and could support targeting of prevention and early intervention services. They integrated data from the New Zealand public benefit and child protective services systems to develop their risk algorithm. It is particularly relevant to the U.S. now as many state and local governments are using the impetus of national healthcare reform to redesign health and human services information and service delivery systems. As the authors note, predictive risk modeling (PRM) is most advanced in healthcare utilization, and it is an increasingly important tool in a wide range of innovations to improve quality and “bend the cost curve” in the U.S. healthcare system. The integration of data from multiple sources, including all-payer claims databases and electronic health records, is providing the foundation for identifying individuals at high risk, targeting interventions for chronic disease management, reducing hospital admissions and readmissions, improving end-of-life care, and recognizing many other opportunities for improvement. A whole new industry is emerging to capitalize on the analytic promise of “Big Data.” In recent years, heightened attention is also being directed to modernizing the information systems that support human services. The National Human Services Interoperability Architecture (NHSIA) initiative sponsored by the Administration for Children and Families (ACF) within the U.S. DHHS and the National

Destroying Sanctuary: The Crisis in Human Service Delivery Systems

Destroying Sanctuary: The Crisis in Human Service Delivery Systems

Human Service Delivery in a Multi-Tier System: The Subtleties of Collaboration among Partners

This article examines the nature of interorganizational relationships that are formed within a multi-tier human service delivery system. Taking into account the hierarchical structure of a statewide initiative to support early childhood education, the study investigates the differences in the relationships between organizations at the service and administrative levels of the system. Forty-nine administrative level and 146 service delivery level relationships are evaluated. Findings indicate that organizations involved in direct service delivery form more collaborative relationships. Thus, when government provides funding for human services, policymakers must seek to balance public accountability with the advantages believed to be inherent in devolved service delivery. Furthermore, practitioners who appreciate the importance and nuances of interorganizational relationships will be in a position to better manage their organizations in an environment of increased collaborative activity and joint delivery of services. Going forward, human service systems will continue to involve organizations from the public, nonprofit, and private sector. a better understanding of how these organizations work together is crucial to the effective delivery of these essential services.

Destroying Sanctuary: The Crisis in Human Service Delivery Systems

Destroying Sanctuary: The Crisis in Human Service Delivery Systems

Destroying Sanctuary: The Crisis in Human Service Delivery SystemsDestroying Sanctuary: The Crisis in Human Service Delivery Systems by BloomSandra L. FarragherBrian; New York, Oxford University Press, 2011, 440 pages, $45

Destroying Sanctuary: The Crisis in Human Service Delivery SystemsDestroying Sanctuary: The Crisis in Human Service Delivery Systems by BloomSandra L. FarragherBrian; New York, Oxford University Press, 2011, 440 pages, $45

Towards a unified perspective on human service delivery systems: Application of the teaching-family model.

Towards a unified perspective on human service delivery systems: Application of the teaching-family model.

Utilisation of strategic analysis and planning by occupational therapy services

Many occupational therapists in practice can testify to the continually changing environments that impact on the delivery of effective services in the modern human service delivery system. It is within this context that occupational therapists are urged to regularly undertake strategic planning to keep track of and deal with these ongoing changes. In the present article, strategic analysis and planning will be discussed as a tool for occupational therapists in practice. The first step in strategic planning is an analysis of the external and internal environments of a particular service. The current article will provide an example of an environmental analysis as first step. This is followed by a discussion of the second step: the consideration of appropriate strategies and models of service delivery. The aim of the present article is to emphasise the importance of critical reflection by practitioners in order to adapt to the environmental changes influencing occupational therapy service delivery.

From Data to Intelligence

Technology is transforming societal systems in ways not previously considered. Businesses have had the resources and incentives to implement technological advances much quicker than have human service agencies. This article examines business uses of technology and applies the concepts and principles to the human service delivery system. The result is the conceptualization of an intelligent organization linked to a virtual infrastructure that connects agencies locally and globally in order to accumulate, enhance, and disseminate agency, field, and professional expertise. Concepts are illustrated using examples from the area of child protective services. This analysis points to the need for human service professionals to become partners in creating the global knowledge and the technology infrastructure that deliver information when and where it is needed to guide then-decision making and create systems that learn.

Walking Through the Fire: Integrating Technology to Enhance the Research Skills of Minority Mental Health Student Researchers

SUMMARY The information technology revolution and the “communication age” have brought many new and challenging imperatives for educators and researchers interested in the enhancement of community-based human service delivery systems in mental health. A technology-supported training environment is described to enhance the development of research skills of undergraduate level multicultural mental health researchers.

Aggression in adolescent girls: Implications for policy, prevention, and treatment.

Abstract This review of literature focuses on aggression and adolescent girls. Recent official crime statistics from Statistics Canada show an increase in violent offences by girls. This statistic has created considerable interest in a heretofore largely ignored area of childhood maladjustment. Important differences regarding the development and expression of aggression with girls in contrast to boys is provided. In the context of what is acknowledged to be a limited literature, there are important themes for human service-providers and policy-makers to consider in examining assessment, treatment, and prevention strategies for aggressive adolescent girls. Finally, an orientation towards furthering a research agenda in the area of aggression with adolescent girls is provided. Recent high-profile cases involving violence with girls (e.g., witness the media coverage of the Reena Virk murder in British Columbia) has focused the attention of the public on a heretofore unacknowledged societal problem: violence involving adolescent girls. The present review of literature is concerned with aggression and adolescent girls of which violent expression is but one component. The review includes literature pertinent to girls' use of aggression in a variety of contexts, including peer on peer aggression, same and opposite gender aggression, as well as dating violence. It is presented with the belief that a careful reading of that literature will further an agenda of understanding regarding the unique aspects of girls who display violent behaviour. Relative to the literature regarding violence with adolescent boys, the literature with girls is limited. Yet, our reading of what is available suggests that there is now a basis for a serious discussion regarding the unique needs of girls who may be prone to acting in violent ways. Our conclusion is that there is an obvious need for professionals to begin to draw on assessment, treatment, and prevention options that are sensitive to the unique needs of girls. Again, while the number of studies with girls may seem limited, it is not premature to begin exploring some of the potential findings that could relate to the unique human service needs of girls. This review begins within the context of the increasing rate at which girls are proceeding through the youth court in Canada for violent offences. Following the review will be a discussion of potential explanations for that increase with reference not only to problems of definition for childhood and adolescent aggression, but also to some of the unique aspects of the juvenile justice process that may affect rates of reporting violence with girls. Drawing primarily on research in North America, this review examines those studies focused on aggression for girls between the ages 12 to 17, the corresponding ages in Canada under the Young Offenders Act. Empirical studies that relate to the understanding of the correlates of aggression with adolescent girls and to possible measurement issues for risk prediction will be summarized. This group of studies fits the criteria for inclusion by age and gender with data that reports an association of factors for girls and aggression. Suggestions will then be given for human service, including assessment, treatment, and prevention. These suggestions will reflect an understanding from the literature on aggression with adolescent girls on how a gender-sensitive human service delivery system in youth justice could be developed. Finally, recommendations for furthering a research agenda in understanding aggression and adolescent girls will be made. Overview of Violence and Adolescent Girls Concern with respect to violence and young people in Canada is now without precedence. Fear amongst Canadians for the out-of-control behaviour of young people is high (Labor, 1999). This fear is present despite the fact that Statistics Canada has recently reported that violent crime amongst young people overall has shown a reduction over the past five years (Statistics Canada, 1999). …

Planning, investment and evaluation procedures to support coordination and outcomes based funding in a local United Way system

This article describes the characteristics of a planning, investment and evaluation model that could be implemented in local human services delivery systems oriented toward achievement of specific results. In aggregate, community agencies that provide human services related to specific social problems constitute potential systems designed to achieve important social goals. For the purposes of this article, a human services delivery system at the local level is defined as an administrative organization or unit and affiliated human services agencies. Methods for accomplishing planning, investment and evaluation tasks at the system level as illustrated by the practices of a local United Way and the concept of outcomes based funding are defined. The implications of this approach for coordinating human services delivery at the local level are discussed.

Ecological factors impacting provider attitudes towards human service delivery reform.

Although reform efforts are substantially altering the structural operations and guiding ideological framework of the human service delivery system, little empirical work has been done to systematically examine these transformations. This study examines providers' attitudes regarding two reform elements that are being widely implemented: an increased emphasis on interagency collaboration and a shift from a medical model service delivery philosophy, that focuses on client deficits, to one that emphasizes consumer strengths. Through survey data collected from 186 providers from 32 human service agencies in one county, the relationship between providers' perceptions of contextual support for human service delivery reform and providers' attitudes towards these initiatives is explored. The findings from this study support the importance of attending to the ecology in which we initiate system reform efforts. For both reform elements, working within contexts that are perceived as providing ideological and functional support for change was associated with positive provider attitudes towards those changes. Staffs' perceptions of the external environment played the most critical role in shaping staff attitudes. Interestingly, unique aspects of providers' work environments were related to positive attitudes towards the two different reforms. The implications of these findings for the success of human service delivery reform are discussed.

Human service providers' perceptions of system response to the 1997 Red River of the North Flood

Disasters of monumental proportions, like the 1997 Red River of the North Flood, can push local human service delivery systems beyond their limits and create untold stress among providers of mental health services. To determine the impact of this disaster on mental health practitioners and the human service delivery system, an exploratory study was conducted one year following the flood. Findings indicate that although most respondents were considered primary disaster victims, they appropriately fulfilled their professional duties during and following evacuation. Also demonstrated was a statistically significant improvement in the respondents' perceptions of agencies' relationships following the flood. Furthermore, there was a statistically significant improvement in services provided to clients after the flood compared to before the flood. Additionally, qualitative and quantitative findings indicate that services were coordinated effectively and efforts were made to work cooperatively with various local, state, and national human service providers.