Integrated Service System Research Articles

Fostering development of nursing practices to support integrated care when implementing integrated care pathways: what levers to use?

BackgroundCare integration has been the focus of recent health system reforms. Given their functions at all levels of the care continuum, nurses have a substantial and primordial role to play in such integration processes. The aim of this study was to identify levers and strategies that organizations can use to support the development of a nursing practice aligned with the requirements of care integration in a health and social services centre (HSSC) in Quebec.MethodsThe research design was a cross-sectional descriptive qualitative study based on a single case study with nested levels of analysis. The case was a public, multi-disciplinary HSSC in a semi-urban region of Quebec. Semi-structured interviews with 37 persons (nurses, professionals, managers, administrators) allowed for data saturation and ensured theoretical representation by covering four care pathways constituting different care integration contexts. Analysis involved four steps: preparing a predetermined list of codes based on the reference framework developed by Minkman (2011); coding transcript content; developing general and summary matrices to group observations for each care pathway; and creating a general model showing the overall results for the four pathways.ResultsThe organization’s capacity for response with regard to developing an integrated system of services resulted in two types of complementary interventions. The first involved investing in key resources and renewing organizational structures; the second involved deploying a series of organizational and clinical-administrative processes. In resource terms, integration efforts resulted in setting up new strategic services, re-arranging physical infrastructures, and deploying new technological resources. Organizational and clinical-administrative processes to promote integration involved renewing governance, improving the flow of care pathways, fostering continuous quality improvement, developing new roles, promoting clinician collaboration, and strengthening care providers’ capacities. However, progress in these areas was offset by persistent constraints.ConclusionsThe results highlight key levers organizations can use to foster the implementation and institutionalization of integrative nursing practices. They show that progress in this area requires a combination of strategies using multiple complementary levers. They also suggest that such progress calls for rethinking not only the deployment of certain organizational resources and structures, but also a series of organizational and clinical processes.

Project ECHO NI

Introduction: Project ECHO® (Extension for Community Healthcare Outcomes) http://ECHO.unm.edu is a pioneering telementoring programme developed in the School of Medicine at University of New Mexico (UNM). ECHO model is designed to address the growing demand for secondary care services and is focussed on increasing capacity within primary care, through de-monopolisation of specialist knowledge. Aims and objectives: Project seeks to develop clinician capacity to safely and effectively treat common, chronic and complex diseases in rural and underserved areas and to monitor outcomes. With the use of video-conferencing technology, participants benefit by sharing evidence-based, best practice guidance, and case-based learning. This hub (multidisciplinary team of experts) and spoke (primary care providers) model has been shown to be an effective way of improving access to specialist supported care and improving patient outcomes. The ECHO Institute has developed and trained superhubs, who can successfully replicate the ECHO model. In 2014, Northern Ireland Hospice (NIH) was granted the licence to provide this service within Europe and has trained several NI and UK organisations. Following a successful pilot in 2014-15 with NIH community staff, the NIH is working in collaboration with the Health and Social Care Board (HSCB) in NI to pilot the use of the Project ECHO model in the following areas; - GP Trainees – Dermatology - Palliative Care – Nursing Homes - Optometry/Ophthalmology - Diabetes - Palliative Care (Carers) Results: NIH Community Evaluation Report: http://spcare.bmj.com/content/early/2015/12/01/bmjspcare-2015-000935.abstract HSC evaluation report; http://echonorthernireland.co.uk/2016/05/echo-ni-evaluation-report/ The quantitative and qualitative findings from both these studies support the use of ECHO in NI by demonstrating statistically significant improvements in knowledge and self-efficacy, replicating findings in other ECHO knowledge networks in the US. The ECHO model has been proven to be an effective cross-sectoral collaboration tool, building learning communities for services such as palliative care that include private nursing homes. Project ECHO NI is currently running 20 ECHO Knowledge Networks in 2016-17. They are; - Acute Eye - Macular/glaucoma - Regional quality improvement & patient/Client safety - COPD - Paediatrics - Practice Based Pharmacists via GP Federations - Nursing Home In Reach - Prison Healthcare (NI, UK & Ireland) - Marie Curie - Outpatient Reform - Dermatology - Carers - Dementia - Outpatient Reform - Cardiology - Diabetes - Pain in Palliative Care/ Cancer Pain Northern Ireland & Liverpool - Autism - Mental Health Trauma Network - Regional Child & Adolescent Mental Health Services - Outpatient Reform – Gynaecology - Palliative Care – SE Trust Conclusions: As a low-cost high-impact model, ECHO can be adapted to meet the needs of different communities and populations. At a time when healthcare providers are under mounting pressure to do more and spend less, this model provides an affordable solution to addressing growing need in the UK in training and supporting healthcare professionals. Project ECHO is a tool which can support change in service delivery and systems integration and is a safe space to share knowledge and experience and could therefore be a powerful tool for creating new governance and learning opportunities.

Research on Thinking and Governance of Sports and Health Management for College Students from the Perspective of Life Philosophy

At present, the sports and health management for college students in China was not good, ignoring the life characteristic of college students. Combining the development experience of foreign countries and the reality of our country, the study suggests to take improving the index system, establishing the intervention system, building resources integrated service system as the key way, and take structural establishment, optimal allocation of resources, guarantee and supervision as the important part of development strategy. It will encourage the full development of theory and practice of Chinese college students' sports and health management with the core of the life characteristic and sports and health need of college students.

Service providers’ sustainable service innovation: service-dominant logic

ABSTRACTThis study examined the service innovation in different service providers with multiple case-study approach. From the perspective of service-dominant logic, four service innovation development models can be distinguished in Technology Development Program companies in Taiwan, including service system integrator and niche market, innovative service solution provider and niche market, innovative service solution provider and mass market, and service system integrator and mass market. Service providers develop ICT platforms, customer relationship management systems, community commerce services, and multi-channel services that are appropriate for a specific industry. On the one hand, active improvement of ICT service system integration extends company capabilities toward external cooperative partners through the provision of integrated product services and comprehensive solutions. On the other hand, innovative service solutions optimize consumer experience and customer relationship management and improve business effectiveness and reduce operations costs due to an important role assigned to services and experience in product sales.

Risks for Mental Illness in Indigenous Australian Children: A Descriptive Study Demonstrating High Levels of Vulnerability.

Policy Points: The developmental origins understanding of mental illness suggests the possibility of prevention, through addressing childhood adversities. More than 43% of Indigenous Australian children aged 6 to 10 years have 6 or more risk factors for mental illness in adulthood, and 23% are experiencing current psychological distress. Substantial risk is already present in infancy (eg, 67% exposed to 3 or more stressful family life events, and 42.5% are not living with both birth parents). An integrated service system response that can both offer high‐level therapeutic services and address associated multiple adversities, from conception to late adolescence, is urgently needed to address current psychological distress in Indigenous Australian children and to reduce the future burden of mental illness. ContextMental illness is a high source of disease burden across the globe. Mental illness is now understood as largely developmental, with its genesis at least in part in adverse childhood experiences. We sought to estimate the prevalence of childhood risks for poor mental health in Indigenous Australian children, noting that Indigenous Australians by virtue of their history of traumatic colonization and dispossession, child removal, and racism are potentially at greater risk.MethodsWe conducted a descriptive study of the modifiable risks and adversities associated with mental illness in Australian Indigenous children (infancy to 10 years), using data from the Longitudinal Study of Indigenous Children (LSIC), a cohort of 1,671 infants enrolled in 2008 and followed up annually. Risk factors of interest were identified from a comprehensive literature review of childhood determinants of adult mental illness by Fryers and Brugha (2013). The age‐category prevalence of individual risks and a multiple‐risk score were computed using data extracted from 6 waves of LSIC.FindingsThe analytic data comprised 8,378 person‐observations from the first 6 waves. Children in LSIC experience high rates of adversities. In utero, nearly 50% were exposed to smoking and 22% to alcohol. As infants, 42.5% were not living with both birth parents. Over two‐thirds of survey children were in households that had experienced, in the previous 12 months, 3 or more major life events; 22% to 26% lived in households with a drug or alcohol problem; and 18% were exposed to domestic violence (41% were ever‐exposed to age 10). At school, nearly 40% of children were bullied. Over 45% of children aged 6 to 10 years were exposed to 6 or more risks for mental illness. Few children (< 2%) were exposed to low parental warmth and, despite the high exposure to adversities, less than 5% of children report low self‐confidence. This suggests considerable resilience. More than 1 in 4 children had conduct problems in the clinical range and more than 1 in 5 were experiencing high psychological distress.ConclusionsIndigenous children in Australia face extreme levels of multiple disadvantage, exposing many to current psychological distress and high risk of developing mental illness, despite considerable resilience. For policymakers, this is a call for preventive action targeting the multiple risk factors already present in childhood. An integrated service system offering culturally appropriate, high‐quality early childhood education services, linked to infant, child, adolescent, and family mental health services, and intensive family support services will be crucial in addressing this public health crisis.

Drafting the Substance Materials of The Regional Regulation of Badung Regency on Public Service


 
 
 
 The Government of Badung Regency provides public services, both in the forms of services and goods, to its community as part of its duty in performing governance. In the implementation, such public services are regulated in regulation which is derived from the existence of policy in the delegation of authority. The regional regulation as such is containing what so called the substance materials. The substance materials of Regency/City Regional Regulation mean that such regulation contains typical substance materials that are not contained in other Laws and Regulation both in the local and central level. The formulations of legal norms in the Regional Regulation are conducted by using the single and pairs formulations. The targets that will be realized, the scope of regulation and drafting direction of Regional of Badung Regency on Public Services, among others: scope of public services, integrated service system, guidelines for the standrad services preparation, the proportion of community groups and categories in a tiered services and community participation in performing the service.
 
 
 

THE PROBLEMS OF PERFORMANCE MONITORING TO TAKLE THE TASKS OF THE AIRCRAFT CONTINUED AIRWORTHINESS

Improving of the aircraft continued airworthiness system is currently becoming of particular importance applied both to aircraft of domestic and foreign production, used in civil aviation of Russia. This article discusses the background and content of the tasks for long-haul aircraft continued airworthiness, which presents a challenge directly related to the provision of intensive, regular, economically viable, and safe operation of assigned airline fleet. A special place among the problems of continued airworthiness is held by the creation and organization of mechanisms and methods of resource status and age of the assigned airline fleet monitoring to manage its forecasting and timely updates. Not least important among the issues of resource and age structure monitoring to be considered is the need to improve the design of aircraft, taking into account preliminary technical and economic feasibility assessment of its modifications in the interests of the operator. A deep study of the contents of the monitoring allows to develop up-to-date methodological and scientific basis for building an integrated system of aircraft resource management and timing services. This system is developed based on the integrated approach that allows to provide a solution to the entire set of problems presented in this article and faced by professionals and scientists involved in the aircraft maintenance programs development on the stages of their design and manufacturing and long operation of aircraft continued airworthiness.

The last ten years of research at Tarquinia

The Centro di Ricerca Coordinata ‘ProgettoTarquinia’ of the Universita degli Studi di Milano is a LERU (League of European Research Universities) exemplary interdisciplinary research project that involves groups from the Universita Statale di Milano (Archaeology, Information and Communication Technologies, Geoarchaeology, Palaeoanthropology), the Politecnico di Milano (Architecture and Topography) and bridges the gap between soft and hard sciences. This project stems from the ‘Progetto Tarquinia’ conceived by Maria Bonghi Jovino in 1982. During the last ten years, our integrated system of tools and services, supported by ICTs (ArchMatrix), through which multidisciplinary domain experts can examine all the typologies of data of a given culture, has made it possible to concentrate on the links between data-sources focusing on the recurrence of association rates within different aspects of material evidence and phenomena. The fields of application of our methodology in the domain of archaeology and epigraphy are multifaceted as regards the inside and outside connections of the Tarquinian heritage, whose necropolis with the famous painted tombs is a UNESCO World Heritage Site. Research includes areas of the Civita plateau: the ‘monumental complex’, the Ara della Regina sanctuary, fortifications, and archaeological sites previously explored. In the past ten years, research in the necropolis (roughly 6,000 tombs, of which 400 are painted) and in the surrounding territory has also been implemented and has produced the complete corpus of the painted tombs of Tarquinia. Our holistic approach encompasses archaeological analysis of small (mobile finds), medium (archaeological contexts) and large scale (territory and landscape) architectural analysis and applications for integrated solutions for the cultural heritage, including the first bilingual Virtual Museum dedicated to an Etruscan city.

Interoperable Information Exchange as Enabler of NFF Related TES

The lifecycle of a product is managed through the Product Lifecycle Management (PLM) including the integration of Product Service Systems (PSS) as well as Through-life Engineering Services. Both activities are performed by staff throughout the entire lifecycle and require the input of knowledge of different product lifecycle phases. The authors demonstrate the necessity of information exchange between the beginning of life and the middle of life on the example of NFF. The provision of the right information in the middle of life should be an information based TES which can only be achieved if the interoperability challenges are solved between the life-cycle phases. This paper demonstrates how existing semantic data integration approaches could be applied to enable the required information exchange. For that purpose, the modelling of test process related knowledge as ontology and corresponding extraction methods are presented.

FEATURES OF GEOSPATIAL ORGANIZATION OF RETAIL TRADE SERVICES IN RURAL AREAS

Formulation the problem. The service sector serves as an important component of the economy of any state, region. It became to develop especially rapidly for the last decades due to formation post-industrial society. The service sector plays a significant role in vital activity of society since it provides the population employment, satisfy population’s need in services, and ensures filling the local budgets. One of the most dynamic branches of the service sector is retail trade. There are significant transformations of this sector in rural areas, its organization, but there is a lack of human-geographical research on the mentioned topic. The aim of the article is consideration the human-geographical approach to the study of service sector and retail trade in rural areas in particular. Research results . The author has analyzed the concept of territorial systems of services as a set of direct and indirect interconnected enterprises. Territorial systems of services are components of the socio-geographical system. There are direct (links between enterprises in one branch) and indirect (links to the common use of territory, industrial, transport infrastructure, flows of people to satisfying needs, administrative and managerial, economic links) links within the system of services. The specialized system of services (a set of interconnected enterprises in one branch) is highlighted, which is a part of the integrated system of services, it has bodies of sectorial and sectorial-territorial management, it is characterized by incomplete completeness, the specialized system of services is found in its “pure form” very rarely, it is distinguished by a noticeable internal differentiation. Productive, managerial, and competing links plays significantly in formation the specialized systems of services. The following indicators are used for the study of the system of services: provision of commodity mass, provision of retail space, provision of staff, concentration of trade objects, average radius of the service area of the center (enterprise). The technique of the analysis differentiation of indicators involves the study the content of the development of a chosen process (phenomena), choice of indicators, delimitation the study area, statistical ordering of indicators, construction the cartographic models, identification spatial dependencies, trends, prospects development.

A case study of servicescape design from altruistic point of view

This is the era when service and experience is also designed. As paradigm in industry shifts from manufacturing industries to service industries, economic player and power to consume this naturally shifts from supplier-oriented one to consumer-centered one. This phenomenon makes it more important to understand service design, human-centered and contextual design method of analyzing consumers’ needs and solving a problem on the basis of understanding of customer also in design and designer. In this paper, it is intended to define service design as altruistic approach to entire service environment such as design delivery system and method and process through multidisciplinary, mutually cooperative and integrated service system, centering on consumer, human and other people. Designers are intrinsically altruistic in that they should basically target other people, and naturally analyze the general public’s needs, wants and urges, and grasp the general public’s behavior, and solve problems. In this study, it is intended to apply the value of this altruism to servicescape design as element that enhances and improves service experience. Therefore, on the basis of literature reviews and precedent studies, the objectives of study in this paper are as follows. First, the value of sincerity, empathy and compassion that altruism has is defined as design element. Second, servicescape design mainly limited to physical environment design is extended to and conceptualized as social environment design containing publicness and altruism by analyzing relation with servicescape that creates service experience. With regard to research method, it is intended to analyze cases of domestic and foreign bank, hospital and company in the background, goal, applied process and method and performance evaluation aspect through carrying out multiple case study by applying exploratory case study approach that can ensure validity and reliability.

Social entrepreneurs: innovating rural tourism through the activism of service science

Purpose This study aims to construct an integrated social entrepreneur system in the rural area of Hengshan, Taiwan, that could benefit four stakeholders, namely, tourists, business, community and government. Two social entrepreneur cases demonstrate a mutually beneficial situation of lowering the structural unemployment rate, returning young human capital to villages and innovating rural tourism through the activism of service science. Design/methodology/approach Qualitative approach was applied to data obtained from 12 research projects spanning three years. Service experience engineering (SEE) methods were used to conduct a service design for social entrepreneurs in an integrated service system. The service system aimed to innovate rural tourism through the activism of service science. Findings SEE methods explain a series of service design processes that helped our research team start up two social entrepreneur projects as service prototypes to offer service innovation based on cultural creativity to innovate rural tourism. These two social entrepreneurs in rural tourism offer job opportunities to young people and senior citizens alike. In addition, an integrated service system of interdisciplinary knowledge, multi-stakeholders and local resources fulfills various requirements of stakeholders to promote sustainable rural tourism. Research limitations/implications Real action studies are limited in the research on social entrepreneurs. This case study provides research insights into service science and calls for action in practice to change the future of a local village. The results provide the philosophy and knowledge of service science that social entrepreneurs of rural tourism can use in the village. Designing service innovation for rural tourism has shaped its vision toward a sustainable tourism system. Originality/value Few studies have shown that social entrepreneurs could innovate rural tourism. The present study presents an action case through the activism of service science.

Innovation in service ecosystems

Purpose– The purpose of this paper is to extend the understanding of innovation in service ecosystems by focussing on the role of values resonance in relation to the integration of brands, service systems and experience rooms.Design/methodology/approach– An empirical, explorative case study of an innovative service system is carried out using a narrative approach and presented in the form of a saga.Findings– Insights gleaned from the empirical study are used for conceptual developments. Analysis of the empirical case study is presented as four lessons linked to values, brands, service systems and experience rooms.Originality/value– The paper extends a conceptual framework of innovative resource integration in service ecosystems. The paper also contributes four propositions to inform theory: values resonance is a basis for service innovation, the innovative integration of brands based on values resonance can foster innovation, the integration of resources across service system boundaries grounded in values resonance can enable innovation and the integration of experience rooms into a coherent servicescape based on values resonance can support novel forms of resource integration and value co-creation efforts in service ecosystems.

Blocking Probability Approximations and Bounds for Best-Effort Calls in an Integrated Service System

In this paper, we consider an integrated service system, providing multirate guaranteed services and homogeneous best-effort services. The total system capacity is shared by both service types, while the guaranteed service customers are treated as high priority and are allocated fixed data rate bandwidth units. The best-effort service customers are supported by the remaining capacity leftover by the guaranteed services, in a processor-sharing manner. Admission control on the best-effort service customers is adopted to provide a certain level of quality of service (not guaranteed) to avoid the effect of repeated attempts. The best-effort customer blocking probability is an important metric for network dimensioning. In this integrated service system, we observe that the blocking probability of the best-effort customers is not insensitive to the shapes of their flow-size distributions and the guaranteed customers’ holding-time distributions. We obtain here by light computation, for the best-effort customers, blocking probability bounds, and approximations, which possess the insensitivity property. Considering that the distributions for customers’ holding times and flow sizes may be unknown, the proposed insensitive bounds and approximations will facilitate system design and network dimensioning with predictable and acceptable performance.

Management in New Public Service Systems: Reframing the Position of Managers and Their Training and Development

Management training and development (T&D) plays an important part in enabling managers to deal with complexity and change associated with new public service systems. Using a service-dominant logic approach, this paper explores the relevance of T&D in preparing managers for changing roles, responsibilities and relationships that integrated service systems demand. Exploring the views of service managers working in Community Health Partnerships, the study establishes that present management T&D does not support the delivery of integrated services which require different abilities and new ways of working. New public service systems demand new processes of learning where re-framing the position of managers and their T&D becomes increasingly necessary.

Linking state child care and child welfare policies and populations: Implications for children, families, and policymakers

Policymakers have begun to explore new areas of service system integration, including coordination of services for vulnerable children and families. Early care and education (ECE) research has also begun to pursue more nuanced questions about the role of ECE in the development of vulnerable children, including those involved with child welfare. Yet, to date, very little is understood about the integration of ECE and child welfare service systems or policy. This study examined state variation in federal child care subsidy (CCDF) program policies including eligibility, priority, copays, and activity requirements for families involved in child-welfare. Findings showed that, overall, states made fewer accommodations in their CCDF policies for children in foster care than for those otherwise involved in child welfare, such as by waving copays and activity requirements. Three typologies of states' CCDF policies were identified using latent class analysis: an accommodating typology, a selective accommodations typology, and a not accommodating typology. The relationships between these typologies and indicators of states' child welfare placements (types and stability) were also explored. Findings have implications for state policymakers and researchers interested in the integration and improvement of services for vulnerable children and families.

Repeated entries to the Swedish addiction compulsory care system: A national register database study

This study identified and described specific client groups who have repeated entries to the Swedish addiction compulsory care system. Specifically, through the use of baseline data from the Swedish government Staten's Institutions Styrelse (SiS) database, for 2658 individuals who were assessed at their compulsory care intake interview by social workers in the national social welfare system between 2001 and 2009 the study identified the associations between specific predisposing, enabling and need characteristics and repeated addiction compulsory care entries. The logistic regression model identified that individuals whose children have been mandated to the child welfare system, who have experienced prior compulsory care including compulsory treatment through LVU (law (1990:52) with specific provision about care of young people under 18), and those who have been in prison are more likely to have two or more entries in the addiction compulsory care system compared to their counterparts. Individuals who have been mandated to compulsory care for their substance use disorder two or more times have significant multiple complex problems and repeated experiences of institutionalization. These individuals are a group in need of a well-coordinated and integrated system of aftercare services to reduce the likelihood of re-entry into addiction compulsory care.

IS-043 Comprehensive Coordinated Care For Children With Rare Conditions

Most of the chronic conditions of childhood occur relatively rarely, and many of those rare conditions require complex care. Children with the most complex conditions comprise 5% or less of the paediatric population but account for as much as 70% of paediatric care expenditures. These children are particularly vulnerable to the effects of fragmented care and services resulting in less than optimal health outcomes and higher health care costs. Developed by paediatricians, the medical home model has been promoted by the United States Maternal and Child Health Bureau and the American Academy of Paediatrics as a locus of proactive, coordinated care in the context of an integrated system of child health services and supports. The medical home has now been adopted as a model of care across the life span and occupies a critical position in United States health care reform efforts. This presentation provides an overview of the medical home model and its place in an integrated care model of child health for children with rare and complex conditions. The critical functions of care coordination, written and shared care plans, and explicitly articulated co-management roles for primary care providers, specialists, other ancillary service providers, and families will be explained.

The Analysis and Design of the Dynamic Information Service System Network Architecture of the SOA Based on WAVE Technology

Safety problem is one of the most attention and concern of driving. This paper in the high-speed on the road cars and car, car and road communications, vehicle real-time status, through the network information service system integration on a platform, on the use of related technologies are analyzed, the design of the software system based on SOA architecture.Keywords: network, GPS module, SOA cross platformI. IntorductionWith the development of science and technology and the improvement of people's living standard, Car popularity rate is high, it's hard to believe, families has two or three car. Whether it is the bus or private car is such rapid development, this will bring a lot of problems in road traffic, such as traffic congestion, traffic accident. These problems affect the normal life and travel, it is necessary to carry out management and provide information service for road use advanced technology. Using mobile phone GPS positioning module can obtain the vehicle speed and the basic information, through processing and optimization of information service system, the analysis of data useful, so as to divert traffic, both for the convenience of the user, but also improve the expressway management ability.

Integrated Services and Suicide Prevention Training

The objective of this article is to highlight the benefits of a suicide integration training embedded in an integrated services delivery system. Specifically, the article examines the relationship between the tenets of the training and the low incidence of suicidality experienced at a large mental health agency in Western Massachusetts. Through its new integrated service system, both behavioral health and primary care services are delivered at the Center for Human Development (CHD). On the basis of the experiences of CHD, effective suicide prevention training is essential for maintaining an almost nonexistent suicide rate. The training was developed by Nina Slovik, LICSW, and employed at CHD. It incorporates elements of different practice modalities such as motivational interviewing, the construct of hope, and authenticity. The idea of the "authentic relationship" is emphasized by Slovik. Authenticity is characterized by no pretense that a clinician has something to teach. It is better expressed by the question, genuinely delivered: "So how are you doing?" While clinicians may not always be able to accurately assess a person's suicide risk, looking at the larger context, collaborating as a partner rather than as an expert, and helping find meaning and purpose will improve the chances to recognize risk and provide a positive intervention. Another important difference found at CHD is its use of care managers, a hybridization of medical and mental health case managers, to provide wraparound services and closely monitor the psychological and medical health of CHD's clients through the new integrated services program. • Care management in an integrated service program utilizes a hybrid form of medical and mental health case management. • Contact with primary care providers is common prior to suicide events. • Facets of successful suicide prevention training include motivational interviewing and the construct of hope. • Establishing a genuine and authentic relationship with clients may save lives.