Patterns Of Service Delivery Research Articles

Patterns of Treatment Services and Costs for Young Offenders with Mental Disorders

This study describes mental health treatment service delivery patterns and costs for youth in a juvenile justice system. A secondary data analysis on a random sample of juvenile offenders (N = 312) was completed. Service patterns and costs were described. Selected variables were examined for their ability to predict who received treatment. Only 23% of youth diagnosed with a mental disorder received any treatment. Older youth and African American youth received fewer services, and race was the only significant predictor for receiving treatment (p = .001). Mental health treatment services were scarce, and the data reflects a race bias in the provision of services. Although the law protects the right to treatment for these individuals, provision of services remains a challenge.

Patterns of foster care service delivery

This study explored direct client services provided by one foster care program. A cohort of 44 families was followed for up to 36 months by monitoring the frequency of eight service activity categories (i.e., service planning, therapy, family visits, court hearings, foster child contacts, foster parent contacts, family of origin contacts, collateral contacts) provided by the program's front-line staff. Service activity data recorded by staff on daily time sheets were used to describe the type and frequency of service provided to families between intake and discharge. Findings revealed that service delivery peaked immediately following intake and at regularly scheduled reviews such as the hearing to decide termination of parental rights. Overall, the frequency of foster care services to clients declined over the time that children were in care. Factors associated with the receipt of fewer services were the following: families with young children, relative care placements, placement stability in one foster home, caseworker turnover, and adoption. Race of the birth family was associated with different patterns of service delivery. Overall, the findings suggest that foster care service patterns emerged more from responses to client and system demands than to the program's service model.

Resource allocation for psychosis in Australia

Using a census-based prevalence survey (Jablensky et al, 2000), we estimated the cost of psychosis in urban Australia at AU$2.25 billion (£0.86 billion) per year when valued at prices pertaining in the year 2000 (Carr et al, 2003). About 40% of these costs were spent on direct mental health care, the remainder being the costs of lost productivity (limited to unemployment in our study). The total costs amounted to AU$46 200 (£17 722) per person per year, 20% higher than the average annual male income. The bulk of the treatment cost was accounted for by in-patient care, which appeared to have become the default option in the absence of adequate levels of supported community accommodation. This was indicated by the fact that after 'non-discretionary' treatment costs (42% of direct costs) were accounted for (i.e. visits to a general practitioner, medication, crisis or emergency care, acute hospitalisation), almost three-quarters of the remainder was spent on long-stay hospitalisation (Neil et al, 2003). When patterns of community-based service delivery were examined, we found a marked paucity of delivery of psychosocial treatments, rehabilitation and substance use interventions, reflecting the skewing of expenditure towards long-term hospitalisation and away from community care.

Patterns and correlates of treatment: findings of the 2000-2001 NSW minimum dataset of clients of alcohol and other drug treatment services.

The aim of this study was to provide an overview of the first year of the NSW Minimum Dataset for Alcohol and Other Drug Treatment Services data collection, including describing the patterns and correlates of people having received treatment in New South Wales. All closed treatment episodes for the 2000-2001 financial year were included for descriptive, univariate and multivariate analyses. There were 33,459 closed episodes of care in New South Wales in the 2000/2001 financial year. The majority of clients (69%) were male and the mean age was almost 34 years. The majority of treatment is sought for problems related to alcohol (37%) and heroin (33%) use. More than a third (40%) of clients were new to drug and alcohol treatment. Half the clients had a history of injecting drug use with 6.3% of those with heroin as their principal drug of concern, never having injected. The most common main service provided was in-patient withdrawal (26%). Multivariate logistic regression revealed that being older, not homeless, non-indigenous and having heroin as the principal drug of concern predicted receiving out-patient withdrawal management. Analyses of length of stay in residential treatments and number of service contacts in non-residential treatments are reported. The NSW MDS AODTS is a critical information source for policy development, service planning and surveillance. The results of this paper illustrate the utility of the data collection for identifying emerging issues in the patterns of drug use and service delivery for clients with alcohol and other drug problems.

The availability of psychiatric programs in private substance abuse treatment centers, 1995 to 2001.

The high rate of co-occurrence of substance abuse and mental disorders renders the availability of psychiatric programs, or integrated service delivery, a vital quality-of-care issue for substance abuse clients. This article describes the availability of psychiatric programs and integrated care for clients with severe mental illness in the private substance abuse treatment sector and examines these patterns of service delivery by profit status and hospital status. S: Survey data from the National Treatment Center Study, which is based on a nationally representative sample of privately funded substance abuse treatment centers, were used to identify the proportion of centers that offered psychiatric programs in 1995-1996, 1997-1998, and 2000-2001. Centers reported whether they treated clients with severe mental illness on-site or referred them to external providers. Repeated-measures general linear models were used to test for significant changes over time and to assess mean differences in service availability by profit status and hospital status. About 59 percent of private centers offered a psychiatric program, and this proportion did not significantly change over time. The proportion of centers that referred clients with severe mental illness to external providers increased significantly from 57 percent to 67 percent. For-profit centers and hospital-based centers were significantly more likely to offer psychiatric programs and were less likely to refer severe cases to other providers. S: Although the importance of integrated care for clients with dual diagnoses is widely accepted, data from the private substance abuse treatment sector suggest that this pattern of service delivery is becoming less available.

Services for aphasia, other acquired adult neurogenic communication and swallowing disorders in the United Kingdom, 2000

Purpose: We developed a questionnaire designed to determine the state of services provided by the National Health Service within the UK for adults with acquired neurologically caused communication disorders. A further aim was to compare our results with those from a similar survey conducted 10 years ago by Mackenzie et al.1Method: We sent questionnaires to 264 managers and directors of adult speech and language therapy services in the UK. We asked questions about staffing levels, regional variations, patterns of service delivery at acute and chronic stages and staff time spent working with different communication and swallowing problems.Results: Nearly 53% of average staff time was spent working with swallowing disorders accompanying neurological damage (dysphagia) compared to 24% with aphasia. As the percentage of time spent working with swallowing increased, the percentage of time spent working with aphasia reduced. Out of the time spent on aphasia treatment, 48% averages less than 3 h per week duration and just 4.8% averages more than 3 h per week, which was correlated with total number of speech and language therapists employed by a service. We found a significant difference only between London, with the highest total staff numbers, and the South West, with the lowest. We also found significant relationships between staff numbers and population size and staff numbers and the level of referrals to the service.Conclusions: Our main conclusions are: (1) while there may have been an increase in the number of speech and language therapists working with acquired and progressive neurogenic conditions in the past 10 years, they are mainly working with swallowing disorders, and (2) findings agree with recent studies showing that the amount of treatment or therapy that aphasic clients receive is well below that recommended by the literature.

Counselling provision for staff in the National Health Service in England: A survey of patterns of provision

This paper reports the findings of a research project carried out in 2001, mapping the provision of counselling services for staff in the National Health Service in England. A postal survey was used to gather both quantitative and qualitative data in order to produce a picture of service provision in NHS Trusts throughout England. Analysis of information concerning the qualifications, experience and pay structure of counsellors, and patterns of service delivery, revealed significant variations across Health Trusts. Findings are discussed in relation to implications for policy, practice and future research.

Choices, Policy Logics and Problems in the Design of Long–term Care Systems

Establishing a public, comprehensive, independent, mainly community–based long–term care system, separate from medical care and social services, can lead to the provision of more effective and consumer–oriented services, and also to a more appropriate mix of public/private financing. Of the two main approaches to financing long–term care (LTC), a tax–based model is more flexible in providing benefits according to the individual’s need, since income levels and the family’s ability to provide care will be taken into consideration, while a social insurance model is more rigid because the individual’s rights are more explicitly defined. The latter system is likely to provide more opportunities for choice, including decisions about the mix of health and social services. Policy–makers must decide which approach to take after weighing the positive and negative aspects of each, and the existing organizational infrastructure. Decisions must also be made on the practical issues of coverage, fairness, form of benefits, service delivery patterns, relationship with medical and social services, and controlling costs. With increasing pressure to contain public sector expenditures and improve efficiency, the focus of care will gradually shift from medical care to LTC, and within LTC, from institutions to housing. How to make this process proactive and planned, instead of ad hoc and reactive, is the challenge for public policy.

'No change' is not an option.

Primary care is the cornerstone of our health services with more than three-quarters of NHS contacts being through general practices (Audit Commission, 2002). However, the work of general practices has changed considerably over the last 50 years, reflecting many organizational changes as well as numerous developments in clinical care, which have both extended life and enabled effective complex disease management outside hospitals. Unfortunately the hoped-for reduction in workload from the establishment of NHS Direct and Walk-in Centres has not been realised. Further, one-third of the workforce is approaching retirement age and despite intensive recruitment and retention initiatives many GP, practice nurse and community nurse vacancies remain unfilled. Compounded with this is the recognition that services need to be modernized so that they meet population needs, with the convenience of users taking precedence over established service delivery patterns. This has resulted in numerous tensions between the traditional model of service delivery focused around the GP and modern expectations which demand rapid access, uniform care standards and extended provision to minimize hospital contact (Audit Commission, 2002).

Interorganizational Networks: Using a Theoretical Model to Predict Effectiveness of Rural Health Care Delivery Networks

Interorganizational health care delivery networks have potential for sustaining health services delivery in rural areas faced with economic and demographic challenges. Four Nebraska rural health care delivery networks (Albion-Ord, Blue River Valley. Rural Partners. Inc., and Western Nebraska) were compared to an interorganizational model based on theories of interorganizational relations, exchange, population ecology, and synthesized collaboration. It assumes that outcomes, including effectiveness, are influenced by external and internal factors that are operationalized through external control, technology, structure, and operational process variables. Data were collected by a non-random, two-level cluster mail survey of network, members (45/59 = 76.3% response rate). All networks received technical assistance from the Nebraska Office of Rural Health. Networks have formal organization, strategic plans, and official coordinators. Hospital administrators hold most leadership positions; few doctors or citizens are involved. Correlation and multiple regression analysis show partial fit between the research model and study networks. Effectiveness, measure by the gap between best possible and actual practice, increased with network connectivity (r=.36, p<.05), group methods of administrative decisionmaking (r=.52, p<.001) and sequential pattern of service delivery (r=.39, p<.05). Greater dependence on vertical funding corresponds to greater external control (r=.43, p<.01). The prediction that, as scope narrows, task intensity (r=.56, p<.001). duration (r=.41, p<.01), and task volume (r=.50, p<01) increase is upheld. Centrality and network size decrease together (r=.43, p<01) where there is little reliance on vertical sources of funds (r=.36, p<.05). The integrated interorganizational model demonstrates some efficacy for testing potential effectiveness of networks.

Influences of spatial practices on pressure ulcer management in the context of spinal cord injury.

Nursing practice is significantly influenced by the type and use of space in which nursing is practised. While investigating current patterns of service delivery for the management of pressure ulcers from the perspective of people with spinal cord injuries and their families, the space in which care was delivered was identified as a central determinant of care. Qualitative methods were used to investigate consumer perspectives among patients residing in both metropolitan and rural communities who had been hospitalized for the management of pressure ulcers. Issues related to the spatial practices of the hospital are discussed, demonstrating a link between well-being and the creation of an appropriate caring milieu. It is concluded that service could be improved markedly if health-care professionals placed more consideration on the impact of space on their service delivery.

Organizational and structural reform in aged care organizations: empowerment towards a change process.

Aims The aims were first to explore strategies for both structural and organizational reform by the process of action research, and second to use collective self-inquiry by all study participants as a way of examining problems and deciding on actions to bring about change. Rationale It was hoped that this process would empower the staff, aged residents and family members to own and therefore be meaningfully involved in improving practice and care standards. Background/introduction Three aged care centres expressed a desire to enhance the quality of care provided in order to meet the criteria for accreditation. They wanted to participate in a process that would assist them in critically examining their resource allocation, service delivery patterns and outcomes for residents. Research methods Original data were collected in three different aged care facilities over a three-year period from 1996 to 1998 in order to seek answers to the usefulness of action research in the change process. The methodology included participant observation, interviews and focus group discussions with all participants. Results/findings Organizational change occurred across the three centres with subsequent changes in the outcomes for both residents and staff. The themes which emerged from the data analysis process and which enhanced the participatory process included the need for flattened organizational structures and management's willingness to fully support the process and to be more transparent. The factors that inhibited the process included the organizational culture and tokenistic support by management. Discussion/conclusion Participatory action research was found to be a successful process for identifying and acting on the enhancers and inhibitors to structural and organizational reform.

Employment-related psychological evaluations: Risk management concerns and current practices

Pre-employment psychological evaluations and fitness for duty evaluations are an increasingly important part of police psychology services. While it is assumed that agencies display differences in how they handle these functions, there has been to date no systematic study of the specific methods and patterns of service delivery for pre-employment and work fitness evaluations. The current study presents results from a national survey of the fifty largest police and sheriffs' agencies using department size to partition the data. Of particular interest are the methods of communication of confidential findings to the department in light of restrictions set forth by professional guidelines and by a recent California Appellate decision in the Pettus case. Implications for addressing conflicting elements of ADA requirements and reducing risk factors for professional liability are addressed in our discussion of these findings.

Assessing the Satisfaction of Caregivers of Adult Day Services Participants

Satisfaction with adult day services is an important outcome measure in developing standards for quality care and for changing the service delivery patterns. However, currently there is no valid tool available to assess caregiver satisfaction with adult day services. This pilot study was undertaken to develop and test a satisfaction measure using a caregiver sample of 143. Factor analysis of the satisfaction scale reveals two distinct dimensions of services, “satisfaction with staff care” and “satisfaction with facility services.” The authors discuss the underlying concepts, scale reliability, recommendations for improving the measure, and implications for adult day service staff and administrators.

The cardiothoracic surgery workforce in Australia: Supply and requirements 2000–2011 report of the Australian medical workforce advisory committee 2001

To establish a national profile of the current cardiothoracic surgery workforce and advise the Australian Government on workforce requirements to 2011, the Cardiothoracic Surgery Workforce Working Party brought down a report in May 2001 to The Australian Medical Workforce Advisory Committee. The survey data were taken from half the current Fellows of the Royal Australian College of Surgeons engaged in cardiothoracic surgery. Australian cardiothoracic surgeons are typically middle-aged males working more than 60 h per week. Their work has both private and public sector components and most surgeons provide services in both cardiac and thoracic surgery to an average catchment of 180 000 people. Concentrated in the capital cities, mainly on the eastern seaboard, they devote 90% of their working hours to service delivery, with little time spent in research and developmental aspects of their profession, or in administrative roles. The committee provided 10-year projections for surgical services, predicting an annual growth in service requirements of 1.8% in Australia to 2011. The report concludes that maintenance of the present intake of surgical trainees at five per year — offset by the projected retirements of 2.7 surgeons annually — will be sufficient to meet demand. This conclusion is based on an assumption of a decade of unchanged national health structures and patterns of workforce participation and service delivery.

Speech-Language Pathology in Malta: Meeting Local Needs in a Global Perspective

Education in logopaedics and patterns of service delivery for the communication-disordered have expanded over the past decade in the Maltese Islands to address local needs, culture and circumstances. This paper provides an overview of the expansion of trained staff, caseloads and mode of service delivery. Various strategies are reported as having been adopted by the relatively underresourced training establishment to ensure the preparation and maintenance of competent and accountable practitioners, as recommended by the International Association of Logopedics and Phoniatrics. The success in training is perceived as being the result of the collaborative approach adopted with local service providers and expatriate colleagues. Strategic plans to strengthen the profession and service provision are also discussed.

Pioneers, paediatricians and public health: the evolution of community child health services, Clifton, Nottingham 1983–1999

Since 1976 developments in the training and services provided by general practitioners and community paediatricians have led to a series of changes in clinical services provided for children in the community. A series of studies carried out in the Clifton area of Nottingham from 1983 to 1999 illustrate this. A changing pattern of service delivery is reported in which clinical medical officers provided a largely primary care service in 1983 developing into a paediatric secondary care service in the next decade with the primary health care team having taken over the role of child health surveillance. The community services in the 1990s were taking over the investigation and management of paediatric problems previously seen in the hospital outpatient clinic. The studies illustrate the advantages of locally based services in terms of ease of parental access and consultation between the primary health care team and specialist children's services. Public Health (2001) 115, 412–417.

‘A critique without a focus’: a response to Ward’s re‐interpretation of urban politics

roles and responsibilities of local government, and the relations between central and local state and state and non-state interests. Likewise, in the 1920s, local government played an increasingly important role in the expansion of the welfare state and, in particular places, became a focus of political resistance to centralization (see, Branson 1979; Cochrane 1993; Duncan and Goodwin 1988). The post-war period saw the development of the modern welfare state system, with local government taking on greater responsibilities and adopting broader political, economic and social roles. During the 1980s and 1990s, the emergence of new institutional structures played a key part in the implementation of central policy agendas. It is hardly surprising, therefore, that the changing nature of the local state, and of local government within it, is a perennial concern to academics and to policy makers alike (see, for example, Atkinson and Wilks-Heeg 2000; Cochrane 1993; Morris 2000; Raco and Imrie 2000; Rhodes 1997). Our paper in Transactions (Imrie and Raco 1999) represented a contribution to these debates by examining the continuities and contrasts between contemporary forms of local governance in the UK and 'old' modes of local government. Using evidence from two British cities, Cardiff and Sheffield, we argued that the 'new' local governance is not dissimilar to the substantive policy objectives or procedural policy styles of 'old' modes of local government. We demonstrated that the new local governance, far from representing a radical shift in styles and practices of governance is necessarily tied, albeit in complex ways, to the structures, policy styles and trajectories of 'old-style' local government. In this, we concur with Morris (2000, 3) who notes that historians should 'remind political scientists that many of the patterns identified with [local governance] in the post-1970s were not new'. Partnerships, networks, fragmented patterns of service delivery and boosterist politics have always been part of local governance since the nineteenth century. As such, we sought to challenge both (political) neo-liberal

Competitive health policies and community health

Since 1992 there have been fundamental changes in health care policy in Victoria, Australia, as the state government moves to competitive market models of service delivery and the measurement of service provision through output based funding. The introduction of competitive relationships to the public health system has had a major impact in the primary health care sector, particularly on community health centres. Most community health centres in Victoria have traditionally been semi-independent agencies controlled by community based committees of management. Such policies have had huge implications for the management and organisation of these agencies, as they have led to different patterns of service delivery and different models of management practice, often devaluing traditional philosophical perspectives of ‘primary health care practice’. Although many agencies have embraced change as providing opportunities for growth and development and to have more influence in the provision of mainstream public health care, primary health care models of practice should be supported for their intrinsic and increasing value.

Patterns of Service Delivery in Educational Psychology Services: Some implications for practice

This article describes research into models of service delivery for Educational Psychology Services in England and Wales. Questionnaires completed by Principal Educational Psychologists (PEPs) during 1998 reveal trends in the way we commonly engage with schools. In particular, aspects of practice associated with consultancy models of service delivery are explored and the extent to which they are employed is examined. Some links with other organisational artefacts, such as supervision and appraisal, are also discussed. The research provides an illuminative study of current service delivery practice and suggests some conclusions about the way we deliver services to schools, the cultures within EP Services and the frameworks we draw upon to inform our practice.