Personalized Service Delivery Research Articles

Distributed network intelligence: A prerequisite for adaptive and personalised service delivery

Mobile computing is undoubtedly one of the predominant computer usage paradigms in operation today. The implications of what might be cautiously termed a usage paradigm shift have still not crystallised fully, either for society, or those envisaging a new raft of applications and services for mobile users. However, fundamental to the current and future success of mobile computing are mobile telecommunications networks. Such networks have been a success story in their own right in recent years, both as traditional voice carriers and, increasingly importantly, as a conduit of mobile data. The potential for new mobile data applications is immense, but, crucially, this potential is severely compromised by two factors inherent in mobile computing: limited bandwidth and computationally restricted devices. Hence, the academic and commercial interest in harnessing intelligent techniques as a means of mitigating these concerns, and ensuring the user experience is a satisfactory one. In this paper, the broad area of intelligence in telecommunications networks is examined, and issues relating to the deployment of intelligent technologies are explored. In particular, the potential of intelligent agents is identified as a viable mechanism for realising a full end-to-end deployment of intelligence throughout the network, including possibly the most crucial component: the end user's device. As an illustration of the viability of this approach, a brief description of a mobile blogging application is presented.

Evolving the Convergence of Telecommunication and TV Services over NGN

The convergence of telecommunication, cable TV, and broadcast networks towards the Internet technology will enable the provision of emerging multimedia services as well as the integration of rich communication capabilities with TV services. However, enabling efficient delivery of interactive personalized multimedia services with mobility support requires an advanced overlay control framework. The IP Multimedia Subsystem (IMS) offers the basic functions to manage multimedia sessions over different access networks. This paper outlines current standardization activities that address the provisioning of TV services over IP networks—known as IPTV—and proposes a novel end-to-end overall architecture based on IMS that enables the delivery of converged multimedia services. Furthermore, the paper presents the FOKUS Media Interoperability Lab as a reference implementation of this framework which covers a widespread spectrum of converged interactive scenarios. The final section gives an impression of the system performance by providing the end-to-end signaling delay of a session setup for live TV service delivered over unicast transmission mode.

Focus on Alcohol & Drug Abuse: Improving Service Delivery for Individuals With Co-occurring Disorders: New Perspectives on the Quadrant Model

This column summarizes findings of a study that examined the usefulness of the quadrant model for improving service delivery for persons with co-occurring disorders. The authors discuss treatment recommendations, goals and barriers related to delivering care, policy recommendations for implementing evidence-based interventions, and strengths and limitations of the model. They conclude that although the quadrant model is useful for conceptualizing systems-level factors for improving delivery, its further development is unlikely to result in improved care at the clinical level. They call for research to develop and implement evidence-based practices targeted to specific populations of persons with co-occurring disorders.

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

Health Care Needs of Aging Adults: Unprecedented Opportunities for Social Work

The most recent census reports that 34 million Americans are ages 65 or older and that this group is 17 percent of the U.S. population (U.S. Census Bureau, 2006). Demographers have estimated that the aging of the United States will rapidly expand over the next 20 years, with the number who are age 65 or older increasing by 75 percent to 69 million Americans (U.S. Administration on Aging [AOA], 2004). This growth will plateau at 20.7 percent of the U.S. population (86 million) by 2050 (AOA).The most dynamic growth will be in the oldest-old age category (those ages 85 and older), with the number of Americans in this category increasing from 1.5 percent of the population (4.2 million) to more than 5.0 percent (18.2 million) by 2050. By 2050, analysts also predict that nearly one-third of aging Americans will be from an ethnic minority population. Most aging adults have at least one chronic health condition such as hypertension, arthritis, heart disease, cancer, or diabetes (AOA, 2006).Advancements in medical technology, pharmaceuticals, and treatment protocols have extended life expectancy but at a significant financial cost. For example, Medicare expenditures are projected to grow from 2.7 percent to 9.0 percent of the gross domestic product by 2050 (Van deWater & Lavery, 2006).The cost of the prescription drug benefit alone will be more than $534 billion over the next 10 years. Furthermore, overall health expenses steadily increase with age, with those age 75 and older having the highest per capita health expenditure of any cohort, $3,741 per year (U.S. Bureau of Labor Statistics, 2006). This growing need for and rising cost of care services will require more informed, efficient, and cost-effective methods for addressing the health needs of aging adults. Scholars and experts have voiced concern about health care systems being prepared to address the needs of aging adults, both in professional expertise and in resources (Berkman & Harootyan, 2003; Haber, 2003).There is a clear need to increase social work knowledge, skill, and leadership to keep pace with and be prepared for the health care needs of aging adults. JOHN A. HARTFORD FOUNDATION: CHANGING THE FACE OF SOCIAL WORK EDUCATION AND RESEARCH IN GERIATRICS The John A. Hartford Foundation's investment in geriatrics has changed the face of social work education and research. The foundation's primary goals are to enhance and expand the training of social workers, doctors, nurses, and other health professionals who care for aging adults as well as to promote innovations in the integration and delivery of services for all older persons (John A. Hartford Foundation, 2003). From 1998 to 2005, the foundation authorized $41 million for programs related to social work (www. jhartfound.org/program/social_workers.htm).The common goal of the various components of the foundation's Geriatric Social Work Initiative is to develop the capacity to train qualified social workers to improve the health care and well-being of the aging population (John A. Hartford Foundation). Dr. Barbara Berkman, Helen Rehr/Ruth Fizdale Professor of Health and Mental Health at Columbia University's School of SocialWork, is an individual scholar serving as a true champion in geriatric care. Through her countless funded studies, scientific articles, books, and national and international service, she epitomizes social work leadership. As past editor-in-chief of Health & Social Work, she advocated for stronger research content and moved the .journal forward in scholarly content. She has served as principal investigator for the John A. Hartford Geriatric Faculty Scholars Program, which is one component of the Geriatric Social Work Initiative. Dr. Berkman, working through the Gerontological Society of America and with her partner Linda Harootyan, deputy director and program officer for the Hartford Faculty Scholars and Doctoral Fellows Program, has invested in 72 faculty members; the results of their initiative are tremendous. …

Telehealth service delivery for persons with alcoholism

Videoconferencing at a bandwidth of 384 kbit/s was used in open sessions for subjects with alcohol use disorders (AUD). Study participants received eight sessions of group therapy over a four-week period from an accredited addictions counsellor. Outcome assessment included self-report measures, a qualitative interview and a chart review. Of the 18 subjects who started the study, 14 attended at least four sessions of therapy, completed self-report assessments and the thematic interview. The participants reported high levels of satisfaction with telepsychiatry, found the intervention to be highly credible, had good session attendance and attrition comparable to that expected with conventional same-room treatment. In all, 82% of subjects reported that they would recommend the service to a friend or family member. The results demonstrate the feasibility of using videoconferencing for service delivery to adults with AUD, and encourage the future performance of randomized controlled trials.

Telehealth service delivery for persons with alcoholism

Videoconferencing at a bandwidth of 384 kbit/s was used in open sessions for subjects with alcohol use disorders (AUD). Study participants received eight sessions of group therapy over a four-week period from an accredited addictions counsellor. Outcome assessment included self-report measures, a qualitative interview and a chart review. Of the 18 subjects who started the study, 14 attended at least four sessions of therapy, completed self-report assessments and the thematic interview. The participants reported high levels of satisfaction with telepsychiatry, found the intervention to be highly credible, had good session attendance and attrition comparable to that expected with conventional same-room treatment. In all, 82% of subjects reported that they would recommend the service to a friend or family member. The results demonstrate the feasibility of using videoconferencing for service delivery to adults with AUD, and encourage the future performance of randomized controlled trials.

Service Delivery for Persons with Blindness or Visual Impairment and Addiction as Coexisting Disabilities: Implications for Addiction Science Education

ABSTRACT Although research strongly suggests that individuals who are blind or visually impaired (BVI) experience alcohol and other drug abuse (AODA) disorders at rates higher than those expected within the general population (NAADD, 1999), less is known about specific barriers that influence AODA treatment for these consumers (Koch & Nelipovich, 1999). Accurately describing these barriers presents an extremely complex challenge due to the fact that problems may arise (a) directly as a result of the BVI (blind or visually impaired) disabilities; (b) directly as a result of the AODA disorders; or (c) only in circumstances where both disabilities co-occur or co-exist. Although some preliminary research on this problem exists (Koch, 2000; Moore, Greer, & Li, 1994; NAADD, 1999), few researchers have collected data describing these barriers from rehabilitation and AODA counselors who are actively working with the population of persons with visual impairment and blindness. The purpose of this study was to condu...

Continuity of care in mental health services: toward clarifying the construct.

To clarify "continuity of care" (COC), a construct associated with the delivery of services for persons suffering from severe and persistent mental illness (SPMI), with attention to the service recipient's perception of COC. The study involved a systematic appraisal of the literature on COC, supplemented by interviews with 36 SPMI patients and their families. Statements highlighting attributes of COC were extracted from both sources. Comments by patients and families corresponded to descriptions of COC in the mental health literature. Attribute classifications by independent teams of judges showed good consistency. The following 4 attribute domains of the COC construct were identified: service delivery, accessibility, relationship base, and individualized care. Service recipients' perceptions of COC overlapped with representations of the construct in the mental health literature. The qualitative inquiry resulted in a draft, 47-item, self-report questionnaire for use in studies of interventions designed to facilitate COC.

Delivery of preventive services for low-income persons over age 50: a comparison of community health clinics to private doctors' offices.

This study focused on the use of 14 evidence-based preventive services for the low-income population over age 50: colorectal, breast and cervical cancer screening, cholesterol screening, counseling around diet, exercise, tobacco, alcohol and illicit drugs, and immunizations for influenza, tetanus and pneumonia. Population characteristics and rates of delivery of these preventive services are compared for low-income users of community health clinics vs private doctors' offices/HMOs. Three nationally representative data-files from the National Health Interview Survey--the Person-Level File, Sample Adult File, and Sample Adult Prevention File--were linked to obtain the necessary data on preventive services use in the 12,024 persons over age 50. Among the population of persons over age 50 living below 200% of the poverty threshold, those using community clinics were more likely to be younger, a racial or ethnic minority, less formally educated, in poorer health, uninsured, and more likely to face time, transportation or cost barriers to obtaining health care (p < .01 for all comparisons), than their counterparts using private doctors' offices/HMOs. Community health clinics performed as well as private doctors/HMOs in the delivery of cancer screening, cholesterol screening and immunizations to lower income persons over 50 years. Rates of counseling about diet and exercise were higher among users of private doctor's offices than among users of community health clinics users (40% vs. 31% respectively, p = .02). Despite the severe resource constraints under which they operate, and the greater vulnerability of the population they serve, community clinics deliver preventive services at rates comparable to private doctors' offices and HMOs.

No Time to Lose: Working With Young Children With Severe Disabilities Who Are Presymbolic

No Time to Lose: Working With Young Children With Severe Disabilities Who Are Presymbolic

Preference, choice, and persons with disabilities: A synopsis of assessments, interventions, and future directions

A recent revolution in service delivery for persons with developmental disabilities encompasses increased client independence and improved quality of life. Specifically, care providers have focused on client expressions of preference, choice-making, and choice availability as key elements of study in this new revolution. We review and critique the primary methods of assessing preference and choice for persons with disabilities, including interviews and questionnaires, pictorial presentations, technological apparati, and direct observation. We also provide an overview of the burgeoning literature on intervention programs designed to enhance choice for this population, such as giving more choice to clients, teaching choice-making skills, and improving staff member skills regarding choice availability. Finally, we provide a synopsis of the future directions in this area that should receive the most attention from researchers and caregivers.

A state-university collaboration to serve persons with developmental disabilities and mental health needs.

Persons with developmental disabilities and mental health needs present a complex and potentially rewarding challenge to workers in both developmental disabilities (DD) and mental health (MH) fields. These individuals may be shuttled between (DD) and (MH) systems. Effective care requires the person obtain services from both systems. This paper describes one possible mechanism of service delivery for persons with developmental disabilities and mental health needs.

Assessing psychiatric care settings. Hospitalization versus outpatient care.

This paper presents a discussion of the historical development of deinstitutionalization in the United States, including the political, ideological, and social origins of that policy. The outcomes of deinstitutionalization are considered, including the impact of the policy on the quality of life of people with severe mental disorders. The authors also provide a brief review of the literature on the efficacy and cost-effectiveness of hospitalization versus outpatient (community) care. Recent developments in the use of involuntary hospitalization are discussed, along with a number of important trends in the delivery and financing of services for persons with severe mental disorders.

HIV/AIDS in the rural United States: epidemiology and health services delivery.

This integrated research review addresses the epidemiology of rural human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and the organization, financing, and delivery of health services for rural persons living with HIV or AIDS (PLWHIVs, PLWAs). Several abstracting services, indexing services, and bibliographies were searched. An annotation form served as the guideline for data extraction. Several conclusions emerged from this review. Epidemiological evidence indicates that there has been a dramatic increase in the relative proportion of rural HIV/AIDS incident cases over the past 5 years. Explanations for the rural increase focus on injection drug use, heterosexual behavior, and sexually transmitted disease levels. Dramatically elevated rates of infection in rural Black women are indicated. Rural areas experience important levels of in-migration of HIV/AIDS-infected individuals. The health services literature suggests that rural providers and institutions have limited resources and little experience with PLWHIVs or PLWAs.

Pew refines health program for more impact.

Pew refines health program for more impact.

Health Care Services for Children and Adolescents

Abstract The authors of this paper identify risks to health and other factors that determinethe need for health care services among children and adolescents. They documentservice utilization patterns in the areas of well-child care and immunizations, acuteambulatory care and hospital services, and injury prevention. They also acknowledgethe special health care needs of adolescents and of children with chronic illnesses.It appears that neither the traditional personal health service delivery system nor thepublic health system alone can effectively provide all of the health services childrenneed. Collaboration between public health and personal health service providers isessential to future efforts to improve the health of children and adolescents. Recom-mendations include development of community-based preventive care programs inall parts of the country, extension of current traditional primary care capabilities,assurance of access to primary care services, enhancement of public health activities,expansion of specialized adolescent health programs, and coordination of a com-prehensive set of medical and other services for children with chronic illness andtheir families. The authors conclude that, to be effective, future health systemreforms must be implemented through a coordinated program of care rather thanthrough competing systems of services.

Social Skills Training for Persons with Chronic Mental Illnesses

In the past three decades, persons with psychiatric disabilities have become increasingly able to join community living. This progressive move from institutional-based to community-based service delivery for persons with disabilities has been significantly aided by legislation.