Service Delivery Issues Research Articles

Women and Depression: Introduction

Although women's 2 to 1 likelihood of developing a depressive disorder is a well-established fact, research over the last decade has expanded our knowledge of risk factors and issues of treatment and service delivery. The American Psychological Association convened an interdisciplinary Summit in 2000 on Women and Depression to examine these findings and to make recommendations on future research and policy needs, and to highlight treatment implications. This special section contains five articles from the Summit addressing a range of issues, including the relationship between women's depression and their lesser power and status in society (resulting in physical and sexual abuse and poverty), and the menstrual cycle and depression. Additionally, the special section includes articles on the rehabilitation of women with depression and treatment of depressed women in primary care settings.

Strengthening research to improve the practice and management of long-term care.

Past investments in long-term care (LTC) research have improved the quality of care and the quality of life for LTC recipients by conceptualizing the goals and measuring the outcomes of care, designing practical assessment tools, testing clinical interventions, and evaluating new service delivery programs and models. To build a balanced portfolio of LTC research that will yield and sustain increased dividends in quality and outcomes will require (1) increasing investment in both basic and applied LTC research to ensure that critical service delivery issues are addressed in a rigorous and timely fashion, (2) fostering better communication between researchers and users to ensure research salience and credibility, and (3) dedicating more resources to identifying and implementing successful methods for translating LTC research into practice.

Family Service Delivery in Early Head Start: Perspectives of Professionals in Six Midwestern States

Early Head Start (EHS) faces multiple challenges in trying to meet the diverse needs of its clients due to the recent changes in welfare reform and the reauthorization of IDEA (1997). Using primarily a survey method, this study examined 3 issues of family service delivery in 40 EHS programs (Waves I-IV) in 6 Midwestern states. They include (a) the extent to which EHS staff believe in and implement family-centered practice, (b) EHS staff's perspectives about the Family Partnership Agreements (FPAs), and (c) their perspectives about the Individualized Family Service Plans (IFSPs). Results showed that EHS staff believed in the importance of family-centered practice, yet faced difficulty in implementing it. Results also revealed that the FPA and the IFSP are 2 common and distinct processes. Important to both is the relationship-based model in which staff establish partnerships with families and other community agencies. Collaboration is the key to an effective IFSP process. Policies at the program, state, and federal levels need to support the efforts of staff to strengthen families.

Not Worlds Apart After All

Not Worlds Apart After All

Private long-term care insurance: a look ahead.

The author's objective is to summarize and synthesize what is known about the private long-term care insurance market and its impact on public expenditures, policyholders, their families, and providers. Primary data were compiled from national studies and published and nonpublished information from the long-term care insurance industry. The study design was the review and analysis of empirical data. Data were collected from in-person, mail, and telephone interviews, as well as from a review of the literature. The market is growing rapidly in part due to the vast improvements in product design and to federal and state public policies. Growth in the market should result in modest reductions in public long-term care expenditures. Most claimants are satisfied with their policy, but many still do not feel that their needs are being met. Service delivery and provider issues are critical to making money work for disabled persons and insurers will be increasingly called on to help address this issue. The market for long-term care insurance will continue to grow. Over time, this insurance will likely play a more meaningful role in meeting the needs of disabled elders and their families.

Teen Living Programs for Young Mothers Receiving Welfare: An Analysis of Implementation and Issues in Service Delivery

Changes in welfare programs are likely to have several important effects on populations served by social workers. While most attention has addressed the work requirement and time limits imposed by welfare reform, other aspects of the legislation also require attention. Living requirement legislation for teen parents receiving welfare has led the state of Massachusetts to develop Teen Living Programs (TLPs). TLPs are residential programs that allow teen parents to fulfill the living requirement when they are unable to live in the home of a parent or adult guardian. Data collected during program site visits to report on the implementation of the programs are used in this paper. This report identifies and analyzes issues related to service delivery that may be useful to social workers, policymakers, and program developers interested in supporting adolescent mothers affected by living requirement legislation. Analysis includes discussion of programming and staff, standardization of services, flexibility and individualized services, the residential model, and limitations of the program response.

The Co-Occurrence of Child Abuse and Domestic Violence: An Issue of Service Delivery for Social Service Professionals

In order to add to the growing literature on intergenerational rates of family violence, data were collected from a community-based child abuse agency. The study's purpose was to compare the co-occurrence of child abuse/neglect (CAN) and domestic violence (DV), and the prevalence of CAN and parent's childhood history of abuse. Data were collected from 537 families through intake and subsequent interviews in an attempt to determine the relationship among CAN and DV, and CAN and parent's childhood history of abuse. A chi-square analysis indicated significant relationships among these variables. Of the participants in this sample, 48.9% had experienced both CAN and DV. These results also indicated that 66.3% of participants had a childhood history of CAN and were currently experiencing issues of CAN with their own children. Logistic regression was utilized to examine whether families involved with Child Protective Services (CPS) were at higher risk for DV and/or parental childhood history of CAN. The results indicate that CPS-involved families were approximately three times as likely to have a parent reporting a childhood history of CAN but were not at significantly higher odds for DV. Implications for service delivery are discussed.

Personnel Preparation and Service Delivery Issues in Rural Areas: The State of the Art

Preparation of high quality personnel to provide educational services to students with disabilities living in rural areas is, at best, challenging. Findings from a comprehensive study concerning the status of the implementation of the Individuals with Disabilities Education Act (IDEA) in rural settings and the issues such implementation presents to teacher education programs in these areas are discussed. Members of the American Council on Rural Special Education (ACRES) participated in the study. Results indicated that strategies for enhancing personnel preparation, recruitment, and retention of individuals to institutions of higher education and K-12 schools in rural settings include distance learning, on-site professional development opportunities, salary incentives/increments, and benefits. Linking evaluation data to the general education curriculum and determining how the student's disabilities affect his/her progress in general education are issues for practitioners implementing IDEA in rural settings. Recommendations are provided for enhancing personnel preparation and service delivery based on the results.

The National Survey of Mental Health and Well-Being in Australia: impact on policy.

To provide a synopsis of the 3-part National Survey of Mental Health and Well-Being in Australia and to examine the yield in terms of policy and other changes in mental and general health services. Published data are examined, and a commentary is provided on service-delivery issues that the data have revealed. One-year prevalence estimates for the common mental disorders, defined according to ICD-10 criteria and assessed using the automated version of the Composite International Diagnostic Interview (CIDI-A), have indicated rates similar to those of other countries (17.7%). Alarmingly high rates were found for alcohol and substance abuse in young persons, especially among young men. The number of years of life lost owing to disability attributable to mental disorders exceeds the number lost owing to cardiovascular disease and cancer. Only 35% of persons with 1 or more of the common mental disorders had sought help in the 12 months prior to interview. The point prevalence for mental health problems was 14% for persons aged 4 to 17 years. The point prevalence for psychotic disorders was 4.7 per 1000. An encouraging finding is that 81% of affected individuals had been to their general practitioner (GP) in the last year. However, only 20% had participated in any rehabilitation program in the past year. The Survey results are based on a national population sample, not on individuals reaching services. They have therefore proved to be of great value in influencing policy at federal and state levels and may have contributed to increased funding for both services and research.

Electronic aids to hearing.

Despite many scientific developments in the biology of hearing, there remain no wide-spread medical or surgical interventions for listeners with sensorineural hearing impairments. In addition to describing technical advances, this chapter identifies important aspects of candidature for hearing aids and some issues of service delivery.

Internet service delivery, application platforms, and product evolution

The emerging converged networks have created new networking paradigms, which are largely made possible by the Internet and its services and applications. Due to today's increasing processing power and the extensive distributed nature of the new paradigms, it is critical that issues of service delivery based on service intelligent infrastructure and application platforms be carefully considered. Among the most important elements of the paradigms are the dynamic control through intelligent signaling between network layers and a scalable network management infrastructure. Design of easy-to-implement platforms requires expandable hardware and short software-development cycles. Software should support standard interfaces to fully utilize network capabilities and encompass innovative services for subscribers of both wireline and wireless networks. A service creation environment, along with content delivery systems, proxies, and tools for offering such services, also should be implemented. Other requirements for realizing the new networking paradigm are:

APA’s Fall Institute to Focus On Community Systems

Back to table of contents Previous article Next article APA InstituteFull AccessAPA’s Fall Institute to Focus On Community SystemsPaula G. Panzer, M.D.Paula G. PanzerSearch for more papers by this author, M.D.Published Online:7 Jun 2002https://doi.org/10.1176/pn.37.11.0013A trip to the country’s midwest capital is just what you need this fall. Make plans now to travel to Chicago for APA’s 2002 Institute on Psychiatric Services, which will be held October 9 to 13.APA’s smaller, intimate fall meeting offers an opportunity to expand your clinical knowledge while you catch up with colleagues and make new friends. The institute’s small size and flexible schedule allow attendees to reach their educational goals while enjoying the sights, cultural institutions, and culinary delights of the windy city.The Scientific Program Committee has recently rewritten its mission statement, with the aim of helping attendees feel connected to this educational gem:“The mission of the Institute on Psychiatric Services is to train and support psychiatrists to provide quality care and leadership through study of the array of clinical innovations and services necessary to meet the needs of individuals who suffer from serious mental illness, substance abuse, or other assaults to their mental health due to trauma or adverse social circumstances, in order to assure optimal care and hope of recovery.”The theme of this year’s institute is “Community Counts: Creating and Supporting Systems of Care.” Among the sessions highlighting this theme will be a discussion group led by APA President Paul Appelbaum, M.D., on “Confidentiality in Psychiatric Treatment: HIPAA and Beyond.” The rest of our rich program reflects the clinical and service delivery issues we face in diverse communities.APA members and colleagues have submitted their best work to address the issue of chronic illness and communities in distress. Invited lecturers will focus on a wide range of topics including children, policy, trauma, recovery, and chronic mental illness. The debates will address cost considerations and the best possible care for our patients. Intellectually exciting options abound.When you receive the preliminary program, I am sure you will understand my pride in this meeting. Twenty-five national and local experts from multiple disciplines will offer stimulating lectures. The 2002 Adolf Meyer Award will be presented to Herbert Pardes, M.D., who was an APA president and NIMH director. The institute is honored to host this prestigious award lecture, which is presented for outstanding contributions to the science and practice of psychiatry. The Psychiatric Services Achievement awards, as well as the Arnold L. van Ameringen and Frank J. Menolascino awards, will be announced at the Opening Session. The “Innovative Programs” format will cover a range of topics in such sessions as “Connections to Community,” “Organizational Models for Community Care,” “Community Education,” “From Youth to Adulthood: Alternatives to Hospitalizations,” “Provider Education,” and “Telepsychiatry.”Residents and medical students will join with other members in various stages of their careers to discuss clinical issues and the challenges of service delivery during the eight discussion groups and three clinical consultations. Other highlights include special sessions for residents and fellows, such as sessions on career and leadership development, CME courses in half-day and full-day formats, and useful research updates.The 2001 institute occurred shortly after September 11. At that meeting attendees came together to learn, grieve, and offer support. One year later we will reflect on our work, healing, and future challenges. Please join us and continue the tradition of supporting community work and education at this wonderful fall meeting.A copy of the preliminary program booklet, which includes registration, housing, and air travel information, can be obtained by calling (888) 357-7924 or by clicking on the institute’s logo on APA’s Web site at www.psych.org. ▪Dr. Panzer is chair of the Scientific Program Committee for the 2002 Institute on Psychiatric Services. ISSUES NewArchived

Including ourselves: New Labour and engagement with public services

Increasing participation in public service issues is a central theme in New Labour’s “modernisation” programme. This concerns service delivery issues but also connects to a broader concern for “democratic renewal”. Underpinning this is New Labour’s continuation of the attempt to re‐shape and redefine the welfare state by the construction of “active citizens”. Active choice is a central theme of the “third way”, which requires that governments recognise the need for reflexive citizens to secure “ontological security” through choice. New Labour then attempts to secure social cohesion by a communitarian appeal to duty and responsibility, central themes in its re‐structuring of welfare services. This exhortation to participate can be seen as a “technology of government”, and, drawing on the Foucauldian concept of “governmentality”, we can see how it is an attempt to “make up” citizens who “take responsibility for themselves”, allowing the government to “control at a distance”.

Breaking Away from Broken Windows: Baltimore Neighborhoods and the Nationwide Fight against Crime, Grime, Fear, and Decline

* List of Tables and Figures * Acknowledgments * List of Acronyms Part 1: Background on the Place, the Theory, and Policies * 1. Introduction * Philadelphia, Pennsylvania * Oakland, California * Focus * Incivilities, Disorder, Social Disorganization, Collective Efficacy, and Social Capital * Broader Theoretical and Empirical Context of Current Approaches * Evidence * The Argument and the Chapters Ahead * The Bottom Line, * Notes * References * 2. The Baltimore Context, and Its Context * With Charles David Linne * The War Has Been Won? * Purpose * Changes in People, Housing, and Jobs * Changes in Crime: The City as a Whole * Baltimore Neighborhood Crime Rates * Shifting Incivilities, 1981-1994 * Summary Comments on Changes * The Questions of Fear and Neighborhood Problems * In the News * Notes * References * 3. The Incivilities Thesis: Theory, Measurement, and Policy * Organization * Variations on a Theme * Empirical Support for Hypotheses * A Theoretical Aside on Demographic and Structural Issues * From Theory to Research: Incivilities Indicators * Implications for Policy, Practice, and Theory * Notes * References Part 2: Quantitative Evidence on Origins and Impacts * 4. Origins of Incivilities * A Story About One Broken Window * Focus and Organization * Perspectives on the Origins of Incivilities * An Unexciting, but Necessary, Methodological Aside on Change * Another Necessary, but Unexciting, Aside on Multilevel Models * Overview of Indicators, Outcomes, and Controls * Incivilities Observed * Incivilities As Perceived by Residents * Discussion * Notes * References * 5. Impacts of Incivilities on Later Crime and Decline * A Systemic Perspective * Focus * Data and Analysis, * Changes on Decline Indicators in the 1980s * Crime Rate Changes * Predicting Decline * Discussion * Notes * References * 6. Longitudinal Impacts of Incivilities on Reactions to Crime and Local Commitment * Reactions to Crime * Focus * Data and Analysis * Impacts of Specific Predictors * Closing Thoughts, * Support for Longitudinal Impacts of Incivilities * Notes * References Part 3: Qualitative Evidence from Community Leaders * 7. The Community Perspective: Views About Incivilities and Responses to Incivilities in the Context of Collective Crime Prevention Initiatives * Organization of the Chapter and Questions Addressed * What Influences the Type of Collective Strategies Adopted? Podolefsky's Model * Data Sources * Responses to Drug Sales and Use and Related Crime Problems * Neighborhood Fabric and Responses to Crime and Drug Sales and Use * Closing Comments * Appendix: Sample Selection Procedures and Contact Attempts * Notes * References * 8. Place Power and Implications for Coproduced Safety: Changes and Stability in Neighborhood Names, Boundaries, and Organizations * Neighborhood Mapping and Current Data Sources * Organization * Naming and Bounding * Service Delivery Issues and Community Policing * Stability and Changes * Implications: Can Police-Community Partnerships Organize Around Neighborhood Units? * Summary * Notes * References * 9. Closing Thoughts * Context and Ironies * Does the Theory Get Support? * The Context Outside the Theory, * Notes * References * Index

Service Delivery Issues and Program Evaluation in Pediatric Psychology

Presents a framework for categorizing pediatric psychology research into practice and service system outcomes and functioning. The questions of importance are (a) who is being served, (b) what services are provided, (c) how treatments are implemented, (d) how services are organized and staffed, (e) what are the outcomes of the services, (f) how do various consumers perceive services, (g) how services are reimbursed, and (h) what are alternatives and innovations? The framework of program evaluation is detailed for domains most germane to service delivery in pediatric/child health psychology. Such domains include diagnostic information on patients, types of intervention, behavioral/psychological outcome variables, costs of treatments, service system functioning, and perceptions of satisfaction from multiple sources. This framework may be useful in directing future research on the delivery of services in pediatric psychology settings, thereby adding to the value of the field.

Unique Issues in Rural Couple and Family Counseling

During the past several decades, a variety of authors has suggested that rural mental health practice differs significantly from that of urban practice. Several studies have examined rural mental health service delivery issues. Frequently, couple and family counseling issues have not been addressed in these studies. The purpose of this article is to review the available literature regarding rural couple and family counseling, in conjunction with the findings of research in closely related fields. This review is conducted in an effort to identify unique practice issues facing rural couple and family counselors.

Review of My journey with Jake: A memoir of parenting and disability.

MIRIAM EDELSON My Journey with Jake: A Memoir of Parenting and Disability Toronto, ON: Between the Lines, 2000, 207 pages (ISBN 1-896357-35-0, C$24.95, Softcover) Reviewed by PATRICIA MINNES The experiences of parents of children with disabilities have been widely documented (for reviews see Minnes, 1998; Minnes, Nachshen, & Woodford, 1999). Quantitative studies have highlighted a variety of stressors and the correlates that serve to mediate or moderate such stress. These include resources related to the marriage and family environment, social support, education, information, and socioeconomic status. In recent years, qualitative studies have augmented previous research, providing snapshots of parents' experiences raising a child with a disability (see Turnbull, Patterson, Behr, Murphy, Marquis, & Blue-Banning, 1993). While the information in such studies is valuable, Miriam Edelson's memoir goes beyond these to provide a long view that documents the continuing challenges and lessons learned over a period of nine years with her son Jake. Jake was born with lissencephaly, a rare genetic disorder (1 in 300,000 births) in which the brain stops developing between 12 and 14 weeks after conception. The surface of the brain is often smooth and in Jake's case an mRI indicated the absence of a corpus callosum. Seizures, low muscle tone, sucking and swallowing problems are common. Such children are given a very guarded prognosis, with feeding problems and aspiration pneumonia often leading to death. In Jake's case, supplementary tube feedings were necessary. He continued to have frequent fevers and respiratory problems that required suctioning of mucous to clear his airways. Edelson traces her journey from Jake's birth through traumatic days at Toronto's Sick Children's Hospital and then at home, and describes her struggles with decisions about heroic measures and her battles to find sympathetic doctors. The issue of accommodation for Jake emerged in the first year. Edelson highlights the many challenges faced by parents in times when deinstitutionalization and homecare are the approaches of choice, and in many cases the only choice. Jake's medically fragile condition posed additional problems and it was only after much searching that a group home was found in which the model of palliative care fit Jake's medical needs. The process took its toll as Jake's parents struggled with special needs agreements and the bureaucracy of the Children's Aid Society, which handles the funding for such accommodation. An additional price she was forced to pay was the twohour drive to the home from Toronto where Edelson and her husband lived. In addition to being Jake's mother, Edelson was and is an activist who has worked for the Public Service Alliance of Canada (PSAC) and the Ontario Public Service Employees Union (OPSEU). She was also the Executive Director of the CBC National Radio Producers Association representing journalists across the country. The juxtaposition of Edelson's life as mother and her life as activist provides interesting insights. For example, the skills Edelson developed while negotiating contracts and advocating for women proved to be very helpful in dealing with government bureaucracy and inflexible professionals involved in lake's care. In addition to highlighting her own experiences as a parent, Edelson provides figures regarding the numbers of children with disabilities in Ontario, and information about service delivery and policy issues. She describes the battles that parents continue to fight to maintain residential facilities for children with disabilities, using the move to close Thistletown Regional Centre in Toronto as an example. Edelson's experiences with health professionals provide important information for educators and clinicians about the ways in which families can be either thwarted or empowered when dealing with extremely difficult decisions about a child's care. …

The place of spirituality and religion in mental health services.

Mental health professionals have raised concerns about the role of spirituality and religion in services for people with severe mental disorders, but this chapter offers compelling reasons for increased attention to spiritual issues in service delivery.

Collaboration as a Tool to Resolve the Issue of Disjointed Service Delivery

Collaboration as a Tool to Resolve the Issue of Disjointed Service Delivery

Intensive Home-Based and Wellness Services to Native American Families Living on Reservations: A Model

For decades, providing services to Native American families residing on reservations has presented challenges to the social work profession. Historically, and in some locations currently, the federal government has been the primary family service provider. Non-Indian workers in key programs and administrative positions often staff these federal services. Often service delivery by non-Native workers is organized, administered, and delivered in a culturally insensitive manner. There has recently been an increase in American Indians that provide services for their own and neighboring Indian communities, but the issue of effective service delivery remains. This paper suggests a model of intensive home-based treatment and wellness services to Native American families living on reservations. The model acknowledges the importance of culturally competent leadership and workers, focuses on the prevention of placing of adults, elders, and children off the reservation, and maintaining balance in the family by emphasizing tribal values and wellness.