Service Delivery Problems Research Articles

Establishing and using a community inter-agency client monitoring system to develop addictions treatment programs.

The Substance Abuse Monitor is a comprehensive community-based addictions information system that forms the basis for an innovative approach to community needs assessment. This paper describes: (1) the conditions that created the need and support for the monitoring system; (2) the community development strategy that was employed to secure the commitment of agencies to the project; (3) the specifics of the needs assessment procedures; (4) some of the theoretical, clinical and methodological issues on which the procedures are based; (5) the practical applications of the system; and (6) the limitations of the system. The establishment of the database was based upon the idea that there would be benefits at several levels: the community, the participating agencies, the individual counsellors and the clients. The realization of these benefits requires that the information collected and the results generated must be capable of addressing specific service delivery problems with practical and tangible solutions. It is argued that the project has been successful in generating such solutions, and has considerable potential as an ongoing needs assessment tool.

Competitive Employment and Service Management for Adolescents and Young Adults with Emotional and Behavioral Disorders

Summary Adolescents with emotional and behavioral disorders (EBD) pose difficult service delivery problems as they display the types of behaviors that are least tolerated inschool, work, and community settings. This population has (a) the highest drop-out rate (over 50%) and (b) the highest unemployment rate (52%) four years after leaving high school of all disability groups served by special education. Further, there are few transition programs and interventions with documented long-term benefit for this population and age group. Given the variety and severity of the complex problems associated with EBD (e.g., poverty, substance abuse, family planning, counseling, criminal activities, etc.), and the poor transition experiences of this population, it is imperative that a coordinated systern of vocational training and social support be afforded adolescents and young adults with EBD to have maximum effect. This article describes such a service model and summarizes preliminary data on the effect of the program.

Services for offenders with mental impairments: A Texas model

The Texas Council on Offenders with Mental Impairments stands as a model for envisioning and implementing the resolutions to problems of service development and delivery to offenders with mental impairments. Acting upon an uncommon sensitivity to the range of problems experienced by persons incarcerated with mental impairments, consumer groups, elected officials, and agency administrators moved to create the Council. The Council's coalition membership cuts across disciplines and agencies to promote close, effective coordination and collaboration. Most importantly, the Council was conceived, organized, mobilized, and continues to operate with advocacy as its primary guiding principle.

Forensic psychiatry in the USA and the UK: a clinician's view

AbstractThe UK and the USA share a fundamental belief in the rule of law, but they have different beliefs about the relationship between government and the individual. The laws which govern forensic and general psychiatric practice reflect those differences. The two countries differ also in forensic psychiatry training and practice and in the organisation of forensic mental health services. Strengths in the UK include the extensive training of forensic psychiatrists and the integrated forensic health and social care systems. The two countries face common ethical problems, and common problems of service delivery to forensic patients. Copyright © 1996 Whurr Publishers Ltd.

Traveller children and the state: Welfare or neglect?

AbstractTravellers' historical experience is of persecution. Recent policy in England and Wales reflects assimilation or exclusion, with Travellers facing the paradox of pressure to settle and insufficient sites because of the failure to implement legislation. The conditions for many Travellers are damaging, and undermine access to other rights and services. Children are particularly severely affected, resulting in societally imposed neglect. Traveller children's low health status and the negative effects on their development are documented in practice reports, seminars and research. Policy trends have culminated in the Criminal Justice and Public Order Act 1994 which removes rights and increases penalties for travelling, and is likely to exacerbate an already problematic situation for many Traveller children. Welfare services both have contributed to and can counteract this societal neglect. Problems of access and service delivery are outlined in relation to health, education and social services, and new service developments described. Key criteria for positive practice are found to be common to these areas of welfare provision, and include anti‐discrimination and cultural respect, outreach and community‐oriented work; hand‐held records; specialist provision focused on immediate needs and commitment to mainstream change; flexibility and inter‐agency development work; and advocacy and campaigning alongside Travellers.

UNRESOLVED HEALTHCARE ISSUES IN RURAL AND REMOTE AUSTRALIA: PRELIMINARY FINDINGS FROM A NATIONAL RURAL HEALTH UNIT SURVEY

ABSTRACT: A preliminary analysis of a survey answered by 317 health practitioners with interests in heath in rural and remote Australia is described. The most important unresolved issues in rural health were service delivery problems, difficulties experienced with attracting and retaining staff, continuing education, Aboriginal health and shortage of finance.

A personal reflection on information control and agency failure: the case of the New York State Drug Agency, 1973-76.

This paper reviews some personal experiences as a researcher at the New York State University drug agency from 1969-70, and from 1973 to 1976, which offer a perspective into its operation and activities. In particular, the evaluation studies in which my staff and I were involved between 1973 and 1976 provide insight into the "misjudgment, mismanagement, and misrepresentation" (Inciardi, 1988, p. 547) that characterized the agency during this period. The agency's neglect to respond in a constructive manner to service delivery problems identified in these evaluation studies exacted a bitter price; and underscores the importance of agency maintenance of integrity in its various activities.

Assessments of community mental health support systems: a key informant approach.

This article describes the development of a 'key informant survey' to assess the performance of local systems of care for persons with a chronic mental illness. The measure yields ratings of: (1) the extent to which clients experience service delivery problems in 11 community support system elements, (2) overall performance of the community support system, and (3) the performance of local mental health authorities. Following pre-testing, the survey was administered to 699 respondents in nine U.S. cities. Internal consistency coefficients were found to be within acceptable ranges for all of the scales across all nine cities. Analyses comparing mean values for performance ratings showed that the nine sites could be arranged into three groups representing high, medium and low system performance. These findings support observations from site visits conducted over several years and suggest that the survey is a valid instrument for assessing local systems of care.

Child Abuse Prevention: The Community as Co-Worker

Much of the literature on community organization describes the efforts of a worker to enable a community to coalesce arouund an external enemy in order to resolve systemic service delivery problems. Based on the mid-point of a federally-funded child abuse prevention project, this article describes the roles of worker and community as colleagues in an effort to enhance the community's capacity to shape its own values and behaviors to reduce child abuse and neglect. This article poses a challenge to the social work education community to be more responsive to the potential of becoming a co-worker with the community, and to enhance the social worker's skills in defining strenghts rather than weakness of communities.

ESSENTIAL ELEMENTS OF A FAMILY PSYCHOEDUCATION PROGRAM IN THE AFTERCARE OF SCHIZOPHRENIA*

This paper describes a psychoeducation program designed for families and caregivers of patients who suffer from schizophrenia on an inpatient ward of an acute care hospital in a major metropolitan city. It is based on 10 years of experience working with over 600 relatives and caregivers. It discusses the research pertinent to developing such a program, the five elements the authors consider necessary to its success, and the stages of the actualprogram. The five elements include universal service, crisis intervention, social functioning of patient and famly, 2 years continuity of care postdischarge, and the role of the family clinician. It addresses issues raised by working as a muultidisciplinary team and problems in service delivery. A case history illustrates the process.

A GENERALIZED APPROACH TO MODELING THE HIERARCHICAL MAXIMAL COVERING LOCATION PROBLEM WITH REFERRAL

ABSTRACT Several investigators have developed hierarchically structured maximal covering location problems, especially for hierarchies with two levels such as clinics and hospitals: Moore and ReVelle developed and applied a hierarchical covering model to a medical service delivery problem in Houduras; and Church and Falon developed two alternate model forms of hierarchical covering that were applied to a medical services planning, problem in Colombia. In this paper, we proposed a hybrid formulation that encompasses all three of these previous models and which allows for the trade‐off of up of four different objectives. This new model formulation is also an improvement in that it has a significantly more efficient and compact structure, even while encompassing a more complete location problem, of which the three previous works are special cases. Example solutions are given for two different data sels involving regions in Colombia and Uganda. In addition, two further model formulations of a closely related nature are presented without computational results.

Using Situation Analysis Data to Assess the Functioning of Family Planning Clinics in Nigeria, Tanzania, and Zimbabwe

Situation analyses conducted in Nigeria. Tanzania, and Zimbabwe have revealed problems in the functioning of many of the subsystems of family planning service delivery, namely in supplies of commodities; in facilities and equipment; in staffing and training; in information, education, and communication; and in record keeping. Although a clear pattern of clinic use exists, in that only a few service-delivery points provide contraceptive services to the majority of new family planning acceptors in the three countries, an attempt to explain how clinics with more clients differ from those that are visited less frequently revealed only a weak association between subsystem functioning and use.

Using qualitative methods to evaluate health service delivery in three rural Colorado communities.

Qualitative and quantitative methods can be used simultaneously for hypothesis generation and testing. A pilot study was conducted in 1991 in three rural Colorado communities to clarify health service delivery problems related to cancer. The analysis focused on the perceptions of three types of respondents in each community related to whether cancer was a major problem, whether health services were adequate in their community, and what perceived solutions could be implemented. Respondents included community influentials, health care providers, and cancer patients or family members. Semistructured phone interviews were used to collect perceptions of these community members. Transcripts from the three communities were combined, coded, and tallied. Several distinct themes emerged from the analysis. These included: cancer was a major problem; public and provider education was needed; community systems and support to identify and solve health problems were lacking; medical networking needed to be expanded; transportation was a problem for remote communities; inability to pay for services was a problem for rural communities. Most respondents identified the problems as relevant to other chronic and acute diseases as well as cancer. This method identified the critical problems for the majority of the people without losing sight of the outlier responses.

Special Education in Northwest Ohio: A Case Study of Rural Service Delivery Problems.

This article describes the core of a larger study that examined rural special education service delivery problems as perceived by various personnel within County Boards of Education as opposed to, County Boards of Mental Retardation and Developmental Disabilities within a 12-county area of northwest Ohio. By utilizing instrumentation similar to an earlier national study conducted by Helge (1983), responses were compared between agencies within the 12 counties themselves, as well as, parallel comparisons drawn with national outcomes. Limited access to educational support services, geographic isolation, commuting distance, carreer opportunities, burnout, and scarcity of personnel were identified as problem areas. Recommendations that are low-to-no-cost are provided that address each identified problem area within the 12-county region.

Effectiveness of Family Reunification Services: An Innovative Evaluative Model

This article describes the implementa tion of the Professional Review Action Group (PRAG) model for reviewing cases of disrupted family reunification. The PRAG model provides for care re views, periodic reporting of review find ings (a feedback mechanism for the agency and community), and recom mendations for and documentation of corrective actions. In the first 62 cases reviewed, both family and service deliv ery problems were found to contribute directly to placement reentry. The most frequent contributor to placement reen try was nonresolution of parent prob lem that precipitated placement. Mul tiple service delivery system problems, including high caseload size, staff turn over, and insufficient regulation of re unification practice, interacted with the serious nature of families' problems to reduce the chances for successful reuni fication. The authors describe correc tive actions implemented and conclude that the PRAG model provides an effec tive tool for understanding and ad dressing unwanted policy, program, and practice outcomes. IN 1987, the U.S. Department of Health and Human ervices iden tified unsuccessful family reunifi cation as a child welfare system out come failure, citing national figures regarding the high proportion (29 to 33 percent) of children reentering the child welfare placement system (Fed eral Register, 1987). The agency as serted that when a former foster child reappears at the agency the system has the responsibility to examine in sufficient detail not only the reason for deciding again to place the child in foster care but the factors that led to this traumatic repetition (Gersh n son, 1987, p. 1). To that end, the e partment funded a three-year project to pilot the Professional Review Ac tion Group (PRAG) model for review ing cases of disrupted family reunifi cation in an eight-county area in Indiana. This service evaluation and corrective action model provides for case reviews, periodic reporting of review findings (a feedback mecha nism for the agency and community), and recommendations for and docu mentation of corrective actions (Fig ure 1) (Hess & Folaron, 1992).

Why Study Treatment Outcome?

Concern about the spiraling cost of mental health care has increased the need for reliable data about the outcomes of such care. Treatment outcome studies, although difficult to design and carry out, are essential in demonstrating the efficacy of psychiatric treatment, rationalizing clinical decision making, and encouraging public support for the availability of appropriate, cost-effective care for the mentally ill. Ideally, outcome studies should focus not only on clinical symptomatology but also on patients' social, interpersonal, and occupational adjustment as well as on factors that, taken together, shape the quality of life. The authors discuss these issues and some of the impediments to collecting useful outcome data, including the complexity of the mental health service delivery system and problems related to patient selection, study design, and how treatment is defined.

A Community-Based Education Model for Identification and Prevention of Elder Abuse

This article discusses the problems of identification and service delivery to abused elderly who reside in the community. A model for sensitizing the public to the concerns of elder abuse is presented as it was implemented in Brooklyn, N.Y. Three target groups for education were identified: professionals, community leaders and the elderly themselves. Educational objectives were conceptualized for each target group and a series of educational workshops were designed to facilitate these objectives. Recommendations and strategies for such community-based education programs are presented.

The training of district medical officers: a methodology tested in Senegal

The training of Senegalese doctors is similar to that of doctors in developed countries. It does not prepare them well for the responsibilities of a district medical officer - a role of crucial importance to public health services and particularly to the optimal use of scarce resources. To compensate for this deficiency in training, the Thies project has developed a programme for teaching district medical officers already in service how to organize health delivery systems. This three-month programme consists of a series of modules aimed at finding solutions to frequently encountered health service delivery problems, followed by a period of on-going training in the form of supervision in the field. The objective of the course is twofold: to have an immediate impact on the quality of health service delivery; and to motivate the doctor in his work which, until now, has only required the use of his academic training in the area of clinical practice. This article describes the methodology used in the initial three-month stage of this training programme.

Building university-community partnerships: Increasing urban competitiveness

Universities, in cooperation with the private and public sectors, can make significant contributions to addressing both the social and service-delivery problems of a region, while creating and reinforcing a regional culture of competitiveness and preparedness for a challenging world economy. In the early years of public higher education, formal patterns of educational-agricultural cooperation were common. Today's urban, informationbased economy can benefit much from the educational and technological resources of colleges and universities.

Serving Emotionally Disturbed Students in Rural Settings: A Case Study of Service Delivery Problems and Alternative Solutions

Serving Emotionally Disturbed Students in Rural Settings: A Case Study of Service Delivery Problems and Alternative Solutions