Service Provision For People Research Articles

Athafnafólk í opinberri stefnumótun á óvissutímum: Hvernig hugmyndin um notendastýrða persónulega aðstoð varð að veruleika á Íslandi

Þessi rannsókn leitast við að útskýra tímamótaákvörðun í þjónustu við fatlað fólk á Íslandi. Opinber stefnumótun hefur löngum einkennst af hægfara breytingum, sem gerast í smáum skrefum. Stundum bregður þó svo við að meiriháttar breytingar verða og stefnumál, sem verið hefur baráttumál hagsmunahópa um margra ára skeið, ná fram að ganga. Dagskrárkenningar leitast við að útskýra meiriháttar stefnubreytingar með því m.a. að beina athyglinni að því hvernig og hvers vegna tiltekin málefni koma til kasta stjórnvalda á hverju tíma. Bandaríski stjórnmálafræðingurinn, John W. Kingdon, setti fyrst fram kenningu sína um straumana þrjá og glugga tækifæranna fyrir rúmum 30 árum. Nýlegar rannsóknir evrópskra stjórnmálafræðinga halda því nú fram að nálgun Kingdons geti varpað ljósi á það hvernig það pólitíska kerfi sem stefnumótunin fer fram í virkar og hvernig hegðun og aðferðir þátttakenda í ferlinu hafa áhrif. Í þessari eigindlegu rannsókn er skoðað hvernig hugmyndin um notendastýrða persónulega aðstoð (NPA) varð að veruleika á Íslandi. Rannsóknin byggir á fyrirliggjandi gögnum og viðtölum við lykilfólk um þá framvindu mála sem leiddi til ákvörðunar um að innleiða NPA hér á landi. Rannsóknin lýsir því hvernig og undir hvaða kringumstæðum NPA komst á dagskrá stjórnvalda. Niðurstöðurnar sýna hvernig breytingar á verkaskiptingu milli ríkis og sveitarfélaga gáfu tækifæri fyrir nýja hugmyndafræði sem nýttist bæði notendum, viðskiptahagsmunum og pólitískum hagsmunum. Niðurstöðurnar benda til þess að þar hafi ekki aðeins verið réttur maður á réttum stað á réttum tíma, heldur varpa þær fræðilegu ljósi á það hvað einkennir athafnafólk í opinberri stefnumótun og hvernig og hvers vegna það skiptir máli á óvissutímum í stjórnmálum.

Contextualizing medications for opioid use disorder and peer support service provision in the probation system with implementation science

BackgroundMedications for opioid use disorder (MOUD) is an evidence-based approach that reduces opioid-related mortality, particularly among criminal legal-involved persons who are at increased risk of adverse outcomes related to OUD. Implementing evidence-based approaches in the context of probation settings requires an in-depth understanding of specific contexts to improve intervention efficacy and effectiveness. Here, we use the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to understand implementation contexts for MOUD provision in the probation setting.MethodsIn-depth individual interviews were conducted with key programmatic stakeholders (treatment providers and probation staff involved in service provision for people on probation). The study examined stakeholder perspectives regarding MOUD and Peer Support Service (PSS) implementation among people who are involved in community supervision. Deductive and inductive thematic analysis was conducted, and subsequently the codes, subcodes, and themes were mapped onto the EPIS framework to better understand implementation contexts.ResultsWe deduced key inner, outer, and bridging contexts that shape treatment service provision for individuals with OUD who are on probation. Inner contexts include a strong organizational climate that supports MOUD implementation and enthusiasm for peer support services. Outer contexts include difficulty navigating insurance among providers, treatment costs, and systemic stigma towards MOUD. Bridging contexts include a lack of collaboration/communication between relevant agencies (e.g., probation and courts).ConclusionsFindings indicate the implementation is complex and requires a coordinated effort between correctional systems, probation agencies, and community-based treatment providers.

Digitalization of welfare organizations for persons with intellectual disabilities: between democratic ideals, legitimacy and institutional logics

Information and communication technology (ICT) and digital media are less accessible for persons with intellectual disability (ID) but are important for citizenship. The aim was to conceptualize officials understanding of ICT usage among people with ID, and to analyze the possible influence of this understanding on the provision of services for people with ID. A qualitative study was conducted, using semi-structured interviews with municipal officials and politicians in the disability service area. Thematic analyses were conducted. ICT use is understood as an arena for democratization. Findings also illustrate the tension between integrity and protection as well as between legal and moral aspects of digital transformation in service provision. This understanding of digitalization is permeated by an individualized approach but conditioned by organizational issues. Disability services can be understood as undergoing digital transformation where regulative and normative elements in this area need to be harmonized to facilitate digitalization successfully.

WS10.04 Exploring the effects of Kaftrio on the physiotherapists’ role and service provision for people with cystic fibrosis: a UK and Republic of Ireland (ROI) survey.

WS10.04 Exploring the effects of Kaftrio on the physiotherapists’ role and service provision for people with cystic fibrosis: a UK and Republic of Ireland (ROI) survey.

Effectiveness and cost-effectiveness of sector-independent treatment coordination for people with substance-related disorders following an online assessment (ASSIST): study protocol for a randomized controlled trial

BackgroundThe implementation of person-centred, need-oriented and flexible care for people with substance-related problems is often insufficient, in large part due to the complexity of addiction support services among different providers. A standardized online assessment and subsequent sector-independent treatment coordination could provide individuals with more appropriate services, thereby making better use of individual services and leading to a more effective addiction support system as a whole. The aim of this study is to determine the effectiveness and cost-effectiveness of sector-independent treatment coordination following an online assessment, in comparison with the current standard of care and treatment process in Germany.MethodsThe sample size of this randomized, controlled trial has been set to a total of 400 participants with substance-related problems. Participants living in Stuttgart, Germany, will be randomly allocated to (1) the intervention group with immediate online assessment and subsequent sector-independent treatment coordination (ASSIST) or (2) the waitlist group. Participants in the waitlist group will initially remain in usual care and only be provided with the online assessment 6 months later. Short-term effects (over 2 months) and medium-term effects (over 6 months) of ASSIST will be compared between the intervention and the waitlist groups. The primary outcome is improved treatment satisfaction. Secondary outcomes include improved subjective quality of life and empowerment, reductions in patients’ substance use, unmet needs and illness-related clinical and social impairment. Health economic evaluation as well as quantitative and qualitative process evaluations will be conducted.DiscussionThe results of this study are expected to provide information on whether sector-independent treatment coordination following an online assessment contributes to improved health care service provision for people with substance-related problems. This randomized controlled trial will help identify facilitators and barriers to the sustainable implementation of a cross-sectoral care concept in substance abuse services.Trial registrationGerman Clinical Trial Register DRKS00026996. Registered on 29 October 2021

A qualitative study of continence service provision for people living with dementia at home in the UK: Still inadequate?

IntroductionIncontinence is a major problem for people with dementia (PWD) and their family/friend caregivers, often causing substantial harm, including residential care admission. The incontinence needs of PWD are complex and different from those of people without dementia.The aim of this study was to investigate carer and nurse perceptions of continence service provision and potential improvements.MethodsA secondary analysis of qualitative data was undertaken. Semi-structured interviews (n = 45) were undertaken with PWD, family caregivers and healthcare professionals (continence or dementia nurses) in the UK. PWD and caregivers were recruited via www.joindementiaresearch.nihr.ac.uk and via dementia/carer groups. Nurses were recruited via their employers. Framework analysis was used. The COREQ Research guideline statement assists reporting.ResultsFour themes were found. Firstly, there was a lack of awareness of the service and waiting time. Many caregivers were unaware of continence services and dementia nurses often viewed it as a pad provision service. Caregivers reported long waits not meeting their urgent needs. Secondly, product provision was often inadequate. Most caregivers self-purchased all or many products and substantial variation in product provision was found. The number of products provided was often inadequate. Thirdly, a sense that “nothing can be done” was observed by some nurses and caregivers. Caregivers believed that, if nothing else, care information should be provided. Finally, suggestions for improvements were made, including proactive service signposting, joint clinics with dementia services, improved information before crisis point, dementia training for continence nurses and improved product provision.ConclusionContinence service inadequacies for PWD and caregivers have been reported for many years. This study demonstrates service provision remains unsatisfactory in the UK. Stakeholders propose a range of service improvements. It highlights that listening to the voices of PWD, caregivers and nurses is crucial for services seeking to improve continence services for PWD living at home.

Provision of Services for People with Vascular Disease 2021

Provision of Services for People with Vascular Disease 2021

EDITOR'S FOREWORD

Welcome to the February issue of the Journal of Vascular Societies Great Britain and Ireland (JVSGBI). We are really pleased with the response to the launch issue, which took place at the Vascular Societies GB&I Annual Scientific Meeting held in December 2021. Attendees from all societies and industry were delighted to see the journal, which is open-access and represents the whole vascular community. On behalf of the Editorial Board I would like to extend my thanks to all authors who have submitted articles. This issue includes two important editorials which present the views of both the trainers and the trainees regarding the recent changes to the Vascular Curriculum. This issue also contains further outcomes from individual Special Interest Groups who worked with the James Lind Alliance and perhaps most importantly vascular patients, to identify research priorities across the sub-specialties of vascular surgery. These priorities, I am sure, will guide vascular research and funding for the foreseeable future. It gives me great personal satisfaction to see this crucial work in print. Thank you for all the hard work. We cannot escape the impact of COVID-19 and this issue contains articles highlighting the impact of the pandemic on vascular surgical training in Scotland and the innovative modifications made to the ASPIRE 7 and 8 courses to enable delivery of these important courses despite heavy COVID associated restrictions. Please remember this journal is for members of all societies involved in the management of vascular patients, and we would encourage submissions from all areas of interest to the vascular community. If you would like to share your work and experience with your fellow society members, and the wider vascular community, please submit your articles to JVSGBI, to ensure we can represent everyone with our content. There is also a supplement to this issue of the journal – Provision of Services for People with Vascular Disease 2021. This update sets out the views of the UK Vascular Societies regarding the provision of high quality, evidence based, patient centred vascular services. We hope your organisation can use POVS 2021 to optimise the care delivered to people with vascular disease across your local vascular network. The UK vascular societies are committed to this aim, as is the Vascular Society charity, the Circulation Foundation. Visit the journal website to access the document. Finally, I hope you enjoy reading this issue of JVSGBI, and please do continue to share your work by submitting articles for publication.

An evaluation of podiatry service use for people with inflammatory rheumatic diseases: a review of a rheumatology podiatry clinic in Aotearoa New Zealand

BackgroundFoot problems, including foot pain, structural deformities, skin and nail lesions, and footwear difficulties, are common in people with inflammatory rheumatic diseases. However, dedicated podiatry services are limited, including in Aotearoa New Zealand. This study aimed to evaluate the podiatry service use for people with inflammatory rheumatic diseases who attended a specialist podiatric rheumatology clinic in Aotearoa New Zealand.MethodsThis retrospective review included people with an inflammatory rheumatic disease who attended the Auckland University of Technology Podiatric Rheumatology Clinic between 2010 and 2021. Data were extracted manually from patients’ clinical records, including variables relating to patient characteristics, appointment details, presenting complaint, assessments performed, and treatments provided.ResultsFrom 2010 to 2021, 157 people with inflammatory rheumatic diseases attended 1570 appointments. The most common presenting concern was foot pain (reported by n = 121, 77.1% patients during at least one appointment), followed by skin/nail lesions (n = 98, 62.4%) and footwear/orthotic needs (n = 90, 57.3%). A range of podiatric interventions were provided to address foot-care needs, in which education (n = 151, 96.2%) and general skin/nail care (n = 107, 68.2%) were the most common treatments provided. The majority of patients also received footwear interventions at some point during their period of service provision (n = 96, 61.1%), followed by orthoses, other padding/offloading devices, wound care, exercise prescription and referrals to other health professionals.ConclusionsThis is the first study to review podiatric service provision for people with inflammatory rheumatic diseases attending a specialist podiatric rheumatology clinic in Aotearoa New Zealand. The results of this study have shown that a podiatry clinic dedicated to people with inflammatory rheumatic diseases addresses the wide range of foot problems through an extensive provision of treatment services.

COVID-19 and the HIV care continuum in Uganda: minimising collateral damage

The novel coronavirus, SARS-CoV-2, has spread across the world within months of its first description in Wuhan, China in December 2019, resulting in an unprecedented global health emergency. Whilst Europe and North America are the current epicentres of infection, the global health community are preparing for the potential effects of this new disease on the African continent. Modelling studies predict that factors such as youthful and rural population may be protective in mitigating the spread of COVID-19 in the World Health Organisation (WHO) African Region, however, with 220 million infections and 4.6 million hospitalisations predicted in the first year of the pandemic alone, fragile health systems could still be placed under significant strain. Furthermore, subsequent disruptions to the provision of services for people living with HIV, or at risk of acquiring HIV, are predicted to lead to an extra 500,000 adult HIV deaths and a 2-fold increase in mother to child transmission of HIV in sub-Saharan Africa in 2020-2021. Ignoring these predictions may have severe consequences and we risk “stepping back in time” in AIDS-related deaths to numbers seen over a decade ago. Reflecting on our current experience of the COVID-19 pandemic in Uganda, we explore the potential impact of public health measures implemented to mitigate spread of COVID-19 on the HIV care continuum, and suggest areas of focus for HIV services, policy makers and governments to urgently address in order to minimise the collateral damage.

The Impact of COVID-19 on Service Provision for Emergency Department Patients Post-Opioid Overdose: A Field Report.

Background:To minimize the spread of COVID-19, health and ancillary care providers altered service delivery patterns. These changes included an increase in reliance on telemedicine modalities, a reduction in services or hours of operation, and prohibiting guests and nonessential personnel from healthcare settings. We describe a rapid environmental assessment with senior emergency department (ED) practitioners in Rhode Island to understand how COVID-related procedural changes impact the provision of post-overdose care in ED.Methods:Semi-structured interviews were conducted with 14 senior healthcare practitioners in EDs across Rhode Island from June to July 2020. Interviews were part of a larger, ongoing study examining the implementation and effectiveness of post-opioid overdose care in EDs and sought to understand how COVID-19 had impacted the provision of services for people who use drugs (PWUD).Results:COVID-related policy changes challenged the provision of services to PWUD in the ED, and extended challenges in connecting people with OUD to services in the community. Specifically, challenges included transitions to telehealth modalities, required COVID tests for treatment services, and gaps in community resources.Conclusions:This study underscores opportunities to improve the delivery of services amid overlapping public health crises for PWUD, including bolstering the use of telemedicine in EDs and across the care continuum.

Dementia services for people from Black, Asian and Minority Ethnic and White-British communities: Does a primary care based model contribute to equality in service provision?

This study set out to investigate whether there were disparities in service provision for people from Black, Asian and Minority Ethnic (BAME) communities compared to White British (WB) communities within a primary care led dementia service in the UK. Data were extracted from 30 cases from three BAME (African-Caribbean, South Asian and Chinese) communities who had been referred to a dementia service between April 2016 and December 2017. We then extracted data from 30 WB cases matched for gender, age (within 5years) and General Practitioner surgery. We compared service provision for both samples around assessment, diagnosis and post-diagnostic support. The primary source of information in the BAME sample was less likely to be recorded as being the main carer and more likely to be an adult child. Cases from both samples were equally likely to have a CT scan. People from BAME communities were less likely to receive a cognitive assessment, and when they did they scored at a lower level. There was no difference between samples for the diagnoses that cases received, but BAME cases were more likely to be assessed as being low rather than medium or high risk. While cases from both samples were equally likely to receive medication, BAME cases were more likely to be seen by a psychiatrist. Significantly more people from the WB sample were recorded as using or being offered more than one form of community support. This study of a primary care-based dementia service suggests that while many areas of service provision showed no evidence of inequality, important differences remain including the time at which people present for assessment and the range of post-diagnostic services which are discussed. Further research is required to establish the likely causes of these disparities.

COVID-19 and the HIV care continuum in Uganda: minimising collateral damage

The novel coronavirus, SARS-CoV-2, has spread across the world within months of its first description in Wuhan, China in December 2019, resulting in an unprecedented global health emergency. Whilst Europe and North America are the current epicentres of infection, the global health community are preparing for the potential effects of this new disease on the African continent. Modelling studies predict that factors such as a youthful and rural population may be protective in mitigating the spread of COVID-19 in the World Health Organisation (WHO) African Region, however, with 220 million infections and 4.6 million hospitalisations predicted in the first year of the pandemic alone, fragile health systems could still be placed under significant strain. Furthermore, subsequent disruptions to the provision of services for people living with HIV, or at risk of acquiring HIV, are predicted to lead to an extra 500,000 adult HIV deaths and a 2-fold increase in mother to child transmission of HIV in sub-Saharan Africa in 2020-2021. Ignoring these predictions may have severe consequences and we risk “stepping back in time” in AIDS-related deaths to numbers seen over a decade ago. Reflecting on our current experience of the COVID-19 pandemic in Uganda, we explore the potential impact of public health measures implemented to mitigate spread of COVID-19 on the HIV care continuum, and suggest areas of focus for HIV services, policy makers and governments to urgently address in order to minimise the collateral damage.

The chiropractic workforce: a global review

BackgroundThe world is faced with a chronic shortage of health workers, and the World Health Organization (WHO) has estimated a global shortage of 7.2 million health workers resulting in large gaps in service provision for people with disability. The magnitude of the unmet needs, especially within musculoskeletal conditions, is not well established as global data on health work resources are scarce.MethodsWe conducted an international, cross-sectional survey of all 193 United Nation member countries and seven dependencies to describe the global chiropractic workforce in terms of the availability (numbers and where they are practising), quality (education and licensing), accessibility (entry and reimbursement), and acceptability (scope of practice and legal rights). An electronic survey was issued to contact persons of constituent member associations of the World Federation of Chiropractic (WFC). In addition, data were collected from government websites, personal communication and internet searches. Data were analysed using descriptive statistics. Worldwide density maps of the distribution of numbers of chiropractors and providers of chiropractic education were graphically presented.ResultsInformation was available from 90 countries in which at least one chiropractor was present. The total number of chiropractors worldwide was 103,469. The number of chiropractors per country ranged from 1 to 77,000 (median = 10; IQR = [4–113]). Chiropractic education was offered in 48 institutions in 19 countries. Direct access to chiropractic services was available in 81 (90%) countries, and services were partially or fully covered by government and/or private health schemes in 46 (51.1%) countries. The practice of chiropractic was legally recognized in 68 (75.6%) of the 90 countries. It was explicitly illegal in 12 (13.3%) countries.ConclusionWe have provided information about the global chiropractic workforce. The profession is represented in 90 countries, but the distribution of chiropractors and chiropractic educational institutions, and governing legislations and regulations largely favour high-income countries. There is a large under-representation in low- and middle-income countries in terms of provision of services, education and legislative and regulatory frameworks, and the available data from these countries are limited.

Encountering staff-directed aggression within mental health and substance abuse services: exploring conceptions of practice following education

BackgroundStaff-directed aggression represents a considerable concern in mental health and substance abuse services, and presents a substantial challenge to the quality and continuity of service provision for people with mental health and substance abuse problems. The practitioners themselves frequently request increased competence as a way to mediate the negative effects of staff-directed violence and aggression. The aim of this study is to explore how practitioners in municipal mental health and substance abuse services conceptualize practice in prevention and management of staff-directed violence. Furthermore, we seek to explore how these conceptions change following participation in two complementary and specially developed courses advancing respectively, qualified risk assessment and situational awareness and disempowerment-sensitive and de-escalation principles for practice.MethodThe study was conducted by using a qualitative phenomenographic research approach. The data-material comprised two-step semi-structured interviews with ten participants from various parts of community mental health and substance abuse services in the Municipality of Oslo, Norway.ResultsThe analysis resulted in the development of five qualitatively different, hierarchically ordered, yet logically interrelated conceptual categories of practice concerning prevention and management of staff-directed aggression in community mental health and substance abuse services. These are: (1) Observation, reporting and expectation of organizational intervention, (2) Application of personalized de-escalating skills and behaviour, (3) Delivery of team-based and standardized services, (4) Provision of perceptive and responsive services, and (5) Facilitation of sensitive, involving and reflexive care. The categories vary according to the participants’ attentional focus on either the responsibility of the organization, staff members’ personally developed skills and techniques, team-based solutions, knowledgeable information processing in making professional judgements and reflexive, interpersonal service provision, as well as according to what meaning participants assign to practice. The authors have identified varying degrees of conceptual change following education in half of the participants.ConclusionThe results of this study both show that practitioners conceptualize practice in aggressive encounters quite differently. The study also indicate that it is important to consider participant awareness of the phenomenon of interest when devising educational activities for personnel in mental health and substance abuse services.

Knowledge of Hearing Loss among University Students Pursuing Careers in Health Care.

Albeit limited, research suggests that students pursuing careers in health care receive limited training on the provision of services for people with hearing loss. As the incidence of hearing loss continues to increase among Americans, it is critical that medical professionals understand how hearing loss among patients may affect the manner in which they can provide services most effectively. The aim of this project is to assess the amount of experience and confidence that preprofessional health-care students at one university obtain during the course of their training and whether these students would be interested in additional information related to hearing health. Preprofessional health-care students in terminal degree programs at one university completed a survey regarding the provision of services for individuals with hearing loss. Students were asked to quantify their prior training on topics related to hearing loss, report their perceptions of the benefits and barriers to screening hearing, and report their self-efficacy in providing services for individuals with hearing loss. Additional survey items investigated students' interest in receiving further training on these topics. Participants (n = 95; 16.2% response rate) were students at a mid-sized, Midwestern university who were pursuing the following terminal degrees: medicine, physician assistant, nursing, pharmacy, physical therapy, occupational therapy, speech-language pathology, and respiratory therapy (bachelor's degree in respiratory care). Participants were selected based on membership in an interdisciplinary education training program. All students in this program received an invitation to participate in the study. Of the participants, 68 (71.6%) were Caucasian and 86 (90.5%) were female. A 28-item online survey on various topics related to hearing loss was used to document student responses. All students enrolled in a university's interdisciplinary professional education course (n = 586) received an online link to the survey via an initial email, which contained a brief introduction to the study, the assurance of response anonymity, and a statement regarding implied consent. A second email was sent to students, which reminded participants of the request to complete the survey. Overall, 60% of participants reported an interest in receiving additional information on hearing health and 66.3% of respondents indicated that they wished to receive training via an in-service or internet workshop facilitated by their university program. Most of the participants reported that they had not received training and did not feel confident identifying the signs and symptoms of hearing loss and making an appropriate referral, which led to the request for additional information. The results of this study suggest that preprofessional health-care students have an interest in receiving additional education on various topics related to hearing loss including a better understanding of how hearing loss impacts the quality of life in affected individuals. These findings provide an incentive to provide additional training related to hearing loss identification and management for preprofessional health-care students to foster increased competency and improved patient care.

Формування та реалізація моделі державно- приватного партнерства щодо соціально-економічного забезпечення осіб з інвалідністю в Україні

Статтю присвячено дослідженню питань формування та реалізації моделі державно-приватного партнерства щодо соціально-економічного забезпечення осіб з інвалідністю та розглянуто її інструменти.
 Метою статті є дослідження процесів формування та реалізації моделі державно-приватного партнерства щодо соціально-економічного забезпечення осіб з інвалідністю в Україні, їх оцінка та надання пропозицій щодо їх удосконалення.
 Наукова новизна. Запропоновано концептуальну модель державно-приватного партнерства щодо удосконалення системи соціально-економічного забезпечення осіб з інвалідністю. Визначено фактори регулювання якості послуг у системі соціально-економічного забезпечення осіб з інвалідністю, а також роль державно-громадського співробітництва та участь громадських організацій у формуванні й розвитку вітчизняного ринку послуг щодо соціально-економічного забезпечення осіб з інвалідністю.
 Висновки. Визначаючи основні підходи до реформування системи соціально-економічного забезпечення осіб з інвалідністю в Україні, акцентуємо увагу на необхідності запровадження державно-приватного партнерства, що забезпечить надання якісних соціальних послуг особам з інвалідністю та дасть можливість отримувати, за бажанням, відповідну допомогу як у державних закладах, так і в приватних.
 В умовах неспроможності державних, комунальних соціальних закладів виконувати належним чином покладені на них обов’язки – надавати послуги щодо соціально-економічного забезпечення осіб з інвалідністю в достатніх обсягах і відповідної якості, постає питання залучення до цього процесу приватних суб’єктів, які надають такі послуги, зокрема громадських, благодійних, релігійних організацій. Нестача бюджетних коштів, інших ресурсів через часті фінансово-економічні кризи, політичну нестабільність ще більше спонукають державу до партнерства та співробітництва між суспільними секторами, зокрема державним (центральні, місцеві органи влади), неурядовим (громадським сектором) та приватним (бізнесом), тобто розвитку моделі державно-приватного партнерства у досліджуваній сфері.
 Упродовж останніх років, а особливо в реаліях сьогодення, громадські організації в Україні помітно активізували свою участь у формуванні та розвитку вітчизняного ринку послуг щодо соціально-економічного забезпечення осіб з інвалідністю, переконливо демонструючи високу спроможність надавати такі послуги якісно, ефективно та результативно. Громадські організації реалізують цілу низку інноваційних проектів, пов’язаних із наданням соціальних послуг, підвищенням рівня професіоналізму соціальних працівників, інших фахівців, які надають послуги соціально-економічного забезпечення особам з інвалідністю.

La asistencia personal como nuevo derecho de ciudadanía: una mirada desde el ámbito de los profesionales de la salud

espanolObjetivo: El objetivo principal de esta investigacion es conocer la figura del asistente personal para personas con discapacidad. Asimismo, se pretende exponer la importancia de los cuidados y el acompanamiento profesionalizado frente a los cuidados familiares. Metodo: Abordaje de investigacion mixto consistente en la revision de bases de datos oficiales, asi como la realizacion de entrevistas semiestructuradas a 11 profesionales de la enfermeria pertenecientes al Servicio Publico de Salud de Galicia (Espana). Resultados: Los resultados apuntan a que la figura del asistente personal continua sin ser mayoritaria en la prestacion de servicios para personas con discapacidad. El personal de enfermeria entrevistado considera que las funciones de asistencia personal deben enfocarse hacia una clara profesionalizacion por sus caracteristicas especificas. Conclusiones: Los resultados de este estudio, constituyen un marco propio para la reflexion sobre la intervencion y acompanamiento en personas con discapacidad. Sin duda, es necesario el trabajo interdisciplinar dentro de un abordaje conjunto de profesionales con formacion sanitaria y social. EnglishObjective: The main objective of this research is to familiarize ourselves with the figure of the personal assistant for disabled people. It also seeks to reveal the importance of professionalized care and accompaniment compared with family care. Methods: Joint research consisting of the review of official databases, as well as the performance of semi-structured interviews with 11 professional nurses belonging to the Public Health Service of Galicia (Spain). Results: The results suggest that the figure of the personal assistant is still not predominant in the provision of services for people with disabilities. The interviewed nursing staff considered that the functions of personal assistance should be clearly professionalized due to their specific characteristics. Conclusions: The results of this study constitute a framework for reflection on intervention and support for people with disabilities. No doubt, interdisciplinary work is necessary within a joint approach of professionals with health and social training. portuguesObjetivo: O objetivo principal desta pesquisa e conhecer a figura do assistente pessoal para pessoas com deficiencia. Da mesma forma, pretende-se expor a importância do cuidado e o acompanhamento profissionalizado versus cuidado familiar. Metodo: Abordagem de pesquisa mista composta pela revisao de bases de dados oficiais, bem como entrevistas semiestruturadas a 11 profissionais de enfermagem pertencentes ao Servico de Saude Publica da Galiza (Espanha). Resultados: Os resultados sugerem que a figura do assistente pessoal continua sem ser uma maioria na prestacao de servicos para pessoas com deficiencia. A equipe de enfermagem entrevistada considera que as funcoes de assistencia pessoal devem estar focadas em uma profissionalizacao clara devido as suas caracteristicas especificas. Conclusoes: Os resultados deste estudo constituem um marco adequado para a reflexao sobre a intervencao e acompanhamento de pessoas com deficiencia. Sem duvida, o trabalho interdisciplinar e necessario dentro de uma abordagem conjunta de profissionais com formacao em saude e social.

Training and service provision for people with intellectual disability and mental illness: the views of psychiatrists

Objectives: The objectives of this mixed methods study are to 1) investigate the knowledge and skills of mainstream psychiatrists in managing patients with Intellectual Disability (ID) and comorbid mental health disorders, 2) assess their perception of the quality and accessibility of services for this population, and 3) establish the local implementation of the Green Light Toolkit.Method: We surveyed mainstream psychiatrists in the Thames Valley region working in general adult, forensic, and older adult services, to ascertain their opinions about their knowledge and skills in managing patients with ID and comorbid mental disorder, as well as quality and accessibility of services. We compared our findings with previous UK and international research.Results: Respondents mirrored views expressed in earlier studies that inpatient care should be provided in dedicated units for people with ID, rather than general adult inpatient wards. Limited resources, training and competence, and lack of collaborative working were highlighted as key barriers to provision of effective care.Conclusion: Psychiatrists broadly support a specialist service model for people with ID. In the UK, specialist psychiatric services for people with ID have been delivered through inpatient and community services, but there is a current shift towards integrating ID with mainstream service models. Participants expressed concern that mainstream services fail to meet the mental health needs of this patient group, and lead to increased patient vulnerability. The Green Light Toolkit was not well known or used within services. A number of ways of improving collaborative care between services are suggested.

F132. IDENTIFICATION OF PATIENTS WITH RECENT ONSET PSYCHOSIS IN KWAZULU NATAL, SOUTH AFRICA: A PILOT STUDY WITH TRADITIONAL HEALTH PRACTITIONERS AND DIAGNOSTIC INSTRUMENTS

BackgroundThere is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data is available of low- and middle-income countries (LMICs). Obtaining valuable evidence from under-represented regions such as Sub-Saharan Africa holds the promise of advancing our knowledge and understanding of psychosis and will provide a strong basis for redressing inequities in service provision for people with psychotic disorders living in LMICs. Many patients in these countries remain undetected and untreated, partly due to lack of formal health care facilities. This study in rural South Africa aimed to investigate if it is possible to identify patients with recent onset psychosis in collaboration with traditional health practitioners (THPs).MethodsWe developed a strategy to engage with THPs. Key to the collaboration between psychiatry, THPs and the local community, was the building of trust by recognizing and acknowledging local authorities, mutual respect for health constructs, taking time to find common ground, and adaptation of the procedures to sociocultural norms. Fifty THPs agreed to collaborate and were asked to refer help-seeking clients with recent onset psychosis to the study. At referral, the THPs rated probability of psychosis (“maybe disturbed” or “disturbed”). A two-step diagnostic procedure was conducted, including the self-report Community Assessment of Psychic Experiences (CAPE) as screening instrument, and a semi-structured interview using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). Accuracy of THP referrals, and test characteristics of the THP rating and the CAPE were calculated.ResultsIn six months, 149 help-seeking clients were referred by THPs, of which 44 (29.5%) received a SCAN DSM-IV diagnosis of psychotic disorder. The positive predictive value of a THP “disturbed” rating was 53.8%. Test characteristics of the CAPE were poor.DiscussionThis pilot study in rural South Africa found that it is possible to identify patients with recent onset psychosis in collaboration with THPs. THPs not only grasped the concept of psychosis, they recognized “being disturbed” as a condition that is often difficult to treat and for which collaboration with psychiatric mental health care might be beneficial. By contrast, the CAPE performed poorly as a screening instrument. Collaboration with THPs is a promising approach to improve detection of patients with psychosis in LMIC.