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Results for “Interinstitutional Relations”

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PubMed2005

Interagency collaboration between child protection and mental health services: practices, attitudes and barriers.

OBJECTIVE: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. METHOD: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers, 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). RESULTS: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. CONCLUSIONS: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level.

Adult↗

PubMed1996

Organizational models of medical school relationships to the clinical enterprise.

The authors analyzed existing relationships between medical schools and clinical enterprises in order to develop models of these relationships. The conceptual framework for the models uses three variables to assess the nature of the relationships: (1) high academic control-high clinical enterprise control; (2) high academic influence-low academic influence; and (3) self-contained system-open system (i.e., the extent to which the resources needed for clinical education are provided by the relationship between the clinical enterprise and the medical school). The authors present four conceptual models of the relationship between the medical school and the clinical enterprise: (1) The "single ownership; owned integrated system" is characterized by a closed clinical delivery system owned or controlled by the academic institution. (2) The "general partner" organization emphasizes an open clinical environment in which the medical school forms alliances with clinical entities, and the school is a dominant partner. (3) The "limited partner" organization operates with an open clinical delivery system that the school relates to through affiliations and contractual relationships, and the school is a less dominant partner. (4) The "wholly owned, subsidiary" organization operates in a controlled clinical environment in which the medical school is a subsidiary of the larger integrated delivery system. Each model is presented in its pure organizational form, then augmented with descriptions of the different ways that the medical school and other components may relate to each other. Also, the advantages and disadvantages of each model for the medical school are discussed. The authors emphasize that no model is superior to the others; instead, the best choice for a medical school depends on the history, local circumstances, and leadership of the school and other organizations. The authors' intent is to assist the leaders of medical schools as they design strategies for the future relationships of their institutions.

Interinstitutional Relations↗

PubMed2002

NGO and state: co-operation between a leprosy relief association and other institutions in South America.

In a structured questionnaire format, the German Leprosy Relief Association (GLRA) interviewed its representatives in two Federal states of Brazil and four other Latin American countries about the distribution, between itself, the state and other institutions of a) responsibility for funding and b) implementation of activities, in relation to leprosy control. Wherever the political commitment was given, GLRA's role could be reduced to the highly effective support of the government structure in well-defined areas, most particularly in staff training, health education and eventually in programme supervision. This public-private partnership under the umbrella of the host government sustains a small, but important specialized leprosy component whilst routine services are well integrated into the general health system.

Delivery of Health Care↗

PubMed2002

Communication in health care delivery in developing countries: which way out?

Most governments in developing countries have adopted frameworks for health development which stressed community based initiatives and intervention at all levels of the health pyramid (WHO, 1992). But even today, most of the rural communities in these countries are still not developed in terms of available health facilities. What then is/are responsible for these failures? Various authors have come up with various reasons, principal amongst which are inadequate resources, lack of planning, insincerity/non-commitment of the governments, lack of modern information technology, etc. This paper examines some of these factors in relation to how they accentuate or hamper healthcare delivery in developing countries, using African rural communities as a study field. The resultant suggestions are a consortium of varying factors, some of which are economic in nature, policy changes, human resources development, and re-orientation of social and government attitudes towards achieving meaningful results in healthcare delivery, particularly in the rural communities.

Africa↗

PubMedDate not supplied

Relational systems change: implementing a model of change in integrating services for women with substance abuse and mental health disorders and histories of trauma.

This article describes the "relational systems change" model developed by the Institute for Health and Recovery, and the implementation of the model in Massachusetts from 1998-2002 to facilitate systems change to support the delivery of integrated and trauma-informed services for women with co-occurring substance abuse and mental health disorders and histories of violence and empirical evidence of resulting systems changes. The federally funded Women Embracing Life and Living (WELL) Project utilized relational strategies to facilitate systems change within and across 3 systems levels: local treatment providers, community (or region), and state. The WELL Project demonstrates that a highly collaborative, inclusive, and facilitated change process can effect services integration within agencies (intra-agency), strengthen integration within a regional network of agencies (interagency), and foster state support for services integration.

Adult↗

PubMed2003

Market competition: everybody is talking, but what do they say?. A sociological analysis of market competition in policy networks.

From providers and insurers to governments and consumers, it appears that everybody is talking about market competition in health care. However, what do they actually mean? Are they talking about the same things? These questions are relevant for health systems consisting of policy networks, such as in the Netherlands. In policy networks, different actors (besides the government) are engaged in policy-making. Based on their particular frame ('mode of interpretation'), actors proceed and, from this, give meaning to the concept of market competition. Since there are differences in frames (of reference) among the various actors, it is important to understand what market competition means from the perspective of each network participant. This study, with regard to the Dutch health care system, demonstrates 'market competition' as a broad concept, relating to 13 different frames. Only four frames (i.e. cost control, deregulation, competition and increased power) are shared by a maximum of two (out of a total of four) network participants. Clearly, there are differences in the meanings and underlying frames about market competition amongst the key players. The resulting implications and options for policy-making are discussed.

Consumer Organizations↗

PubMedDate not supplied

Research partners: two teams, one study population.

BACKGROUND: Two large research projects funded by the National Institutes of Health, the Disease Management project and the Thrive study, which examine different phenomena in the chronically critically ill population, have combined research teams. Each study has its own project manager and maintains a separate database and budget. Operational tasks for both grants are streamlined through the collaboration and cross-training of all team members. METHODS: The Disease Management project is a randomized clinical trial testing the effectiveness of a care program in improving outcomes for chronically critically ill patients and their caregivers during the first 2 months after discharge. The Thrive study is a prospective longitudinal investigation that aims to describe the weaning patterns of chronically critically ill patients as well as the patterns of illness-related variables. RESULTS: To date, many participants (n = 400) have been enrolled in each study. The results of both studies will be available through future publications. CONCLUSIONS: Although much information has been gleaned from gathering longitudinal data across one study population and examining two rich data sets, there are some limitations to this collaboration.

Chronic Disease↗

PubMed2006

What makes for sustainable Healthy Cities initiatives?--A review of the evidence from Noarlunga, Australia after 18 years.

This paper examines the factors that have enabled the Healthy Cities Noarlunga (HCN) initiative to be sustainable over 18 years (1987-2005). Sustainability related to the ability of the initiative to continue to operate continuously in a manner that indicated its existence was accorded value by the community and local service providers. The analysis is based on a narrative review of 29 documents related to HCN, including a number of evaluations. Nine factors emerged as important to ensuring sustainability: strong social health vision; inspirational leadership; a model that can adapt to local conditions; ability to juggle competing demands; strongly supported community involvement that represents genuine engagement; recognition by a broad range of players that Healthy Cities is a relatively neutral space in which to achieve goals; effective and sustainable links with a local university; an outward focus open to international links and outside perspectives; and, most crucial, the initiative makes the transition from a project to an approach and a way of working. These sustainability factors are likely to be relevant to a range of complex, community-based initiatives.

Community Health Planning↗

PubMed1998

Lessons learned: the managed care experiences of family planning providers.

This article examines key opportunities and obstacles facing community-based family planning agencies seeking to be "players" in the provision of contraceptive and related services in the managed care context. Based on telephone interviews with people working in or closely with a range of family planning provider agencies in five states, it identifies a range of innovative strategies that family planning providers have developed in pursuing arrangements with managed care organizations. It further identifies five difficult issues that have arisen repeatedly in the course of negotiating or implementing those arrangements.

Continuity of Patient Care↗

PubMedDate not supplied

Medical group affiliations: interorganizational relationships and organizational performance.

The hyperturbulent health care environment is causing health care organizations to create interorganizational relationships (IORs). This article reports on a study of 686 medical groups that assessed how 11 types of IORs affected 7 dimensions of organizational performance. Organizational performance was ascertained through self-reported questions about performance relative to local market competitors. Respondents believed that, to varying degrees, all IORs lead to a competitive advantage over local competitors in all seven performance categories. There was no consistent pattern for either loose or tight linkages to be associated with superior performance. Consequently, loose linkages may be preferable to tighter linkages (i.e., membership in a fully integrated delivery system) that require higher levels of resource commitment.

Economic Competition↗

PubMedDate not supplied

Decreasing NICU Costs in the managed care arena: the positive impact of collaborative high-risk OB and NICU disease management programs.

Costs for preterm and critically ill neonates in a neonatal intensive care unit (NICU) can be astronomical related to the number of inpatient day's accrued and professional ancillary fees. NICU births are often associated with maternal risk factors such as previous preterm or low birth weight delivery, maternal infections, chronic disease states, substance abuse and/or human immunodeficiency virus (HIV) infection. Accordingly, Johns Hopkins HealthCare provides a disease management approach for the prevention of NICU births through "Partners With Mom." This maternity disease management program identifies pregnant women that could potentially generate high-dollar claims. The mission of the program is to reduce hospital/NICU admissions related to pregnancy complications and improve maternal/neonatal outcomes. If an NICU birth does occur, multiple avenues are pursued to control costs. By working in concert with Partners With Mom, the NICU Disease Management Program utilizes a multifaceted approach by tracking maternal risk factors, optimizing levels of required inpatient neonatal care and pursuing other avenues of revenue enhancement.

Case Management↗

PubMed2002

Tobacco industry surveillance of public health groups: the case of STAT (Stop Teenage Addiction to Tobacco) and INFACT (Infant Formula Action Coalition).

OBJECTIVES: The goal of this study was to describe how the tobacco industry collects information about public health groups. METHODS: Publicly available internal tobacco industry documents were reviewed and analyzed using a chronological case study approach. RESULTS: The industry engaged in aggressive intelligence gathering, used intermediaries to obtain materials under false pretenses, sent public relations spies to the organizations' meetings, and covertly taped strategy sessions. Other industry strategies included publicly minimizing the effects of boycotts, painting health advocates as "extreme," identifying and exploiting disagreements, and planning to "redirect the funding" of tobacco control organizations to other purposes. CONCLUSIONS: Public health advocates often make light of tobacco industry observers, but industry surveillance may be real, intense, and covert and may obstruct public health initiatives.

Adolescent↗

PubMed2006

Current issues in providing primary medical care to people with serious mental illness.

This article explores some of the current issues in providing primary care for people with serious mental illness. In contrast to many patients in the United States, up to half of patients with serious mental illness in the United Kingdom are seen only by the primary care team. However many General Practitioners feel that the care of this patient group is beyond their remit. In the United Kingdom during the last decade, there have been a variety of policy initiatives, influenced by the generic principle of "partnership working" and the increasing recognition of the importance of patient choice, that have aimed to increase the role of primary care in the delivery of health care to people with serious mental illness. On the ground, these policy imperatives have been realised through different models of shared care and schemes to encourage better communication across the primary/secondary interface. Most recently, and perhaps most effectively, the introduction of a type of performance related pay into primary care may lead to changes to the way in which General Practitioners think and act in terms of their roles and responsibilities with this patient group. Theoretically, therefore the United Kingdom may be entering a new "golden age" of primary care based mental health services for people with serious mental illness, where holistic care, preventive care and health promotion are increasingly seen not as the gold standard, but the norm.

Community Mental Health Services↗

PubMedDate not supplied

A centralized, computerized, and relational data base for student clinical placements.

Quality clinical experiences are a critical component of advanced practice nursing (APN) curricula. Historically, nursing instructors coordinated both the didactic and clinical components of a course. Increasingly, course coordinators organize the didactic component, and external preceptors working in the clinical setting function as practicum teachers. Both scenarios involve labor-intensive processes, and neither facilitate the scheduling of clinical experiences that build on progressive learning across the student's curriculum. A centralized, computerized, relational data base for efficient management of APN preceptors and students across the curriculum was designed. One master's-prepared clinical coordinator maintains the data base and performs all related functions. This system offers numerous benefits to students, preceptors, ] faculty, and nursing school, including balanced and progressively complex clinical learning experiences for students from competent preceptors: consistent interface with students and preceptors; faculty relief from time-consuming tasks; rapid generation of a variety of tables, rosters, and reports; consistent tracking of preceptor evaluations; timely acknowledgment of preceptor assistance; and efficient communication among students, preceptors, faculty, and school administration.

Baltimore↗

PubMed2003

Overview of international environmental health.

Ultimately, the health and quality of life of all human beings depend upon the environment and ecosystems to which we are directly and indirectly connected. The papers in this special edition address a number of the critical environmental health issues on which U.S. government agencies and their collaborating partners are engaged internationally. The agencies are members of the International Environmental Health Subcommittee, chaired by the U.S. Department of Health and Human Services. The activities described span the range from global policy to country-level field activities. While environmental factors related to infectious disease dominate the global burden of environmentally-related disease, acute and chronic exposures to chemicals are increasingly important public health issues at the local, national, and regional levels; arsenic in drinking water is a good example. Intersectoral action involving governments (at all levels), the private sector, and civil society working together in partnership is absolutely critical to sustainably resolving the problems touched on this overview and meeting the environmental health challenges of the twenty-first century.

Cost of Illness↗

PubMed2003

Telemedicine in the state of Maine: a model for growth driven by rural needs.

As of mid-2002, Maine had one of the largest state-wide telemedicine systems, comprising over 150 facilities among 90 health, mental health, and social service provider organizations in two collaborative networks. The rapid growth of telemedicine in this rural, economically disadvantaged state is largely attributable to collaborative development and the service activities of the Maine Telemedicine Services division of a rural community health center, HealthWays/Regional Medical Center at Lubec (RMCL). Annual clinical uses of the system across a broad array of interactive videoconferencing applications currently exceed 1,000 instances for institutional telemedicine and 800 instances for home telehealth. The major applications include mental health/psychiatry, endocrinology/diabetes management, primary care, specialty pediatrics, genetics, and dermatology. Primary care usage derives from a relatively novel use of a mobile telemedicine boat to serve small islands off mid-coastal Maine. Strong future growth is expected in prison telemedicine, emergency medical triage, and nontraditional services such as video relay interpretive services for the deaf, domestic violence advocacy and legal services, and case management for community reintegration of juvenile offenders. The relative success of the two large networks managed by RMCL's Maine Telemedicine Services is evident from the criteria that system usage (1) addresses defined clinical needs, (2) has demonstrable organizational support, (3) is accepted by physicians and patients, (4) exhibits measurable cost and clinical benefits, and (5) is moving toward sustainable operations. Potential bases for this success are discussed in comparison with other networks.

Cooperative Behavior↗

PubMed2004

From disaster to sustainable civil society: the Kobe experience.

Nine years after the Kobe earthquake in Japan, social issues are still prominent, and the rehabilitation process is still ongoing. The earthquake caused two major changes in Japanese society: an increase in voluntary and non-government activities, and the enhancement of cooperation between local government and the residents' association. People's participation in the decision-making process was a significant achievement. To sustain the efforts generated after the earthquake, the Kobe Action Plan was formulated and tested in different disaster scenarios. The current study suggests that civil societies in urban areas are sustainable if, first, the activities related to daily services are provided by the resident's associations; and second, these are linked to economic incentives. Leadership plays a crucial role in collective decision-making. Creation of the support system is essential for long-term sustainability of civil-society activities. These observations are exemplified in the case study in Nishi Suma, one of the worst-affected areas in the Kobe city.

Community Health Planning↗

PubMed2003

A study of collaboration inpatient treatment between the community psychiatric health services and a psychiatric hospital in Norway.

The aim of this study was to examine factors that may have an influence on the collaboration between the health-care professionals in a psychiatric hospital and two communities' psychiatric health service departments. Interviews were conducted with three psychiatric nurses, one medical practitioner, one health and social manager and one cultural worker; thus a total of nine informants. The transcribed interview texts were analysed by means of qualitative content analysis. The main results showed that the community psychiatric nurses felt a need for more systematic interdisciplinary collaboration. The existing collaboration was characterized by ad hoc meetings. In addition, the need for information about their colleagues' professional competence was reported. The respondents called for a more regular forum for professional guidance and coordination in relation to particular client cases in order to improve the quality of psychiatric care. There was also a need for collaboration within community health care and a link to psychiatric hospital care in order to better evaluate the outcomes of care provided. In conclusion, the lack of continuity in the collaboration between health-care professionals may affect the quality of community health services because continuity is a vital component of care.

Adult↗