Health and social care coordination for severe and persistent mental illness in Australia: a mixed methods evaluation of experiences with the Partners in Recovery Program

Background Care coordination has been identified as a person-centred response to the difficulty in meeting the needs of people with severe and persistent mental illness and complex needs. This study evaluated the processes and outcomes of the Partners in Recovery initiative in the Australian Capital Territory, a program established to improve coordination of health and social care for this population. Methods Client, carer and service provider experiences were investigated using a combination of quantitative and qualitative methods. Quantitative data were collected through questionnaires completed by clients (n = 25) and service providers (n = 14). Qualitative data comprised open-ended written feedback from the surveys, together with semi-structured interviews with selected clients (n = 6), carers (n = 2), and service providers (n = 4). In both study elements, questions focused on dimensions of experience such as communication, continuity and coordination, teamwork and sustainability. Descriptive statistics were calculated for quantitative data; qualitative data were analysed using content analysis. Results Clients were satisfied with the program across the majority of experience dimensions, and there was evidence of improved access to coordinated care. Support Facilitators (care coordinators) were central to client and carer reports of the impacts of the program, and to coordination between services through connections built at the individual level. Challenges included difficulties with information continuity, a lack of role clarity for service providers, and uncertainty about the legacy of the program given the absence of formal agreements connecting different services. Conclusions The Support Facilitator role was critical to the success of the program. Support Facilitators acted as a source of stability and relational continuity for clients, while also enabling connections with external services through the development of individual level partnerships and personal networks. Systems level coordination was limited by communication difficulties and a lack of formalised infrastructure to support cooperation between services, calling into question the lasting impact of the program for system change.Funding for this evaluation was provided by Capital Health Network, the Lead Agency for Partners in Recovery in the ACT. During the conduct of this study, MB was supported by ARC DECRA DE150100637 and OF was supported by ACT Health Services Agreement 2015.27504.340

Medical-Legal Partnerships to Support Continuity of Care for Immigrants Impacted by HIV: Lessons Learned from California.

The United States (US) has experienced a surge of anti-immigrant policies and rhetoric, raising concerns about the influence on health outcomes for immigrants living in the US. We conducted qualitative interviews (n = 20) with health care and social service providers, attorneys, and legal/policy experts in California to understand how agencies were maintaining access to HIV care and prevention for immigrant clients. We conducted a thematic analysis to describe the role of medical-legal partnerships (MLPs) and document best practices. Informants reported high demand for legal services. Referrals were facilitated by case managers, medical providers, and pre-existing relationships between clinics and legal agencies. Informants identified a need for additional funding and further guidance on screening for and supporting patients with legal needs. MLPs have the capacity to create sustainable, efficient, comprehensive structural changes that minimize barriers to HIV prevention and treatment and improve health outcomes among immigrant populations

Effect of spoken language on primary care choice refugee health assessment program patients seen at Boston Medical Center

PURPOSE: There are approximately 21.3 million refugees worldwide. Connection to primary care is essential for these patients because of the potential for long-term and complex care that they require. Primary care and continuity of care also leads to better health outcomes. This study examined what effect primary language had on primary care choice by Refugee Health Assessment Program (RHAP) patients seen at Boston Medical Center (BMC) and whether patients who chose non-BMC primary care eventually returned to BMC. METHODS: A retrospective cohort study was conducted examining RHAP patients’ primary language, and whether those patients continued care at BMC or sought care elsewhere. RESULTS: Significant results were seen among subjects who identified Chinese, Haitian Creole, Somali, Spanish and Vietnamese as their primary language. Spanish, Chinese, and Vietnamese speakers had greater odds of seeking care outside of BMC. Haitian Creole and Somali speakers had greater odds of seeking care at BMC compared to English speakers. 80% of subjects returned to BMC after seeking care elsewhere. CONCLUSIONS: Primary language does effect choice of primary care provider within the refugee population. Providers should use these results to encourage refugee patients less likely to seek care to connect with a primary care provider

IT process architectures for enterprises development: A survey from a maturity model perspective

During the last years much has been published about IT governance. Close to the success of many governance efforts are the business frameworks, quality models, and technology standards that help enterprises improve processes, customer service, quality of products, and control. In this paper we i) survey existing frameworks, namely ITIL, ASL and BiSL, ii) find relations with the IT Governance framework CobiT to determine if the maturity model of CobiT can be used by ITIL, ASL and BiSL, and (iii) provide an integrated vista of IT processes viewed from a maturity model perspective. This perspective can help us understand the importance of maturity models for increasing the efficiency of IT processes for enterprises development and business-IT alignment

Unlocking care: continuing mental health care for prisoners and their families

Summary People in prison have a higher incidence of mental illness than the general population. The prevalence of mental health issues is higher again for women prisoners. Although evidence suggests that some improvement can be achieved during imprisonment, new research reported in this paper finds that average mental health deteriorates in the year following release. The imprisonment of a close family member also places strains on families, including increased mental distress. The effects on children can be long lasting. While the mental health needs of prisoners have been recognised by federal, state and territory governments, the needs of their families has received less attention. Providing continued care from prison into the community is known as ‘throughcare’. The continuation of health services helps overcome some of the barriers people face re-connecting with services in the community and may contribute to a reversal of the decline in mental health following release. Accessing mental health services will often be one challenge among many, including the reestablishment of relationships with children and partners, finding secure housing, maintaining substance-use programs or counselling and finding a job. Coordinating social services for people returning to society will improve the overall success of transition. Families can also play an important role in supporting this transition – therefore, investing more resources into understanding their needs will have a flow-on benefit for former prisoners and society more generally. The design and delivery of mental health services for adults and children needs greater research and coordinated policy development. Federal leadership has led to the measuring and reporting of prisoner mental health. This program should be extended to include measurements following release and widened to include the families of prisoners. Interest in throughcare a decade ago resulted in a move towards the integration of prison and community health services. A majority of jurisdictions – Victoria, Queensland and Western Australia being the exceptions – now have an integrated health service, providing the foundation for the development of throughcare services. Improved delivery of mental health services potentially reduces the risk of re-imprisonment; providing wider personal, familial and community benefits

The Connection Strategy: Preparing Young People to Succeed in College and Beyond

Describes the P-16 approach of linking education strategies from preschool through college graduation to better prepare low-income minority students. Discusses academic content, state policy strategies, and P-16 network efforts in Atlanta

The international symposia on career development and public policy: retrospect and prospect

Between 1999 and 2011, seven international symposia on career development and public policy were held at various venues across the world, and an International Centre was established to support and maintain continuity between these events. These developments were closely intertwined with a number of other significant international developments. The origins of the symposia are described; their core design features are defined; their evolution is outlined and reviewed; and their impact is assessed. This article concludes with a discussion of the prospects for future symposia and for the International Centre

Understanding permanence for looked after children: a review of research for the Care Inquiry

This briefing paper reviews research relevant to understanding permanence for children who are ‘looked after’ under the auspices of the Children Act 1989. It aims to inform the objectives of the Care Inquiry, a collaboration between eight specialist charities which was established in 2012 to investigate how best to provide stable and permanent homes for children in England who cannot live with their birth parents (whether temporarily or permanently)

Identifying common problems in the acquisition and deployment of large-scale software projects in the US and UK healthcare systems

Public and private organizations are investing increasing amounts into the development of healthcare information technology. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardised procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the problems that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail on electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of Healthcare Information Systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems

Addressing Childhood Adversity and Social Determinants inPediatric Primary Care:Recommendations for New Hampshire

Research has clearly demonstrated the significant short- and long-term impacts of adverse childhood experiences (ACEs) and the social determinants of health (SDOH) on child health and well-being.1 Identifying and addressing ACEs and SDOH will require a coordinated and systems-based approach. Pediatric primary care* plays a critical role in this system, and there is a growing emphasis on these issues that may be impacting a family. As awareness of ACEs and SDOH grows, so too does the response effort within the State of New Hampshire. Efforts to address ACEs and the SDOH have been initiated by a variety of stakeholders, including non-profit organizations, community-based providers, and school districts. In late 2017, the Endowment for Health and SPARK NH funded the NH Pediatric Improvement Partnership (NHPIP) to develop a set of recommendations to address identifying and responding to ACEs and SDOH in NH primary care settings caring for children. Methods included conducting a review of literature and Key Informant Interviews (KII). Themes from these were identified and the findings are summarized in this report