Federal Funding for Integrated Service Delivery: A Toolkit

Outlines the integrated approach to career advancement, income enhancements and work supports, and financial and asset-building services of Casey's Center for Working Families. Examines federal funding streams available, eligibility, and potential issues

Ensuring Access to Care in Medicaid Under Health Reform

Outlines discussions about increasing primary care provider participation; specialist and mental health access; safety-net capacity; managed care plans, team-based care, and integrated service delivery; and coordinating Medicaid and exchange coverage

US and UK Routes to Employment: Strategies to Improve Integrated Service Delivery to People with Disabilities

In this report, the authors examine the experience of the United States and United Kingdom in developing effective strategies for providing integrated service delivery. The report examines what works and what doesn't work, and provides a roadmap to improving services for individuals with disabilities. While more research is needed, the report identifies 12 strategies to strengthen integrated service delivery systems, and to assist individuals with disabilities in gaining and maintaining productive employment. Implementing these strategies can benefit clients, who have the opportunity to realize their potential more fully; the taxpayer, who is paying less for disability assistance; and society at large, which gains the productive skill of talented individuals

Promising initiatives for integrated service delivery

Objective: Health service users require local services that meet their needs, are connected and easy to navigate. Delivering well integrated and coordinated health care services is challenging. This review aimed to identify integrated care initiatives that improved outcomes for health service users. Methods: A pragmatic literature review was undertaken using a range of electronic databases, websites and grey literature sources. Lessons learned: Diverse models of integrated care have been established across Australia. The most promising initiatives include: Primary Care Partnerships, community-oriented primary health care centres, GP Super Clinics and comprehensive primary health care approaches. The key mechanisms underlying these initiatives are effective communication and support; appropriate structural arrangements, use of technology and tailoring of services to meet local needs. However, many challenges remain, including limited evidence of effectiveness; limited integration with hospitals; poor alignment with other service boundaries; and lack of appropriate measures to evaluate integration efforts. Implications: While evidence from integrated health service delivery projects has demonstrated improved outcomes, experiences and satisfaction for patients, upstream policies and organisational/system initiatives are also needed to enable effective and efficient integrated care at the service delivery level

Management of chronic conditions in resource limited settings: multi stakeholders’ perception and experiences with receiving and providing integrated HIV, diabetes and hypertension services in Tanzania

Background: The rising prevalence of non-communicable diseases (NCDs) alongside the continuing high burden of HIV poses a serious challenge to middle- and low-income countries’ healthcare systems. Pilot studies of integrated models of service delivery for HIV, hypertension and diabetes have demonstrated that they are feasible and acceptable among patients and care providers. This study assessed multi-stakeholders’ perspectives of the delivery and receipt of integrated care in Tanzania. Methods: A qualitative process evaluation was conducted in Dar es Salaam region of Tanzania where the integrated service delivery model was implemented from July to November 2021. In-depth interviews were held with seven key informants at the national, regional and district levels, eight healthcare providers, two researchers working at the integrated clinic and forty patients benefiting from integrated services at a large hospital. Three focus group discussions were held with community leaders and residents of the hospital’s catchment area, and clinic level observations were conducted. Thematic analysis was conducted followed by the use of Bronfenbrenner’s ecological model to identify factors pertinent to sustaining and scaling up of the integrated model. Results: Participants of the study at all levels were aware of the increased prevalence of NCDs specifically for hypertension and diabetes and were concerned about the trend of increasing co-morbid conditions among people living with HIV (PLHIV). The integrated service delivery model was positively perceived by stakeholders because of its multiple benefits for both patients and the healthcare system. These include stigma and discrimination reduction, improved quality of care, efficient use of limited resources, cost and time saving, reduced duplication of services and fostering of early detection for undiagnosed conditions. The organisation of the clinic was critical in increased satisfaction. Several challenges were observed, which included costs for NCD services relative to free care for HIV and inconsistent availability of NCD medications. Conclusion: Stakeholders reported numerous benefits of the integrated service delivery model that are fundamental in improving the health of many Tanzanians living with NCDs and HIV. These benefits highlight the need for policy and decision-makers to sustain and expand the integrated service delivery model as a solution to many challenges facing the health system especially at the primary care level

FACILITATING INTEGRATED SERVICE DELIVERY VIA NETWORKING FORUMS: LESSONS FROM A CASE STUDY

At the dawn of democracy in South Africa in 1994 the government inherited a welfare system that was fragmented because of apartheid institutional arrangements. Collaboration between different government departments and organisations within civil society was almost non-existent. A silo culture was prevalent as a result of haphazard service delivery efforts, which led to ineffective and inefficient service delivery. Given the disjointed nature of service delivery within social welfare as well as other sectors of the economy, urgent measures were needed to ensure that the population benefits from well-coordinated and holistic service delivery efforts (White Paper for Social Welfare, 1997). It is in this context that the notion of integrated service delivery (ISD) became a national buzzword. There was political pressure for government departments as well as organisations within civil society to ensure that integration of services was promoted at all costs. As a part response to this call, the Department of Social Development (DSD) introduced the idea of networking forums. Several government departments and non-governmental organisations (NGOs) participate in these networking forums. Monthly meetings are held where stakeholders from different NGOs and government departments discuss and formulate coordinated responses to service delivery within particular geographical areas of operation. Thus, through these monthly meetings a platform for networking between NGOs, the DSD and other government departments is created which allows sharing of information and initiation of coordinated efforts in serving the communities within their demarcated radius of operation. This article examines how these networking forums pioneered by the DSD have been instrumental in enhancing integrated service delivery

A framework for integrated early childhood development

This resource is intended to support and encourage integrated service delivery across the early childhood development sector. Integrated service delivery brings together different disciplines and services into a more comprehensive service delivery system. An integrated approach to early childhood development enables families to access multiple services in a cohesive way. The framework for integrated early childhood development draws on current research, Queensland early childhood integrated service reviews and evaluations, and was developed in consultation with several funded services. Research indicates integrated services are increasingly providing positive outcomes for children and their families. In Cairns, Mookai Rosie Bi-Bayan provides a home away from home for women who come to prepare for their babies’ birth or attend medical appointments not available in their far northern communities. One of their integrated programs is the Bi-Bayan Playgroup where playgroup staff work with other members of the Mookai Rosie team to offer holistic parenting support, including culturally supportive behaviour management, nutrition programs, and advocacy and referral pathways for children with developmental concerns. This framework focuses on integration within service delivery and is intended to support early childhood development services to analyse and enhance their integrated approach. It has four main components: 1. An overview of integration in early childhood development; 2. The department’s model for integrated early childhood development services; 3. A reflective tool to support organisations to develop or enhance their integrated approach; and 4. A range of relevant references and tools. The reflective tool is composed of reflective questions which providers can use to enhance or evaluate their services. The reflective tool is enhanced with examples and case studies from Queensland services to illustrate the successes, challenges and variety of approaches to integrated early childhood development. At the Caboolture Early Years Centre, for example, staff recognised that it took a while for everyone to get their heads around who did what when they first started working in an integrated way. To help the process along, they jointly created a plan which formalised staff roles. After six months, people became more comfortable with the integrated model and individual challenges were worked through

Development and implementation of the Ontario Stroke System: the use of evidence

<b>Introduction</b><br> The Ontario Stroke System was developed to enhance the quality and continuity of stroke care provided across the care continuum. <br><b>Research Objective</b> <br> To identify the role evidence played in the development and implementation of the Ontario Stroke System. <br><b><title>Methods</b> This study employed a qualitative case study design. In-depth interviews were conducted with six members of the Ontario Stroke System provincial steering committee. Nine focus groups were conducted with: Regional Program Managers, Regional Education Coordinators, and seven acute care teams. To supplement these findings interviews were conducted with eight individuals knowledgeable about national and international models of integrated service delivery.<br> <b>Results</b><br> Our analyses identified six themes. The first four themes highlight the use of evidence to support the process of system development and implementation including: 1) informing system development; 2) mobilizing governmental support; 3) getting the system up and running; and 4) integrating services across the continuum of care. The final two themes describe the foundation required to support this process: 1) human capacity and 2) mechanisms to share evidence. <br> <b>Conclusion</b><br> This study provides guidance to support the development and implementation of evidence-based models of integrated service delivery