scholarly journals “You know, we can change the services to suit the circumstances of what is happening in the world”: a rapid case study of the COVID-19 response across city centre homelessness and health services in Edinburgh, Scotland

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Tessa Parkes ◽  
Hannah Carver ◽  
Wendy Masterton ◽  
Danilo Falzon ◽  
Joshua Dumbrell ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Social Needs ◽  
City Centre ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Complex Needs ◽  
Health And Social Care ◽  
The Impact

Abstract Background The COVID-19 pandemic has necessitated unprecedented changes in the way that health, social, and housing services are delivered to individuals experiencing homelessness and problem substance use. Protecting those at high risk of infection/transmission, whilst addressing the multiple health and social needs of this group, is of utmost importance. This study aimed to document the impact of the COVID-19 pandemic on individuals who were experiencing homelessness in one city centre in Scotland, and how services adapted in response. Methods Semi-structured interviews were conducted with individuals with lived/living experience of homelessness (n = 10), staff within onethird sector service (n = 5), and external professionals (n = 5), during April-August 2020, using a rapid case study design. These were audio-recorded, fully transcribed, and analysed using Framework. Analysis was informed by inclusion health and equity-orientated approaches to meeting the needs of people with multiple and complex needs, and emerging literature on providing harm reduction in the context of COVID-19. Results Those with lived/living experience of homelessness and problem substance use faced a range of additional challenges during the pandemic. Mental health and use of substances were affected, influenced by social isolation and access to services. A range of supports were provided which flexed over the lockdown period, including housing, health and social care, substance use treatment, and harm reduction. As well as documenting the additional risks encountered, findings describe COVID-19 as a ‘path-breaking’ event that created opportunities to get evidence into action, increase partnership working and communication, to proactively address risks. Conclusions This rapid case study has described the significant impact of the COVID-19 pandemic on a group of people experiencing homelessness and problem substance use within one city centre in Scotland and provides a unique lens on service/professional responses. It concludes with lessons that can inform the international and ongoing response to this pandemic. It is vital to recognise the vision and leadership that has adapted organisational responses in order to reduce harms. We must learn from such successes that were motivated both by compassion and care for those vulnerable to harms and the desire to provide high-quality, evidence-based, harm reduction services.

scholarly journals Having a voice

2018 ◽  
Vol 26 (4) ◽  
pp. 342-352 ◽  
Author(s):  
Rachel Massie ◽  
Richard Machin ◽  
Fiona McCormack ◽  
Judith Kurth
Keyword(s):  
Lived Experience ◽  
Homeless People ◽  
Urban Setting ◽  
City Centre ◽  
Research Approach ◽  
Structured Interviews ◽  
Content Type ◽  
Complex Needs ◽  
Peer Researchers ◽  
The Impact

PurposeThe purpose of this paper is to understand the lived experience of people who have experienced homelessness and street activity, and professional stakeholders’ views about the challenges faced by this client group. The study sought to identify measures to improve the current situation for both individuals experiencing homelessness and professionals working with them.Design/methodology/approachPeer researchers with lived experience of multiple and complex needs conducted semi-structured interviews/surveys with 18 participants (eight individuals experiencing homelessness and street activity and ten professional stakeholders). The authors of the paper conducted a thematic analysis of the data.FindingsThis paper offers insights into both the current challenges and assets for people who are or have been homeless in an urban setting. Key findings include the need for a coordinated partnership approach to address pathways to support, and the importance of developing opportunities for meaningful activity and building on local resources including giving homeless people a voice. These findings are discussed within the context of current policy (Housing First) and legislation (Homelessness Reduction Act 2017) and the impact on integrated care for people who have experienced homelessness.Research limitations/implicationsThe views explored in this study are specific to one city centre in the West Midlands; thus, generalisability may be limited.Originality/valueThis study presents a participatory research approach with peer researchers exploring the perspective of individuals experiencing homelessness and wider stakeholders. The findings of this research are considered with reference to the provisions of the HRA 2017.

scholarly journals Community-based organizations’ perspectives on improving health and social service integration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Etsemaye P. Agonafer ◽  
Savanna L. Carson ◽  
Vanessa Nunez ◽  
Kelli Poole ◽  
Clemens S. Hong ◽  
...  
Keyword(s):  
Los Angeles ◽  
Health Systems ◽  
Social Service ◽  
Social Needs ◽  
Assessment Process ◽  
Structured Interviews ◽  
Community Based ◽  
Community Based Organizations ◽  
Health And Social Care ◽  
The Impact

Abstract Background Collaborations between health systems and community-based organizations (CBOs) are increasingly common mechanisms to address the unmet health-related social needs of high-risk populations. However, there is limited evidence on how to develop, manage, and sustain these partnerships, and implementation rarely incorporates perspectives of community social service organizations. To address these gaps, we elicited CBOs’ perspectives on service delivery for clients, the impact of the Whole Person Care-Los Angeles (WPC-LA) initiative to integrate health and social care, and their suggestions for improving health system partnerships. Methods Using stakeholder engaged principles and a qualitative Rapid Assessment Process, we conducted brief surveys and in-depth semi-structured interviews with 65 key informants from 36 CBOs working with WPC-LA. Results Major themes identified by CBOs included: 1) the importance of a holistic, client-centered, continuously engaged approach that is reliant on regional partnerships; 2) benefits of WPC-LA expanding capacity and networks; 3) concerns about communication and redundancy hindering WPC-LA; and 4) a need for more equitable partnerships incorporating their approaches. Conclusions CBOs value opportunities for integration with health systems, bring critical expertise to these partnerships, and seek to strengthen cross-sector collaborations. Early, equitable, and inclusive participation in the development and implementation of these partnerships may enhance their effectiveness, but requires policy that prioritizes and incentivizes sustainable and mutually beneficial partnerships.

scholarly journals COVID-19 Social Restrictions: An Opportunity to Re-visit the Concept of Harm Reduction in the Treatment of Alcohol Dependence. A Position Paper

2021 ◽  
Vol 12 ◽  
Author(s):  
Christos Kouimtsidis ◽  
Bernadette Pauly ◽  
Tessa Parkes ◽  
Tim Stockwell ◽  
Alexander Mario Baldacchino
Keyword(s):  
Substance Use ◽  
Alcohol Use ◽  
Harm Reduction ◽  
Alcohol Use Disorders ◽  
Position Paper ◽  
Substance Use Treatment ◽  
Health And Social Care ◽  
Substance Use Services ◽  
Alcohol Harm Reduction ◽  
The Impact

The COVID-19 pandemic is presenting significant challenges for health and social care systems globally. The implementation of unprecedented public health measures, alongside the augmentation of the treatment capacity for those severely affected by COVID-19, are compromising and limiting the delivery of essential care to people with severe substance use problems and, in some cases, widening extreme social inequities such as poverty and homelessness. This global pandemic is severely challenging current working practices. However, these challenges can provide a unique opportunity for a flexible and innovative learning approach, bringing certain interventions into the spotlight. Harm reduction responses are well-established evidenced approaches in the management of opioid dependence but not so well-known or implemented in relation to alcohol use disorders. In this position paper, we explore the potential for expanding harm reduction approaches during the COVID-19 crisis and beyond as part of substance use treatment services. We will examine alcohol use and related vulnerabilities during COVID-19, the impact of COVID-19 on substance use services, and the potential philosophical shift in orientation to harm reduction and outline a range of alcohol harm reduction approaches. We discuss relevant aspects of the Structured Preparation for Alcohol Detoxification (SPADe) treatment model, and Managed Alcohol Programs (MAPs), as part of a continuum of harm reduction and abstinence orientated treatment for alcohol use disorders. In conclusion, while COVID-19 has dramatically reduced and limited services, the pandemic has propelled the importance of alcohol harm reduction and created new opportunities for implementation of harm reduction philosophy and approaches, including programs that incorporate the provision of alcohol as medicine as part of the substance use treatment continuum.

scholarly journals The Development and Feasibility Study of a Multimodal ‘Talking Wall’ to Facilitate the Voice of Young People with Autism and Complex Needs: A Case Study in a Specialist Residential School

2020 ◽  
Vol 50 (12) ◽  
pp. 4267-4279
Author(s):  
Norah Richards ◽  
Laura Crane
Keyword(s):  
Young People ◽  
Residential School ◽  
Structured Interviews ◽  
Complex Needs ◽  
Innovative Method ◽  
The Impact ◽  
Further Development ◽  
The Voice

AbstractLimited research has examined methods to investigate the views, preferences and experiences of young people with autism and complex needs. The aim of this study, based at a specialist residential school in England, was to develop and pilot an innovative method for this purpose—a ‘Talking Wall’—that was trialled over a 6-month period. Thematic analysis of data from focus groups and semi structured interviews with staff, combined with structured observations of pupils, resulted in three key themes: supporting the expression and evaluation of emotions that underlie preferences; recognising the impact of transitions; and the important role of familiar adults in interpreting communication bids. These positive, initial findings suggest the Talking Wall approach merits further development and evaluation.

scholarly journals Gaps in the System: Supporting People Living With Dementia and Their Caregivers

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 521-522
Author(s):  
Madeline King ◽  
Allie Peckham ◽  
Monika Roerig ◽  
Husayn Marani ◽  
Gregory Marchildon
Keyword(s):  
New York ◽  
Lived Experience ◽  
New York State ◽  
Social Needs ◽  
Decision Makers ◽  
Structured Interviews ◽  
Care Needs ◽  
Complex Needs ◽  
Program Administrators ◽  
Health And Social Care

Abstract As individuals are living longer, the prevalence of older adults living with dementia and other complex health and social care needs is on the rise (Alzheimer’s Association, 2020; CIHI, 2020). Correspondingly, efforts to develop supportive programming and policies for persons living with dementia (PLWDs) are of paramount importance (CIHR, 2019). The challenges faced by PLWDs and other complex health and social needs are widely known (CIHR, 2019), however, a systematic understanding of how and if current and long-standing efforts are adequately meeting the needs of these individuals remains elusive. This research sought to understand how program administrators, decision makers, PLWD, and caregivers across five North American jurisdictions (British Columbia, Ontario, Newfoundland and Labrador, New York State, and Vermont) perceived specific dementia care programs and support services within their respective jurisdictions. We performed an inductive analysis of semi-structured interviews (N=37) and identified on-going care gaps experienced by participants. We present three main gaps: 1) disconnected and uncoordinated system infrastructure, 2) lack of comprehensive services to meet the diverse needs of PLWD and their caregivers, and 3) inconsistency in how dementia is understood; with associated perceived remedies. The results suggest that even when attempts to address the needs of PLWD and their caregivers are put in place there remains significant limitations of systems. The perspectives of decision makers, program administrators and individuals with lived experience offer unique insight into how these experiences may be improved to better support the complex needs of PLWD and their caregivers.

A general practice provider federation in a mixed health economy in England: a case study investigation

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696929
Author(s):  
Jill Mitchell
Keyword(s):  
General Practice ◽  
Shared Vision ◽  
Health Economy ◽  
Structured Interviews ◽  
The North ◽  
Common Strategy ◽  
Common Purpose ◽  
Collaborative Working ◽  
The Impact

BackgroundThere is an emerging debate that general practice in its current format is out-dated and there is a requirement to move to a federated model of provision where groups of Practices come together. The emergence of federations has developed over the past 5 years but the factors that influence how federations develop and the impact of this new model is an under researched area.AimThe study explored the rationale around why a group of independent GP practices opted to pursue an alternative business venture and the benefits that this strategy offered.MethodA single organisational case study of a federation in the North of England was conducted between 2011–2016. Mixed methods data collection included individual and group semi-structured interviews and quantitative surveys.ResultsFederations promote collaborative working, relying on strategic coherence of multiple individual GP practices through a shared vision and common purpose. Findings revealed many complexities in implementing a common strategy across multiple independent businesses. The ability of the federation to gain legitimacy was two dimensional – externally and internally. The venture had mixed successes, but their approach to quality improvement proved innovative and demonstrated outcomes on a population basis. The study identified significant pressures that practices were experiencing and the need to seek alternative ways of working but there was no shared vision or inclination to relinquish individual practice autonomy.ConclusionOrganisational development support is critical to reform General Practice. Whether central funding through the GP Five Year Forward View will achieve the scale of change required is yet to be evidenced.

scholarly journals Spatiotemporal Variance Assessment of Urban Rainstorm Waterlogging Affected by Impervious Surface Expansion: A Case Study of Guangzhou, China

2018 ◽  
Vol 10 (10) ◽  
pp. 3761 ◽  
Author(s):  
Huafei Yu ◽  
Yaolong Zhao ◽  
Yingchun Fu ◽  
Le Li
Keyword(s):  
Spatial Pattern ◽  
Urban Renewal ◽  
Impervious Surface ◽  
City Centre ◽  
Impervious Surfaces ◽  
Surface Expansion ◽  
The Impact ◽  
Gwr Model ◽  
Runoff Plots

Urban rainstorm waterlogging has become a typical “city disease” in China. It can result in a huge loss of social economy and personal property, accordingly hindering the sustainable development of a city. Impervious surface expansion, especially the irregular spatial pattern of impervious surfaces, derived from rapid urbanization processes has been proven to be one of the main influential factors behind urban waterlogging. Therefore, optimizing the spatial pattern of impervious surfaces through urban renewal is an effective channel through which to attenuate urban waterlogging risk for developed urban areas. However, the most important step for the optimization of the spatial pattern of impervious surfaces is to understand the mechanism of the impact of urbanization processes, especially the spatiotemporal pattern of impervious surfaces, on urban waterlogging. This research aims to elucidate the mechanism of urbanization’s impact on waterlogging by analysing the spatiotemporal characteristics and variance of urban waterlogging affected by urban impervious surfaces in a case study of Guangzhou in China. First, the study area was divided into runoff plots by means of the hydrologic analysis method, based on which the analysis of spatiotemporal variance was carried out. Then, due to the heterogeneity of urban impervious surface effects on waterlogging, a geographically weighted regression (GWR) model was utilized to assess the spatiotemporal variance of the impact of impervious surface expansion on urban rainstorm waterlogging during the period from the 1990s to the 2010s. The results reveal that urban rainstorm waterlogging significantly expanded in a dense and circular layer surrounding the city centre, similar to the impervious surface expansion affected by urbanization policies. Taking the urban runoff plot as the research unit, GWR has achieved a good modelling effect for urban storm waterlogging. The results show that the impervious surfaces in the runoff plots of the southeastern part of Yuexiu, the southern part of Tianhe and the western part of Haizhu, which have experienced major urban engineering construction, have the strongest correlation with urban rainstorm waterlogging. However, for different runoff plots, the impact of impervious surfaces on urban waterlogging is quite different, as there exist other influence factors in the various runoff plots, although the impervious surface is one of the main factors. This result means that urban renewal strategy to optimize the spatial pattern of impervious surfaces for urban rainstorm waterlogging prevention and control should be different for different runoff plots. The results of the GWR model analysis can provide useful information for urban renewal strategy-making.

Three stages of entrepreneurial orientation: the founder’s role

2019 ◽  
Vol 26 (2) ◽  
pp. 285-306 ◽  
Author(s):  
Torbjörn Ljungkvist ◽  
Börje Boers ◽  
Joachim Samuelsson
Keyword(s):  
Entrepreneurial Orientation ◽  
Single Case ◽  
Annual Reports ◽  
Structured Interviews ◽  
Theoretical Understanding ◽  
Content Type ◽  
Five Dimensions ◽  
The Impact ◽  
Over Time

Purpose The purpose of this paper is to understand the development of the five dimensions of entrepreneurial orientation (EO) over time by taking a founder’s perspective. Design/methodology/approach The paper draws on an in-depth single-case study. It combines semi-structured interviews in the company with archival data, such as annual reports, press clips and interviews in business magazines. Findings The results indicate that the EO dimensions change from being personalized and directly solution-oriented to being intangible value-creation-oriented. Originality/value By suggesting ownership-based EO configurations, this study contributes insights into how different ownership forms propel EO. These configurations – that is, personal, administrative based and intangible focused – show the impact of the EO dimensions and provide a systematic and theoretical understanding of EO change over time.

scholarly journals Using RE-AIM to examine the potential public health impact of an integrated collaborative care intervention for weight and depression management in primary care: Results from the RAINBOW trial

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248339
Author(s):  
Megan A. Lewis ◽  
Laura K. Wagner ◽  
Lisa G. Rosas ◽  
Nan Lv ◽  
Elizabeth M. Venditti ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Collaborative Care ◽  
Health Impact ◽  
Public Health Impact ◽  
Integrative Approach ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Care Intervention ◽  
The Impact

Background An integrated collaborative care intervention was used to treat primary care patients with comorbid obesity and depression in a randomized clinical trial. To increase wider uptake and dissemination, information is needed on translational potential. Methods The trial collected longitudinal, qualitative data at baseline, 6 months (end of intensive treatment), 12 months (end of maintenance treatment), and 24 months (end of follow-up). Semi-structured interviews (n = 142) were conducted with 54 out of 409 randomly selected trial participants and 37 other stakeholders, such as recruitment staff, intervention staff, and clinicians. Using a Framework Analysis approach, we examined themes across time and stakeholder groups according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Results At baseline, participants and other stakeholders reported being skeptical of the collaborative care approach related to some RE-AIM dimensions. However, over time they indicated greater confidence regarding the potential for future public health impact. They also provided information on barriers and actionable information to enhance program reach, effectiveness, adoption, implementation, and maintenance. Conclusions RE-AIM provided a useful framework for understanding how to increase the impact of a collaborative and integrative approach for treating comorbid obesity and depression. It also demonstrates the utility of using the framework as a planning tool early in the evidence-generation pipeline.

scholarly journals Substance use Treatment and Harm Reduction Services for Migrants and Refugees in the COVID-19 Pandemic: Findings from a Global Survey

2020 ◽  
Author(s):  
Cornelis De Jong ◽  
Ali Farhoudian ◽  
Mehrnoosh Vahidi ◽  
Mohsen Ebrahimi ◽  
Hamed Ekhtiari ◽  
...  
Keyword(s):  
Substance Use ◽  
Harm Reduction ◽  
Substance Use Disorders ◽  
Mental Health Problems ◽  
World Health ◽  
Substance Use Treatment ◽  
Second Phase ◽  
Addiction Medicine ◽  
Global Survey ◽  
The Impact

Abstract Migrants and refugees are considered vulnerable to mental health problems and substance use disorders; and may be particularly affected by service disruptions associated with the COVID-19 pandemic The International Society of Addiction Medicine (ISAM) ran a multi-phased global survey among clinicians and health professional that are actively working in the field of addiction medicine to investigate the impact of the COVID-19 pandemic on substance use and related services. In March 2020, the first month after the announcement of the pandemic by the World Health Organization, 177 informants from 77 countries took part in the global survey, and only 12.9% of them reported their countries’ substance use treatment and harm reduction services for the migrants and refugees with substance use disorders continued as usual. In May 2020, 11.7% of respondents of the second phase reported that the services for refugees and migrants improved in comparison to March 2020; 11.7% reported that these services in their country discontinued. Results suggest that refugee and migrants access to treatment and harm reduction services has been reduced as a result of COVID-19. It can be concluded that it is crucial to improve the visibility of migrants’ needs and exploit appropriate interventions for those with substance use disorders.

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