Regionalization of health services in Newfoundland and Labrador: perceptions of the planning, implementation and consequences of regional governance

2005 ◽  
Vol 10 (2_suppl) ◽  
pp. 12-21 ◽  
Author(s):  
Doreen Neville ◽  
Gwynedd Barrowman ◽  
Brenda Fitzgerald ◽  
Stephen Tomblin
Keyword(s):  
Health Services ◽  
Full Range ◽  
Health Department ◽  
Governance Structure ◽  
Regional Governance ◽  
Senior Administrators ◽  
Policy Goals ◽  
Integration Of Services ◽  
Key Issues ◽  
Senior Health

Objectives To describe the context and key drivers for regionalization of one provincial health care system in Canada; to document the original expectations of regionalization on governance and the extent to which these expectations were met; to identify the perceived successes and weaknesses of the process; and to examine the key issues and concerns that warrant further consideration and action in the future. Methods Forty-five CEO/senior administrator or senior health department officials in the period 1993-2001 were invited to participate, of whom 35 were interviewed (67% of senior health officials and 85% of CEOs/ senior administrators). Results For the most part, key informants felt that expectations of reform with respect to reduction in the number of boards and integration of services under each board's mandate did occur. However, ongoing financial restraint, failure to include the full range of health services under the regional board mandate (including physician and pharmaceutical services), uncertainty regarding the level of authority the regional boards had for decision-making, and unclear accountability mechanisms between the regional boards and the provincial Ministry of Health limited the extent to which broader expectations related to development of a population health focus, and improved continuity of care for individuals and families was achieved. Conclusions Implications for policy-makers were identified in four main areas: alignment between health policy goals and the governance structure; clarification of authority and accountability relationships; clarification of roles and responsibilities among all key actors; and strengthening of mechanisms that support accountability.

Integrating Mental Health Services through Reimbursement Reform and Managed Mental Health Care

1997 ◽  
Vol 2 (2) ◽  
pp. 86-93 ◽  
Author(s):  
David Mechanic
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Financial Incentives ◽  
Systems Of Care ◽  
Public Mental Health ◽  
Community Services ◽  
Integration Of Services ◽  
The Usa ◽  
The Uk

People with serious and persistent mental illness require a range of community services typically provided by different specialized agencies. At the clinical level, assertive team case management is the strategy commonly used to achieve integration of services across specialized sectors. The USA also has used various financial and organizational approaches to reduce fragmentation and increase effectiveness, including development of stronger public mental health authorities, use of financial incentives to change professional and institutional behavior, requirements to allocate savings from hospital closures to community systems of care, and introduction of mental health managed care on a broad scale. These approaches have potential but also significant problems and there is often a large gap between theory and implementation. These US developments are discussed with attention to the implications for mental health services in the UK.

scholarly journals Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Michael Clark ◽  
Michelle Cornes ◽  
Martin Whiteford ◽  
Robert Aldridge ◽  
Elizabeth Biswell ◽  
...  
Keyword(s):  
Integrated Care ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Policy Issue ◽  
Content Type ◽  
Complex Needs ◽  
Integration Of Services ◽  
Key Issues ◽  
Discharge From Hospital ◽  
High Degree

PurposePeople experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.Design/methodology/approachThe paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.FindingsSupporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.Research limitations/implicationsThe data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.Practical implicationsIntegration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.Social implicationsAddressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.Originality/valueThis paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.

scholarly journals Mapping UK mental health services for adults with attention-deficit/hyperactivity disorder: national survey with comparison of reporting between three stakeholder groups

BJPsych Open ◽  
2020 ◽  
Vol 6 (4) ◽  
Author(s):  
Anna Price ◽  
Astrid Janssens ◽  
Tamsin Newlove-Delgado ◽  
Helen Eke ◽  
Moli Paul ◽  
...  
Keyword(s):  
Mental Health ◽  
Attention Deficit Hyperactivity Disorder ◽  
Mental Health Services ◽  
Young People ◽  
Health Services ◽  
Attention Deficit ◽  
Full Range ◽  
Hyperactivity Disorder ◽  
Stakeholder Groups ◽  
The Uk

Background UK clinical guidelines recommend treatment of attention-deficit hyperactivity disorder (ADHD) in adults by suitably qualified clinical teams. However, young people with ADHD attempting the transition from children's to adults’ services experience considerable difficulties in accessing care. Aims To map the mental health services in the UK for adults who have ADHD and compare the reports of key stakeholders (people with ADHD and their carers, health workers, service commissioners). Method A survey about the existence and extent of service provision for adults with ADHD was distributed online and via national organisations (e.g. Royal College of Psychiatrists, the ADHD Foundation). Freedom of information requests were sent to commissioners. Descriptive analysis was used to compare reports from the different stakeholders. Results A total of 294 unique services were identified by 2686 respondents. Of these, 44 (15%) were dedicated adult ADHD services and 99 (34%) were generic adult mental health services. Only 12 dedicated services (27%) provided the full range of treatments recommended by the National Institute for Health and Care Excellence. Only half of the dedicated services (55%) and a minority of other services (7%) were reported by all stakeholder groups (P < 0.001, Fisher's exact test). Conclusions There is geographical variation in the provision of NHS services for adults with ADHD across the UK, as well as limited availability of treatments in the available services. Differences between stakeholder reports raise questions about equitable access. With increasing numbers of young people with ADHD graduating from children's services, developing evidence-based accessible models of care for adults with ADHD remains an urgent policy and commissioning priority.

Early intervention for psychosis

2019 ◽  
pp. 87-100
Author(s):  
Eric Y.H. Chen ◽  
Sherry Kit-wa Chan ◽  
Wing-chung Chang ◽  
Christy Lai-ming Hui ◽  
Edwin Ho-ming Lee ◽  
...  
Keyword(s):  
Hong Kong ◽  
Early Intervention ◽  
Public Awareness ◽  
Full Range ◽  
Population Based ◽  
Dose Effect ◽  
Intervention Programme ◽  
Resource Setting ◽  
Long Term Follow Up ◽  
Key Issues

This chapter provides a comprehensive review of some of the key issues in early intervention for psychosis using the example of a population-based service in Hong Kong, for which a full range of data is available. The authors review a number of studies addressing: (i) the DUP and its associated factors in Hong Kong; (ii) whether DUP can be changed by public awareness programmes; (iii) the immediate outcome of a two-year early intervention programme; (iv) whether the improved outcome can be sustained after the programme, over ten years; and (v) whether receiving one more year of intervention could further improve the outcome. The results show that even in a low-resource setting in Hong Kong, significant improvements in functioning can be achieved, with reduced hospitalization and reduced suicide. A long-term follow-up study observed that these effects are sustainable over ten years. Further improvements can be attained by providing longer intervention to a group that responded less favourably. However, these enhancements proved more difficult to sustain. Together, these suggest a possible dose effect on the impact and sustainability of early intervention for psychosis. Future work should aim to clarify the role of increased intervention resources such as manpower and a more defined specific programme (e.g. coaching, exercise, cognitive interventions). More work is also required to investigate the culture of early psychosis services (such as a hope-centred culture), as well as how more personalized needs of individual patients can be met.

Advanced allied health assistants: an emerging workforce

2015 ◽  
Vol 39 (3) ◽  
pp. 260 ◽  
Author(s):  
Claire Pearce ◽  
Leanne Pagett
Keyword(s):  
Health Services ◽  
Clinical Experience ◽  
Allied Health ◽  
Governance Structure ◽  
Scope Of Practice ◽  
Positive Contribution ◽  
Australian Capital Territory ◽  
Competency Development ◽  
Literature Reviews ◽  
Career Structure

Objective Nationally and internationally there is work underway to continue to advance the scope of practice of allied health assistants (AHA). The advanced role requires additional training and competency development, as well as significant clinical experience. To build on the evidence relating to advanced scope AHAs, ACT Health undertook a project to explore the potential for the development of the local AHA workforce. This paper provides an overview of the project. Methods The potential for advanced AHAs in the Australian Capital Territory (ACT) was assessed using literature reviews, consultation with other services working with advanced AHAs and interviews with local allied health managers and assistants. Results A role for advanced AHAs within the ACT workforce was recommended, along with the need to further develop the AHA governance structure and AHA training packages and to undertake more research into the AHA workforce. Conclusion AHAs make a positive contribution to the delivery of effective, responsive, consumer-focused healthcare. The advanced AHA role provides further opportunities to enhance the flexibility of allied health services while also providing a career structure for this growing workforce.

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