scholarly journals A Critical Realist Evaluation of an Integrated Care Project for Vulnerable Families in Sydney, Australia

2020 ◽  
Author(s):  
Elaine Tennant ◽  
Erin Miller ◽  
Kathryn Costantino ◽  
Denise De Souza ◽  
Heidi Coupland ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Coordination ◽  
Social Needs ◽  
Local Health ◽  
Programme Theory ◽  
Critical Realist ◽  
Vulnerable Families ◽  
Integration Of Services

Abstract Background Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was established to improve the care of families with complex health and social needs who reside in Sydney Local Health District. HHAN seeks to provide long-term multi-disciplinary care coordination as well as enhance capacity building and promotion of integrated care. We describe the qualitative component of a critical realist pilot case study aimed at exploring, explaining and refining emerging HHAN programme theories in relation to care coordination. Methods Semi-structured qualitative interviews with HHAN clients (n=12), HHAN staff and other stakeholders (n=21). Emerging themes informed the development of Context-Mechanism-Outcome configurations aimed at evaluating HHAN’s effectiveness and refining the programme theory. Results HHAN’s effectiveness was based on two process mechanisms: Engagement of vulnerable clients and integration of services. The relational mechanisms underpinning effective engagement of clients by care coordinators included: building trust, leveraging other family, social and organisational relationships, meeting clients on their own terms, demonstrating staff effectiveness as quickly as possible, and client empowerment. Operational mechanisms for enhancing care integration included knowledge transfer activities and shared learning among collaborators, structural and cultural changes, enhancing mutual respect, co-location of multidisciplinary and/or interagency staff and cultivating faith in positive change among staff. Conclusions Use of a critical realism case study approach served to elucidate the varied influences of contexts and mechanisms on programme outcomes, to highlight what works for whom and in what context. Findings supported the initial programme theory that engagement and trust building with clients, alongside enhanced collaboration and integration of services, improved outcomes for vulnerable families with complex needs. Further research is needed to explore the cost-effectiveness of integrated care initiatives, in view of the long term nature of service provision and the risk of staff burnout.

scholarly journals A critical realist evaluation of an integrated care project for vulnerable families in Sydney, Australia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
E. Tennant ◽  
E. Miller ◽  
K. Costantino ◽  
D. De Souza ◽  
H. Coupland ◽  
...  
Keyword(s):  
Integrated Care ◽  
Care Coordination ◽  
Local Health ◽  
Programme Theory ◽  
Critical Realist ◽  
Vulnerable Families ◽  
Health And Social Care ◽  
Sydney Australia

Abstract Background Healthy Homes and Neighbourhoods (HHAN) Integrated Care Initiative was established to improve the care of families with complex health and social needs who reside in Sydney Local Health District. HHAN seeks to provide long-term multi-disciplinary care coordination as well as enhance capacity building and promote integrated care. The critical realist study reported here is part of the longitudinal development and evaluation of complex integrated health and social care interventions in Sydney, Australia. Methods We describe the qualitative component of a critical realist pilot case study aimed at exploring, explaining and refining emerging HHAN programme theories in relation to care coordination. Qualitative interviews were undertaken with HHAN clients (n = 12), staff and other stakeholders (n = 21). Interviews and coding used a context (C), mechanism (M) and outcome (O) framework. Inductive, deductive, retroductive and abductive modes of reasoning were used with the CMO heuristic tool to inform the developing programme theory. Results The mechanisms underpinning effective engagement of clients by care coordinators included: building trust, leveraging other family, social and organisational relationships, meeting clients on their own terms, demonstrating staff effectiveness as quickly as possible, and client empowerment. Mechanisms for enhancing care integration included knowledge transfer activities and shared learning among collaborators, structural and cultural changes, enhancing mutual respect, co-location of multidisciplinary and/or interagency staff and cultivating faith in positive change among staff. Conclusions Use of a critical realism case study approach served to elucidate the varied influences of contexts and mechanisms on programme outcomes, to highlight what works for whom and in what context. Findings supported the initial programme theory that engagement and trust building with clients, alongside enhanced collaboration and integration of services, improved outcomes for vulnerable families with complex needs. Further research is needed to explore the cost-effectiveness of integrated care initiatives, in view of the long term nature of service provision and the risk of staff burnout.

GPS mHealth Intervention among People Experiencing Homelessness: A Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Leticia R. Moczygemba ◽  
Whitney Thurman ◽  
Kyler Tormey ◽  
Anthony Hudzik ◽  
Lauren Welton-Arndt ◽  
...  
Keyword(s):  
Community Health ◽  
Mobile Health ◽  
Care Coordination ◽  
Information Exchange ◽  
Social Needs ◽  
Local Health ◽  
Hospital Visit ◽  
Mhealth Intervention ◽  
Significant Difference ◽  
E Mail

BACKGROUND People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased utilization, poor health outcomes, and high health care costs. The majority of homeless individuals have a cell phone of some type, which makes mobile health interventions a feasible way to connect a person experiencing homelessness with providers. OBJECTIVE To investigate the accuracy, acceptability, and preliminary outcomes of a global positioning system-enabled mobile health (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness were in the ED or hospital. METHODS This was a pre-post design with baseline and 4-month post-enrollment assessments. A person experiencing homelessness taking at least two medications for chronic conditions who scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9) and had at least two ED or hospital visits in the prior 6 months was eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily e-mail to assess medication adherence. GPS alerts were compared to ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t-tests compared scores on the PHQ-9, Medical Outcomes Study Social Support Survey, and ASK-12 adherence survey at baseline and exit. Semi-structured exit interviews examined perceptions and benefits of the intervention. RESULTS Thirty participants enrolled; the mean age was 44.1 years (SD 9.7). Most were male (67%; n = 20), White (57%; n = 17), and not working (63%; n = 19). The GPS app showed limited accuracy in ED or hospital visit alerts. Only 18.8% of the alerts aligned with HIE data (3/16), mainly due to patients not having the phone with them during the visit, phone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (M=16.9, SD=5.8) and exit (M=12.7, SD=8.2); t(19)=2.9, p=.009 and a significant difference in adherence barriers between baseline (M=2.4, SD=1.4) and exit (M=1.5, SD =1.5); t(17)=2.47, p = .025). Participants agreed that the app was easy to use (M=4.4/5 with 5 = strongly agree (SA)) and indicated the e-mail helped them remember to take their medications (M=4.6/5). Qualitative data indicated that unlimited phone access allowed participants to meet social needs and maintain reliable contact with case managers, healthcare providers, family, and friends. CONCLUSIONS mHealth interventions are feasible for and acceptable to people experiencing homelessness. Objective data from the HIE provided more accurate ED and hospital visit information, but unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination. CLINICALTRIAL Not applicable

scholarly journals Care coordination for vulnerable families in the Sydney Local Health District: what works for whom, in what circumstances, and why?

2018 ◽  
Vol 18 (s1) ◽  
pp. 40
Author(s):  
Suzannah Dewhurst ◽  
Sally Hansen ◽  
Elaine Tennant ◽  
Erin Miller ◽  
Kristy Allworth ◽  
...  
Keyword(s):  
Care Coordination ◽  
Health District ◽  
Local Health ◽  
What Works ◽  
Vulnerable Families

scholarly journals Perspectives on the policy ‘black box’: a comparative case study of orthopaedics services in England

2014 ◽  
Vol 9 (4) ◽  
pp. 383-405 ◽  
Author(s):  
Hugh McLeod ◽  
Ross Millar ◽  
Nick Goodwin ◽  
Martin Powell
Keyword(s):  
Waiting Times ◽  
Black Box ◽  
Control Programme ◽  
Comparative Case Study ◽  
Local Health ◽  
Programme Theory ◽  
Evaluation Approach ◽  
Recent Debate ◽  
The Impact

AbstractThere has been much recent debate on the impact of competition on the English National Health Service (NHS). However, studies have tended to view competition in isolation and are controversial. This study examines the impact of programme theories associated with the health system reforms, which sought to move from a dominant target-led ‘central control’ programme theory, to one based on ‘market forces’, on orthopaedics across six case-study local health economies. It draws on a realistic evaluation approach to open up the policy ‘black box’ across different contexts using a mixed methods approach: analysis of 152 interviews with key informants and analysis of waiting times and admissions. We find that the urban health economies were more successful in reaching the access targets than the rural health economies, although the gap in performance closed over time. Most interviewees were aware of the policies to increase choice and competition, but their role appeared comparatively weak. Local commissioners’ ability to influence demand appeared limited with providers’ incentives dominating service delivery. Looking forward, it is clear that the role of competition in the NHS has to be considered alongside, rather than in isolation from, other policy mechanisms.

scholarly journals Designing an Integrated Care Initiative for Vulnerable Families: Operationalisation of Realist Causal and Programme Theory, Sydney Australia

2019 ◽  
Vol 19 (3) ◽  
Author(s):  
John G. Eastwood ◽  
Miranda Shaw ◽  
Pankaj Garg ◽  
Denise E. De Souza ◽  
Ingrid Tyler ◽  
...  
Keyword(s):  
Integrated Care ◽  
Programme Theory ◽  
Vulnerable Families ◽  
Sydney Australia

scholarly journals Care coordination for vulnerable families in the Sydney Local Health District: what works for whom, in what circumstances, and why?

2018 ◽  
Vol 18 (s2) ◽  
pp. 102
Author(s):  
Suzannah Dewhurst ◽  
Sally Hansen ◽  
Elaine Tennant ◽  
Erin Miller ◽  
Kristy Allworth ◽  
...  
Keyword(s):  
Care Coordination ◽  
Health District ◽  
Local Health ◽  
What Works ◽  
Vulnerable Families

scholarly journals Unraveling community engagement in health promotion among vulnerable families: a multiple case study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Hogeling ◽  
L Vaandrager ◽  
M Koelen
Keyword(s):  
Health Promotion ◽  
Community Engagement ◽  
Multiple Case Study ◽  
Programme Theory ◽  
Active Involvement ◽  
Self Confidence ◽  
Vulnerable Families ◽  
Multiple Case ◽  
Group Interviews

Abstract Community engagement has since long been promoted among health promotion practitioners, policy-makers and scientists. However, many uncertainties remain when it comes to the workings and effects of community engagement in health promotion. The aim of this study is to provide in-depth insights into the workings and effects of community engagement. In a multiple case study, we investigate three health promotion projects among vulnerable families in The Netherlands. The projects are all funded by the Healthy Futures Nearby Programme. Data was collected by group interviews, telephone interviews and written progress reports. We adopted a realist approach, in which we first identified assumptions about community engagement. We then analysed the qualitative data for context-mechanism-outcome configurations to test and refine this programme theory. Preliminary results show that active engagement can strengthen social networks, empowerment and perceived health among vulnerable families. However, specific contexts, in combination with the project interventions, may or may not trigger positive responses (mechanisms). Vulnerable families may feel they matter when asked to actively contribute in a project, which in turn can enhance their self-confidence. In another context, we found vulnerable families overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We will present a full list of context-mechanism-outcome configurations that describe possible effects of community engagement of vulnerable families. The two sides of the assumptions project teams hold about effects of community engagement, show that tension exists around actively involve communities in health promotion projects. In-depth insights into the workings and effects of community engagement will provide health promotion scientists and practitioners with knowledge to shape and optimize community engagement in health promotion projects. Key messages The study shows that, in practice, tensions exist between expected effects of community engagement and actual unclarity about what community engagement can do in for vulnerable people. Contexts of health promotion projects, in combination with specific interventions, may or may not trigger positive responses to active involvement among vulnerable families.

scholarly journals Care Coordination for Vulnerable Families in the Sydney Local Health District: What Works for Whom, under What Circumstances, and Why?

2020 ◽  
Vol 20 (4) ◽  
Author(s):  
John G. Eastwood ◽  
Suzannah Dewhurst ◽  
Sally Hansen ◽  
Elaine Tennant ◽  
Erin Miller ◽  
...  
Keyword(s):  
Care Coordination ◽  
Health District ◽  
Local Health ◽  
What Works ◽  
Vulnerable Families

scholarly journals Small Car Wash Business in Botswana and the Desperate Youth: Entrepreneurs or Employment Seekers? A case study of Gaborone

2016 ◽  
Vol 3 (2) ◽  
pp. 159
Author(s):  
Motsomi Ndala Marobela ◽  
Hanna Mebratu ◽  
John Peter Waziri Shunda
Keyword(s):  
Critical Factor ◽  
Capital City ◽  
High Concentration ◽  
Entrepreneurial Ecosystem ◽  
Critical Realist ◽  
Start Up ◽  
Car Wash ◽  
Alternative Means

In recent years Botswana has witnessed an unprecedented boom in small business informal car washers. This paper explores the emergence and spread of this phenomenon, with specific attention to the capital city, Gaborone, where there is a high concentration of small car washers. Relying on critical realist philosophy and the entrepreneurial ecosystem conceptual model, we explore the issue of youth self-entrepreneurship against the critical factor of employability. Our findings reveal a number of pointers to socio-economic needs and vulnerable livelihoods. While Botswana economy has been largely characterised by growth, however the economy is not creating jobs, hence the unemployment crisis, which pushes many young people to seek alternative means of survival. In this context car wash entrepreneurship becomes appealing as it is relatively simple to start and requires little start-up capital. Car wash businesses provide hope to desperate youth in search for jobs, as well as contributing to the economy. However, in the long term this option is not sustainable and profitable in its present form. This calls for robust policy intervention to formalise it to SMME status.

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