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People with severe persistent mental illness pose a significant challenge to managed care organizations and society in general. The financial costs are staggering as is the community impact including homelessness and incarceration. This population also has a high incident of chronic comorbid disorders that not only drives up healthcare costs but also significantly shortens longevity. Traditional case management approaches are not always able to provide the intense and direct interventions required to adequately address the psychiatric, medical and social needs of this unique population. This article describes a Medicare Advantage Chronic Special Needs Program that provides a Medical Home, Active Community Treatment, and Integrated Care. A comparison of utilization and patient outcome measures of this program with fee for service Medicare found significant reduction in utilization and costs, as well as increased adherence to the management of chronic medical conditions and preventative services.

In many UK mental health services, in-patient psychiatric care is being separated from community care by having dedicated in-patient medical team. We evaluated staff satisfaction in this functionalised in-patient care. A survey was conducted amongst multidiscipli-nary staff from various teams using a questionnaire survey. On an average 14.3% of staff returned a satisfactory response for function-alisation, 57.3% had unsatisfactory response and others were undecided or perceived no change. There was no difference in responses amongst age, gender and professional groups. Mean scores of all groups were within unsatisfactory domain; however community staff compared to in-patient staff and staff with more than 5 years of experience compared to those with 1-5 years of experience returned significantly more unsatisfactory responses regarding functionalisation. Many positive and negative aspects of functionalisation were raised. The results of this evaluation suggest the need for further studies on the effectiveness of in-patient functionalisation. Short and long term clinical outcomes and the satisfaction of the patients should also be studied.

This study aims to explore what kind of perceptions dental students at graduation stage have on leadership and work communities, and themselves as leaders and work community members after completing a leadership course tailored for them.

The research material comprised reflective essays written by fifth-year dental students who had participated in a leadership course. The essays were analyzed using qualitative content analysis.

Most students reported that they had not considered seeking a leadership position before the course, but their views of leadership had grown more positive as a result of completing the course. Students perceived interpersonal communication competence as the most important factor for leaders, the whole work community and for themselves. They assessed that their biggest strengths were found in this area. The biggest challenges in adapting to a work community concerned the students’ professional identities, which were still taking shape at the time of graduation.

The need for leaders in health-care professions is growing due to ongoing reforms, multidisciplinary teamwork, the development of new technologies and patient demands. Therefore, undergraduate leadership education is needed to ensure that students have knowledge of leadership. Graduating dental students’ perceptions concerning leadership and work communities have not been widely explored. Students’ perceptions of leadership were positive after the course and helped students to realize their own potential in this area.

The purpose of this paper is to investigate the effectiveness of the national HIV prevention outreach program for men who have sex with men (MSM) and transgender women (TGW).

It examined changes in condom use, lubricant use, HIV testing and counseling (HTC) uptake and sexually transmitted infection (STI) screening uptake, as well as how and why changes did or did not occur. The study applied mixed methods of both quantitative and qualitative approaches.

There were 16,539 MSM, and TGW reached at least three times in the program during October 2011‒September 2012. The program was found to affect changes in condom use with steady partners (p<0.000), condom use with casual partners (p<0.000), water-based lubricant use (p<0.000), HTC uptake (p<0.000) and STIs screening uptake (p<0.000). Age and province of outreach are associated with HTC uptake and STI screening (p<0.000), slightly as well as gender identity (p<0.1). Gender identity and province of outreach are associated with condom use with steady partners (p<0.000). Gender identity (p<0.000) and sex work (p<0.05) are associated with the use of lubricant. The qualitative results showed that the program had an immediate effect on HTC and STIs screening due to successful bond between the outreach workers and their clients, leading to trust and influencing behavior change.

HIV prevention by peer educators continues to be proved the most effective method, assuming its program consistency. TGW are more vulnerable to MSM to protect themselves, and they have steady partners. Future program for MSM can be replicated and scaled up, but more empowerment component and self-esteem building should be integrated to target TGW.

Mothers with a dual diagnosis (mental ill health and substance use) have delays in accessing services, or their care may be interrupted prior to therapeutic relationships being formed. The purpose of this paper is to explore and describe how engagement merges in the context of mothers with a dual diagnosis.

This is a qualitative, focused ethnographic study at a low-threshold service for substance abusing families. The data contain interviews, observations, field notes, and reflections. The analysis followed several systematic steps.

Engagement is the co-creation of possibilities between workplace staff and the client in different interfaces. It is not a single act, emotion, or verbal communication, but a complex intertwined system of events that can awaken or enable the client to get a grasp on life. The sensitivity of the worker is one tool for engaging the client in manifold ways in different interfaces: even the smallest events with connection are viewed as valuable. Engagement involves the intentional client in the process of interaction: the client needs to participate and become an acting and sensing part of the change, which occurs on an experiential level. The process is described with the metaphor of a seed.

Engagement as inner involvement challenges the current working methods, and requires sensitivity, because the mothers with a dual diagnosis may not have verbalisable goals when arriving to the services.

This study aims to compare and contrast the core organisational processes across high and low performing mental health providers in the English National Health Service (NHS).

A multiple case study qualitative design incorporating a full sample of low and high performing mental health providers.

This study suggests that the organisational approaches used to govern and manage mental health providers are associated with their performance, and the study’s findings give clues as to what areas might need attention. They include, but are not limited to: developing appropriate governance frameworks and organisational cultures, ensuring that staff across the organisation feel “psychologically safe” and able to speak up when they see things that are going wrong; a focus on enhancing quality of services rather than prioritising cost-reduction; investing in new technology and digital applications; and nurturing positive inter-organisational relationships across the local health economy.

Highlights considerable divergence in organisation and management practices that are associated with the performance of mental health trusts in the English NHS

New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices.

This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively.

The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services.

Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.