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Policy requires that those with complex long‐term needs be offered case management, a primary care led service dependent on local health and social care resources. This paper explores the arrangement of networks for a number of case management services, using data from a postal questionnaire.

In the second part of this two‐part feature, four models of inter‐professional collaboration are explored, each of them representing points on a continuum from lower to higher levels of collaboration.The four are:• Communication: interactions are confined to facilitating the exchange of information.• Co‐ordination: individuals remain in separate organisations and locations, but develop formal ways of working across these boundaries.• Co‐location: members of different professions are physically located alongside each other.• Commissioning: professionals with a commissioning remit develop a shared approach to the activity

The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals.

A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced.

The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge.

The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working.

The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy.

Quality of care in the residential aged sector has changed over the past decade. The purpose of this paper is to examine these changes from the perspectives of staff to identify factors influencing quality of residential aged care, and the role and influence of an aged care accreditation programme.

Focus groups were held with 66 aged care staff from 11 Australian aged care facilities. Data from semi-structured interviews were analysed to capture categories representing participant views.

Participants reported two factors stimulating change: developments in the aged care regulatory and policy framework, and rising consumer expectations. Four corresponding effects on service quality were identified: increasing complexity of resident care, renewed built environments of aged care facilities, growing focus on resident-centred care and the influence of accreditation on resident quality of life. The accreditation programme was viewed as maintaining minimum standards of quality throughout regulatory and social change, yet was considered to lack capacity of itself to explicitly promote or improve resident quality of life.

For an increasingly complex aged care population, regulatory and societal change has led to a shift in service provision from institutional care models to one that is becoming more responsive to consumer expectations. The capacity of long-established and relatively static accreditation standards to better accommodate changing consumer needs comes into question.

This is the first study to examine the relationship between accreditation and residential aged care service quality from the perspectives of staff, and offers a nuanced view of “quality” in this setting.

The purpose of this paper is to examine research evidence on collaboration between primary and adult social care in strategic, rather than operational, activities at two different time points, following large-scale changes within the health and social care environments; and discuss the prospects for the future.

This paper reports evidence from two substantial longitudinal studies (Dowling and Glendinning, 2003; Checkland et al., 2012) which followed the development of Primary Care Groups and Trusts (PCG/Ts) and Clinical Commissioning Groups (CCGs), respectively. Each used a combination of national surveys and local in-depth case studies to trace the early development of new structures and ways of working following major changes in the NHS and local government.

PCG/Ts had limited success in collaborating with adult social care partners. Health and Well-being Boards offer a new overarching organisational framework for collaborative strategic working between GP-led CCGs and adult social care services. Mandated joint strategic needs assessments also provide a shared framework within which commissioning decisions by both CCGs and social services are made. However, there remains evidence of long-standing barriers, particularly differences in geographic boundaries and in organisational and professional cultures.

Evidence from both studies is based on the early years of the respective new organisations; later evidence may have yielded a different picture.

This is the first paper reflecting on developments in strategic relations between primary and social care from researchers involved with two longitudinal investigations of the early development of PCG/Ts (1999-2002) and CCGs (2011-ongoing).

Severe mental illness affects a significant number of people and, if left untreated, leads to poor quality of life and disability. Many of the aspirations proposed for new models of care assert that better preventative services, closer integration between professionals, and increased access to cognitive behavioural therapy in primary care will bring substantial benefits and improved outcomes. The purpose of this paper is to explore the benefits of integrating mental health services into primary care, and improving collaboration between secondary services and primary care. There is a transition underway in healthcare whereby a focus on illness is being supplemented with, or refocused towards achieving better patient well-being. New approaches to service provision are being proposed that: focuses on more holistic outcomes; integrates services around the user; and employs innovative system techniques to incentivise professional and organisational collaboration. Such a transition must be inclusive of those with mental health needs managed in primary care and for those people with serious mental illness in secondary care.

This paper discusses the issues of professional collaboration and the need to provide mental healthcare in a continuous and coordinated manner and; how this may improve timely access to treatment, early diagnosis and intervention. Importantly, it is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit of better integrating mental health into a more collaborative system may lie.

Identifying and addressing issues of parity is likely to call for a new approach to service provision that: focuses on outcomes; co-designs services integrated around the user; and employs innovative contracting techniques to incentivise provider integration.

There is a transition underway in healthcare whereby a focus on illness is being supplemented with or refocused towards working towards wellness. Such a transition requires primary care mental health services to be provided in a continuous and coordinated manner in order to meet the health needs of people with serious mental illness.

It discusses the issues of professional collaboration and how this may improve timely access to treatment, early diagnosis and intervention. It is essential to consider the limitations and reality of recent integration initiatives, and to consider where the true benefit may lie.

Workforce development in rural communities to address a surge in opioid addiction and overdose related hospitalizations has been an unaddressed issue in the USA. This study aims to present an integrated, trauma-informed, behavioral workforce development initiative in a midwestern rural setting in the USA.

This is a mixed method, two-phased study: the first phase tracked and analyzed two focus group conferences involving experts (n = 6) and professionals (n = 8) to develop a training protocol; the second phase provided a training (n = 101), based on the protocol to future professionals and compared competencies before and after the implementation of the training.

There is a need of a trauma integrated approach in providing interprofessional training connecting health-care workers in rural communities to address the current opioid crisis to bring about cohesion among integrated and interdisciplinary teams. Workforce building will need to implement best practices not only among medical providers but among community mental health practitioners in rural areas.

This is a unique trauma-informed workforce development initiative in a rural community. Such studies are extremely limited and almost non-existent. Further initiatives need to be taken in this field to identify unique differences within communities that may hinder implementation.

The need for joint working between statutory and non‐statutory bodies is an important component of policy across the UK. While it is something that governments push for, it has not always been delivered effectively in practice. This paper reports on a project that sought to bring together statutory, voluntary and community sector bodies to help improve and strengthen the planning and commissioning of services from the third sector to support health and social care needs. The model was intended to provide planners with a single reference point for procurement of service packages from a combination of statutory, independent and third‐sector organisations for specific regional and local service‐user groups. We report on the experience of the first 18 months of this project, indicating that the project has been highly successful in the eyes of a range of stakeholders. Stakeholders from a range of backgrounds were far more positive about the experience than the literature would predict to be the case. Outcomes monitoring suggests that service users were far more independent and had seen improvements on a range of dimensions. The paper finishes by formulating suggestions for the factors which seem to have contributed to its success.

Services for refugees and asylum seekers frequently experience gaps in delivery and access, poor coordination, and service stress. The purpose of this paper is to examine the approach to integrated care within Companion House (CH), a refugee primary care service, whose service mix includes counselling, medical care, community development, and advocacy. Like all Australian refugee and asylum seeker support services, CH operates within an uncertain policy environment, constantly adapting to funding challenges, and changing needs of patient populations.

Interviews with staff, social network analysis, group patient interviews, and service mapping.

CH has created fluid links between teams, and encouraged open dialogue with client populations. There is a high level of networking between staff, much of it informal. This is underpinned by horizontal management and staff commitment to a shared mission and an ethos of mutual respect. The clinical teams are collectively oriented towards patients but not necessarily towards each other.

Part of the service’s resilience and ongoing service orientation is due to the fostering of an emergent self-organising form of integration through a complex adaptive systems approach. The outcome of this integration is characterised through the metaphors of “home” for patients, and “family” for staff. CH’s model of integration has relevance for other services for marginalised populations with complex service needs.

This study provides new evidence on the importance of both formal and informal communication, and that limited formal integration between clinical teams is no bar to integration as an outcome for patients.

Purpose – Despite growing efforts to treat depression, engaging low-income and minority mothers continues to challenge providers. To address this issue, we conducted focus groups to identify responsive strategies for improving engagement of low-income and racially diverse mothers at high risk for depression.

Methods – Three focus group discussions (one prenatal, two postpartum) with 21 low-income and racially diverse mothers were held to determine their definition of depression, attitudes about depression treatment, and perceived barriers to treatment. Discussions took approximately 60 minutes and were audio-recorded. Detailed notes were taken during the discussions. The notes and audio recordings were analyzed using qualitative methods.

Results – Identification of the source of distress, assessing women's perception of treatment and their related costs and benefits, and addressing cultural and financial barriers to treatment emerged as key themes for improving engagement among participants.

Conclusion – To be responsive to women's depression care needs, treatments should be informed by patient perceptions and needs, while addressing barriers to care.