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This paper examines the impact of the Kansas Mental Health Reform Act of 1990 on the mental health care system, on the budget of the state, and on the budgets of the Community Mental Health Centers. Both the successes and the failures of Mental Health Reform suggest that coordination of institutional and financial arrangements are needed to improve the outcomes of care. From a budgetary perspective, Mental Health Reform demonstrates the central role of Medicare and Medicaid in financing services for vulnerable populations. The reform also demonstrates that shifting costs to Medicare and Medicaid is a component of prudent financial management by the states.

Community health clinics serving the poor and underserved are geographically expanding due to changes in U.S. health care policy. This paper describes the experience of a collaborative alliance of health care providers in a large metropolitan area who develop a conceptual and mathematical decision model to guide decisions on expanding its network of community health clinics.

Community stakeholders participated in a collaborative process that defined constructs they deemed important in guiding decisions on the location of community health clinics. This collaboration also defined key variables within each construct. Scores for variables within each construct were then totaled and weighted into a community-specific optimal space planning equation. This analysis relied entirely on secondary data available from published sources.

The model built from this collaboration revolved around the constructs of demand, sustainability, and competition. It used publicly available data defining variables within each construct to arrive at an optimal location that maximized demand and sustainability and minimized competition.

This is a model that safety net clinic planners and community stakeholders can use to analyze demographic and utilization data to optimize capacity expansion to serve uninsured and Medicaid populations.

Communities can use this innovative model to develop a locally relevant clinic location-planning framework.

Community policing has been around for at least two decades now and it is safe to say that it has become, in large part, more about managing disruptive subjects and virtuous citizens than preventing crime or disorder (Crank, 1994; DeLeon-Granados, 1999; Yngvesson, 1993). While the rhetoric of community may be succeeding where the policing policy is failing, the experience has certainly contributed to the growth of homologous efforts that include community prosecution and community correction. We see a criminal justice system pro-actively seeking to blur the boundaries between its institutions and the communities they work within and, all too often, without. In recent years, there has been a rapid growth in justice approaches that turn their attention toward the community. There are literally hundreds of examples of this trend, from offender-victim reconciliation projects in Vermont and Minneapolis to ‘beat probation’ in Madison, Wisconsin; from neighborhood-based prosecution centers in Portland, Oregon, and New York City, to community probation in Massachusetts. Of course, the most well-known version of community justice is community policing, but localized projects involving all components of the justice system have been widely promoted (Clear & Karp, 1998, p. 3).Like community policing and community prosecution, community correction programs generally focus on partnering with service providers and community groups in order to more finely calibrate their service delivery. For community corrections the recent focus has been on delivering re-entry programs and expanding the availability of intermediate sanctioning options. The sheriff (above) focuses on re-entry, to link jails and communities in two ways: extending the correctional continuum into power-poor communities and increasing political support for expanding the criminal justice system in more affluent communities. Even as fiscal stress translates into budget cuts in education, housing, drug treatment, and other services, the reach of the criminal justice system expands outside the fences as new community-based partnerships and inside the fences as an increasingly program-rich environment. These partnerships are, not surprisingly as we shall see, dominated by criminal justice professionals and dependent on coercive control techniques. Further, their budgets are growing with funds in previous eras earmarked for providing many of the same services in a social welfare, rather, than social control, service delivery context. While these budgetary trends map a macro political trend from an old democratic New Deal toward a new republican new deal network of patronage relationships (see Lyons, forthcoming 2004), this paper examines the micro politics of community corrections developing within an increasingly punitive American political-culture.

The purpose of this paper was to develop deeper insights into the practices enacted by entrepreneurial healthcare managers to enhance the implementation of a partnership logic in integrated care models for older adults.

A multiple case study design in two urban centres in two jurisdictions in Canada, Ontario and Quebec. Data collection included 65 semi-structured interviews with policymakers, managers and providers and analysis of key policy documents. The institutional entrepreneur theory provided the theoretical lens and informed a reflexive iterative data analysis.

While each case faced unique challenges, there were similarities and differences in how managers enhanced a partnership’s institutional logic. In both cases, entrepreneurial healthcare managers created new roles, negotiated mutually beneficial agreements and co-located staff to foster inter-organisational partnerships between public, private and community organisations in the continuum of care for older adults. In addition, managers in Ontario secured additional funding, while managers in Quebec organised biannual meetings and joint training to enhance inter-organisational partnerships.

This study has two main implications. First, efforts to enhance inter-organisational partnerships should strategically include institutional entrepreneurs. Second, successful institutional changes may be supported by investing in integrated implementation strategies that target roles of staff, co-location and inter-organisational agreements.

The public health sector in South Korea introduced district health information systems (DHIS) in health centres in the early 1990s. DHIS aimed to help health centres to provide comprehensive health care services and to achieve effective and efficient management of their works. District health information systems are still being implemented in health centres. Information generated and collected through the systems is to be used by local authorities to plan and manage health services in their areas, and further by the central government to make a health plan and health policy at the national level. However, the adoption and implementation of DHIS by health centres does not meet the initial anticipation. Moreover, reasons for that have not been explored yet. This paper presents the development of DHIS for health centres in Korea, evaluates the project focusing on impacts and problems found in implementing the systems, and provides lessons and recommendations for establishing a nationwide health information network.

Longitudinally (2008–2012) assess whether community-level sociodemographic characteristics were associated with patient-centered medical home (PCMH) capacity among primary care and specialty physician practices, and the extent to which variation in PCMH capacity can be accounted for by sociodemographic characteristics of the community.

Linear growth curve models among 523 small and medium-sized physician practices that were members of a consortium of physician organizations pursuing the PCMH.

Our analysis indicated that the average level of sociodemographic characteristics was typically not associated with the level of PCMH capacity, but the heterogeneity of the surrounding community is generally associated with lower levels of capacity. Furthermore, these relationships differed for interpersonal and technical dimensions of the PCMH.

Our findings suggest that PCMH capabilities may not be evenly distributed across communities and raise questions about whether such distributional differences influence the PCMH’s ability to improve population health, especially the health of vulnerable populations. Such nuances highlight the challenges faced by practitioners and policy makers who advocate the continued expansion of the PCMH as a means of improving the health of local communities.

To date, most studies have focused cross-sectionally on practice characteristics and their association with PCMH adoption. Less understood is how physician practices’ PCMH adoption varies as a function of the sociodemographic characteristics of the community in which the practice is located, despite work that acknowledges the importance of social context in decisions about adoption and implementation that can affect the dissemination of innovations.

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

We show the geographic distribution, funding patterns, and utilization trends for outreach clinics over a 20-year period. Interviews with program planners and outreach clinic staff show how external and internal constraints limited the program’s capacity. We compare clinic operations to the conceptual models guiding program design.

Our findings show that state health officials had to scale back financial support for outreach clinic activities while healthcare providers faced increasing pressure from administrators to reduce investments in charity care. These external and internal constraints led to a decline in the overall number of patients served. We also find that redistribution of clinics to the Milwaukee area increased utilization among Hispanics but not among African-Americans. Our interviews suggest that these patterns may be a function of shortcomings embedded in the planning models.

Planning models have three shortcomings. First, they do not identify the mitigation of health disparities as a specific goal. Second, they fail to acknowledge that partners face escalating profit-seeking mandates that may limit their capacity to provide charity services. Finally, they underemphasize the importance of seeking trusted partners, especially in working with communities that have been historically marginalized.

There has been little discussion about equitably leveraging genetic advances that improve healthcare quality and efficacy. The role of State Health Agencies in mitigating disparities in access to genetic services has been largely ignored in the sociological literature.

Purpose: This chapter examines the implementation of lesbian, gay, bisexual, transgender, and queer (LGBTQ) health curricula in medical education, focusing on how this content is presented to students to understand if these curricula can fulfill goals of achieving healthcare equity for LGBTQ populations.

Methodology: This research draws on data from six months of participant observation of an academic medical center and school and 28 interviews with medical faculty, students, community members, administrators, and LGBTQ Health Center employees.

Findings: This research has three findings: (1) this medical school has variable definitions for LGBTQ health, making it a hybrid form of knowledge based in (a) understanding the unique health needs of; (b) being culturally competent to; and (c) being a (structural) advocate for LGBTQ patients; (2) LGBTQ health is integrated into multiple courses in the curriculum; and (3) LGBTQ health is becoming a medical specialty frequently delivered to students by LGBTQ health experts.

Research limitations and implications: This research used snowball sampling to recruit participants engaged in LGBTQ health at the institution; it therefore risks self-selection bias. Findings from this study are not generalizable.

Originality: This research argues that LGBTQ health experts engage in a new kind of diversity and inclusion work because (1) these health experts are not always LGBTQ identified; (2) this work is not necessarily unpaid or involuntary; and (3) it involves a hybrid knowledge requiring an understanding of LGBTQ identity, medical knowledge, and social science. Because these LGBTQ health experts opt into this work, and broadly define it, a message available to other physicians and students is that LGBTQ health remains elective.

Decentralization of mental health services delivery through the implementation of community‐based mental health centres has greatly increased the complexity in the administration of US mental health programmes. Decision makers have to allocate limited resources between traditional hospital programmes and the community centres. Presents a goalprogramming‐planning model which allows the decision maker to analyse trade‐offs between healthcare objectives as well as to assess the budgetary and staff ramifications of various policy decisions. Illustrates the model through the use of a case example from a Midwestern US mental health services programme.

The purpose of this paper is to explore some of the challenges in putting government policy on the development of a new generation of primary health care centres into practice, at a time when a growing number of property companies are moving into the primary health care market.

The paper begins by outlining the government policy issues driving the development of primary health care centres, it describes the ways in which these centres are being developed and discusses some of the issues involved in putting government policy into practice.

The paper reveals that the government's plans to develop a new generation of primary health care centres have provoked considerable controversy and it explores five sets of issues, namely the quality of health care; location and accessibility; economies of scale and cost savings; the changing balance of public and private sector provision; and impacts within the wider urban environment.

The paper provides an accessible review of the debate surrounding the development of primary health care centres and as such it will be of interest to those working in, engaging with, and studying the primary health care property market.