Service delivery systems

  • 文章类型: Journal Article
    解决严重的物质使用障碍(SUD)的公共卫生危机,这项研究评估了SUD治疗搜索工具的准确性,例如FindTreatment.gov,为患者提供适当的护理。
    为了确保地理多样性,我们从美国四个不同的地区随机选择了一个州(亚利桑那州,佛罗里达,马萨诸塞州,俄亥俄州),然后随机选择不同规模的县(一个大,两个中等,三个小)在每个状态中使用随机数生成器。实践的联系信息是从工具中提取的,并通过电话进行验证。主要结局指标是精确准确率(其中所有信息都是准确的)和功能准确率(其中提供了足够的信息以促进护理建立)。
    评估了来自10个SUD治疗搜索工具中的总共697个实践。十种SUD治疗搜索工具的准确性差异很大,精确准确率为9.1%至76.0%(平均56.0%),功能准确率为50.0%至92.0%(平均82.8%)。与国家工具相比,国家工具在精确准确率(66.3%对49.0%;p=0.2864)和功能准确率(83.8%对82.2%;p=0.9148)方面均表现出更高的精度,虽然私人资助的工具在精确准确率(66.8%对48.9%;p=0.2008)和功能准确率(83.8%对82.2%;p=0.9148)方面都表现出更高的准确率,但这些差异均无统计学意义.
    这项研究发现,SUD治疗搜索工具通常列出不准确的信息,强调需要系统地改进数据管理和验证实践。
    UNASSIGNED: Addressing the critical public health crisis of substance use disorder (SUD), this study evaluates the accuracy of SUD treatment search tools, such as FindTreatment.gov, to connect patients with appropriate care.
    UNASSIGNED: To ensure geographic diversity, we randomly selected one state from four distinct US regions (Arizona, Florida, Massachusetts, Ohio) and then randomly selected counties of varying sizes (one large, two medium, three small) within each state using a random number generator. Contact information for practices was extracted from the tools and validated through phone calls. The primary outcome measures were exact accuracy rate (wherein all information was accurate) and functional accuracy rate (wherein enough information was provided to facilitate care establishment).
    UNASSIGNED: A total of 697 practices from within ten SUD treatment search tools were assessed. Accuracy of the ten SUD treatment search tools varied considerably, with exact accuracy rates ranging from 9.1 % to 76.0 % (mean: 56.0 %) and functional accuracy rates from 50.0 % to 92.0 % (mean: 82.8 %). National tools exhibited higher accuracy for both exact accuracy rate (66.3 % v. 49.0 %; p = 0.2864) and functional accuracy rate (83.8 % v. 82.2 %; p = 0.9148) than state tools, while privately funded tools demonstrated higher accuracy for both exact accuracy rates (66.8 % v. 48.9 %; p = 0.2008) and functional accuracy rates (83.8 % v. 82.2 %; p = 0.9148), but none of these differences were statistically significant.
    UNASSIGNED: This study found that SUD treatment search tools commonly list inaccurate information, underscoring the need for systematic improvements in data management and validation practices.
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  • 文章类型: Journal Article
    作者调查了促进家庭参与精神卫生服务的实践障碍,专注于患有严重精神疾病的人,他们的家人,和心理健康提供者。此外,作者试图确定促进家庭参与精神卫生提供的策略,以突出日常实践中的参与过程,并为组织建立家庭友好型环境提出未来方向.
    在PsycInfo中对1990年1月至2023年3月发表的文献进行了系统搜索,PubMed,CINAHL,社会学文摘,和Scopus数据库。还使用了灰色文献搜索以及前后滚雪球策略。
    回顾了46篇文章,揭示阻碍家庭参与的背景和参与实践。家庭参与的不一致源于组织文化,社会态度,和提供者否定家庭专业知识。关于保密政策的不确定性和缺乏实践指南给提供者带来了挑战。精神卫生系统中家庭的负面经历以及可变的承诺也阻碍了参与。由于隐私问题和对参与程度的不同期望,一些服务用户拒绝了家庭参与。促进共同的家庭工作文化,整合实践标准,从事专业发展活动成为关键战略。
    在实施家庭参与心理健康治疗的政策和实践之间存在差距。如果没有支持与家庭合作的文化和组织转变,家庭参与做法的吸收仍将不足。每个利益相关者对家庭参与的障碍有不同的看法,如果没有就其重要性达成共识,家庭参与仍将难以捉摸。
    UNASSIGNED: The authors investigated barriers to practices that promote family involvement in mental health services, focusing on individuals with severe mental illness, their families, and mental health providers. Additionally, the authors sought to identify strategies to facilitate family involvement in mental health provision to highlight the engagement process in routine practice and propose future directions for organizations to establish a family-friendly environment.
    UNASSIGNED: Systematic searches for literature published from January 1990 to March 2023 were conducted in PsycInfo, PubMed, CINAHL, Sociological Abstracts, and Scopus databases. Gray literature searches and backward and forward snowballing strategies were also used.
    UNASSIGNED: Forty-six articles were reviewed, revealing contextual backgrounds and engagement practices that hindered family involvement. Inconsistencies in family involvement stemmed from organizational culture, societal attitudes, and providers\' negating of family expertise. Uncertainty regarding confidentiality policies and the absence of practice guidelines posed challenges for providers. Negative experiences of families within the mental health system along with variable commitment also hampered involvement. Some service users declined family involvement because of privacy concerns and differing expectations regarding the extent of involvement. Promoting a shared culture of family work, integrating practice standards, and engaging in professional development activities emerged as key strategies.
    UNASSIGNED: A gap exists between implementing policies and practices for family involvement in mental health treatment. Without cultural and organizational shifts in support of working with families, the uptake of family involvement practices will remain inadequate. Each stakeholder has different perceptions of the barriers to family involvement, and family involvement will remain elusive without a shared agreement on its importance.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    作者旨在确定障碍和策略,以支持国家机构之间在智力和发育障碍(IDD)或精神健康方面的协调,以满足同时发生IDD和精神健康状况的人们的精神健康需求。
    在2022年4月至2023年4月期间,采访了美国11个州的州机构以及宣传和服务提供组织的49名员工,这些员工拥有独立的IDD和精神卫生机构。采用专题分析方法对数据进行分析。
    受访者报告说,缺碘症和精神卫生机构之间的关系既有竞争又有协调的因素,协调主要发生在应对危机事件。机构间协调的障碍包括狭隘地关注每个机构所针对的人群,机构结构的州内变化,以及缺乏关于同时发生的IDD和精神健康状况的知识。受访者还描述了两种行政管理(例如,谅解备忘录)和机构文化(例如,专注于全人护理)策略,这些策略可以或可以用于改善协调,为患有IDD和精神健康状况的人提供精神卫生服务。
    支持国家机构从危机应对转向专注于全人护理的策略应优先考虑,以支持为同时发生IDD和精神健康状况的个人协调精神卫生服务。
    UNASSIGNED: The authors aimed to identify barriers to and strategies for supporting coordination between state agencies for intellectual and developmental disability (IDD) or mental health to meet the mental health needs of people with co-occurring IDD and mental health conditions.
    UNASSIGNED: Forty-nine employees of state agencies as well as advocacy and service delivery organizations across 11 U.S. states with separate IDD and mental health agencies were interviewed between April 2022 and April 2023. Data were analyzed with a thematic analysis approach.
    UNASSIGNED: Interviewees reported that relationships between the IDD and mental health agencies have elements of both competition and coordination and that coordination primarily takes place in response to crisis events. Barriers to interagency coordination included a narrow focus on the populations targeted by each agency, within-state variation in agency structures, and a lack of knowledge about co-occurring IDD and mental health conditions. Interviewees also described both administrative (e.g., memorandums of understanding) and agency culture (e.g., focusing on whole-person care) strategies that are or could be used to improve coordination to provide mental health services for people with both IDD and a mental health condition.
    UNASSIGNED: Strategies that support state agencies in moving away from crisis response toward a focus on whole-person care should be prioritized to support coordination of mental health services for individuals with co-occurring IDD and mental health conditions.
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  • 文章类型: Letter
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  • 文章类型: Journal Article
    这项研究的目标(1)有三个方面:确定与辅助技术(AT)公共政策国际辩论有关的主要主题,根据这些主题分析巴西的案例,并吸取可以在巴西和其他国家应用的经验教训,以推动该领域的进展。
    通过批判性文献综述进行了定性研究,涉及到搜索,选择,以及2007年至2023年在两个信息源门户和四个数据库中索引的文章的分析。国际和巴西法律,reports,和其他与AT政策特别相关的出版物也包括在内。
    对186篇文章和巴西文件的分析促进了对四个主题的审查:从人权角度出发的AT政策,公共采购,服务交付系统,和国家计划。然后选择107个出版物的子集进行详细分析。
    实施国家计划等举措,建立AT研究中心,和创建产品目录被认为是良性的。加强产品选择自由和发展公共采购机制被确定为加强巴西人权保护的额外战略。
    政策动态和国家和国际经验表明,在巴西扩大举措和创造新解决方案的潜力。大学和其他科学机构成为产生新知识的有希望的场所,以支持AT政策的制定并促进其辩论和进一步发展。
    我们进行这一重要文献综述的目的是了解与辅助技术(AT)领域的公共政策相关的主要主题。我们发现公共采购,服务交付系统,和国家计划是国家可以用来确保与AT有关的权利的主要战略。
    UNASSIGNED: The objectives of this study(1) were threefold: to identify the main topics related to the international debate on Assistive Technology (AT) public policies, to analyze the Brazilian case in light of these topics, and to extract lessons that could be applied in Brazil and other countries to advance progress in the field.
    UNASSIGNED: A qualitative study was conducted through a critical literature review, involving the search for, selection, and analysis of articles indexed in two information source portals and four databases from 2007 to 2023. International and Brazilian laws, reports, and other publications specifically related to AT policies were also included.
    UNASSIGNED: The analysis of 186 articles and Brazilian documents facilitated the examination of four themes: AT policies from a human rights perspective, public procurement, service delivery systems, and national plans. A subset of 107 publications was then selected for detailed analysis.
    UNASSIGNED: Initiatives such as implementing a national plan, establishing an AT research center, and creating a product catalog are considered virtuous. Enhancing the freedom of choice for products and developing public procurement mechanisms are identified as additional strategies to reinforce protections of human rights in Brazil.
    UNASSIGNED: Policy dynamics and national and international experiences suggest the potential for expanding initiatives and creating new solutions in Brazil. Universities and other scientific institutions emerge as promising loci for generating new knowledge to support the formulation of AT policies and facilitate their debate and further development.
    Our aim in undertaking this critical literature review was to gain an understanding of the primary topics related to public policies in the field of Assistive Technology (AT).We have found that public procurement, service delivery systems, and national plans are the primary strategies that the State can employ to ensure rights related to AT.
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  • 文章类型: Journal Article
    作者试图描述一项针对洛杉矶县无家可归的严重残疾人的试点计划,该计划说明了一个有希望的公共卫生框架,以解决无家可归者与心理健康相关的残疾问题。
    实施门诊监护(OPC)试点计划的无家可归者外展小组采用了人口健康方法,多系统护理协调,以及限制最少的环境的优先级。该计划允许在医院外启动Lanterman-Petris-Short(LPS)保护工作,目标是在限制最少的环境中为高度脆弱的个人提供服务。在2020年8月至2021年7月期间,OPC试点计划为43个客户提供了服务。相当于在此期间外联团队服务的2%。利用观测计划评估数据,作者研究了该计划对参与者样本的影响.
    在12个月时,81%的OPC客户不再经历无庇护的无家可归;65%的人获得了LPS保护。尽管大多数OPC客户都使用了精神病医院,54%的人比没有该程序的情况下更早地保留了锁定设置。第一年,被称为LPS保护的客户中有三分之一使用了未锁定的许可住宅设施。负面事件,比如留在没有庇护的无家可归中,在未接受LPS保护的客户中更为常见。
    及时接受街头服务并协调护理,during,在转诊LPS保存后,减少了限制性设置的使用。OPC计划的组成部分构成了一个有希望的三元框架,用于解决无庇护者的心理健康障碍,值得进一步调查。
    UNASSIGNED: The authors sought to describe a pilot program for gravely disabled individuals experiencing unsheltered homelessness in Los Angeles County that illustrates a promising public health framework to address mental health-related disability in homeless populations.
    UNASSIGNED: Homeless outreach teams implementing the outpatient conservatorship (OPC) pilot program adopted a population health approach, multisystem care coordination, and prioritization of the least restrictive environments. The program allowed initiation of a Lanterman-Petris-Short (LPS) conservatorship outside of a hospital, with the goal of serving highly vulnerable individuals in the least restrictive settings. Between August 2020 and July 2021, the OPC pilot program served 43 clients, corresponding to 2% of those served by the outreach teams during that period. Using observational program evaluation data, the authors examined the impact of the program on this sample of participants.
    UNASSIGNED: At 12 months, 81% of OPC clients were no longer experiencing unsheltered homelessness; 65% accessed an LPS conservatorship. Although most OPC clients utilized a psychiatric hospital, 54% left locked settings earlier than would have been possible without the program. One-third of clients referred for LPS conservatorship used unlocked licensed residential facilities in the first year. Negative events, such as remaining in unsheltered homelessness, were more common among clients not referred for LPS conservatorship.
    UNASSIGNED: Timely receipt of street-based services and coordination of care before, during, and after referral for LPS conservatorship reduced use of restrictive settings. The OPC program\'s components constitute a promising triadic framework for addressing mental health disability among unsheltered individuals that warrants further investigation.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    精神-心理健康(PMH)高级实践护士有教育,认证,和执照,以满足提供者能够提供全面的精神卫生服务的需求,从而增加获得精神卫生保健的机会。尽管PMH执业护士(PMHNP)在这一劳动力队伍中迅速增长,它在劳动力规划和不断发展的国家行为健康劳动力数据库中缺乏可见性。似乎缺乏对PMHNP特征和实践角色的理解。解决这一限制需要围绕该劳动力的实践范围和数据明确传达信息,以表明PMHNP能力如何满足心理健康治疗需求。
    Psychiatric-mental health (PMH) advanced practice nurses have the education, certification, and licensure to address the need for providers who can deliver the full scope of mental health services and thereby increase access to mental health care. Although the PMH nurse practitioner (PMHNP) segment of this workforce is rapidly growing, it has scant visibility in workforce planning and the evolving national behavioral health workforce database. An understanding of PMHNP characteristics and practice roles seems to be lacking. Addressing this limitation demands clear messaging around this workforce\'s scope of practice and data indicating how PMHNP capabilities meet mental health treatment needs.
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