The paraprofessional as a referral link in the mental health delivery system

The role of the paraprofessional in the delivery of mental health services is often ambiguously defined. Even while performing the specific task of making a referral, the activities of the paraprofessional are subject to controversy. In this study the clients, the agency board members, and the community mental health agency workers all have different expectations of the qualifications, the knowledge, and the activities of the paraprofessional referral worker. It is suggested that the disparate views the participants bring to the referral situation make it unlikely that the paraprofessional will satisfy the expectations of all of them.     

Use of traditional and orthodox health services in urban Zimbabwe

BACKGROUND: Health care in Zimbabwe is provided by both orthodox and traditional care providers. With formal medical services under economic strain it is important to understand the extent of consulting with traditional care providers and their effectiveness. METHODS: A cross-sectional community survey recorded consultations and self-treatment for episodes of illness among 1251 individuals in 222 households randomly selected in two high-density suburbs of Harare, Zimbabwe. Three dependent variables (illness experience, consultation behaviour and choice of care provider) were analysed against a range of sociodemographic, episode-related and outcome measures. RESULTS: More than one-third of the sample had experienced an illness and 83% of these had led to consultation. Medical services were consulted eight times more often than traditional ones. Non-consulting behaviour was associated with lack of money or low perceived significance of problems. Physical problems were usually taken to medical clinics where their outcome was better, but non-specific pain and other problems did no better with medical or traditional care. CONCLUSIONS: While members of the community appear to recognize physical problems and take them to medical care, traditional and orthodox medical consultations appear to be equally effective for non-specific pain or non-specific physical problems. The role of traditional medicine in relation to non-specific physical problems and psychological problems is one which deserves further examination from both clinical and administrative perspectives. Poverty appears to be associated with poorer outcomes; this is a potentially important issue in times of increasing economic hardship.     

Role of psychology in the delivery of health services.

Comments on W. Schofield's (1969) statement that there are areas in health care delivery that have been untapped by psychologists. The National Center for Health Services Research and Development provides support in these areas of research. However, psychologists have failed to take advantage of these opportunities. (0 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Problems and limitations in using psychological assessment in the contemporary health care delivery system.

Psychologists report limitations on psychological assessment services and problems gaining authorizations and reimbursement for these services from third-party payers. Documentation and categorization of these problems and limitations is based on responses from well over 500 psychologists responding to a broad solicitation for feedback. This article explores the barriers to access for assessment services, including resistance to psychological assessment, difficulties in the preauthorization process, problems with reimbursement, the clinical decision-making process, and larger systems issues. The authors make recommendations for redress of these problems through work with the profession, other mental health professionals, managed care, and patients–consumers and through political action. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emerging perspectives on the role of psychologists in the delivery of health and mental health services in schools.

This introductory article presents an overview of the APA Committee for the Advancement of Professional Practice Working Group on Schools as Health Care Delivery Sites. Additionally, it provides a health care reform context for exploring the emerging role for psychologists in the delivery of health and mental health services to children in the school setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychology in the delivery of health services.

Considers whether psychology is both a health science and a health profession. The question is answered affirmatively. The pattern of psychological research in the health domain is analyzed. Current and evolving demands for psychological service in both preventive and treatment contexts are surveyed. Implications for training at both doctoral and subdoctoral levels are examined. (52 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Appropriateness in health care delivery: definitions, measurement and policy implications

A major focus of the current health care debate is the notion that a substantial proportion of the health care delivered in Canada is inappropriate. There are two types of appropriateness: appropriateness of a service and appropriateness of the setting in which care is provided (i.e., inpatient v. outpatient or home care). Measuring both types objectively requires the comparison of observed patterns of care with explicit criteria for appropriate care. The few studies of appropriateness conducted in Canada have shown that inappropriate services are provided and inappropriate settings are used. Reducing inappropriate health care delivery could involve active strategies for the implementation of guidelines and better cooperation and coordination within the health care system. However, lower rates of health care delivery or even inappropriate health care will not necessarily translate into higher quality care or lower costs overall.     

Delivery of mental health services in the changing health care system.

Comments on the anonymous article, "Hidden benefits of managed care" (see record 1995-33982-001), in which the author expresses concern that managed care organizations are making decisions on the basis of economics and not the well-being of the patient. B. Miller and L. Farber empathize with the author's concerns, but contend that, if structured properly, HMOs can become the vehicle for the reengineering of mental health services that will produce the best patient outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of cognitive status in the use of inhome services: implications for nursing assessment

The link between cognitive status and use of home-care services by elders and their informal caregivers has received limited research attention. The purpose of this study was to determine whether an association exists between cognitive status and inhome service utilization by elders and their identified informal caregiver (N = 380). A modification of the Andersen-Newman health service utilization model was constructed to facilitate analysis and comparison with other studies. Data from the Manitoba Study on Health and Aging-1 (MSHA-1) were analyzed using hierarchical logistic regression modelling. Elders of 3 types of cognitive status--dementia, cognitive loss without dementia, and no cognitive impairment--were studied; 4 different inhome services--homemaking, inhome nursing, personal care, and home-delivered meals--were examined. The study revealed a weak association between cognitive status and use of inhome services. The findings raise implications for eligibility assessment by nurses and home-care policy.     

Experience with prospective payment in the Veterans Administration: Its impact on the delivery of mental health services.

Contends that the experience of the Veterans Administration in the use of prospective approaches that rely on diagnosis-related groups (DRGs) to guide hospital budget development and control costs is instructive in the debate on bringing inpatient psychiatric services under the prospective payment system used in the Medicare program. It is suggested that comprehensive mental health benefits enable the system to respond flexibly to the major dislocations that can result from the use of a patient classification system such as the DRGs, which many feel is problematic for psychiatric patients. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The financing and the economic efficiency of rural health services in the People''s Republic of China

In the pregnant rat, killed at about mid gestation and 1 h after injection of tritiated thymidine, 40% of the cells in the epithelium lining the uterine lumen at the implantation site were labelled. Between implantation sites fewer than 20% of the surface epithelial cells were labelled. A series of rats was given tritiated thymidine on day 12 of pregnancy and killed at intervals in the next 30 h. A percentage labelled mitoses analysis of the epithelium between implantation sites (interconceptual) and within the implantation site (conceptual) showed that cells in either region spent 7 h in DNA synthesis and 1-5 h in the G2 + 1/2 MITOSIS PHASES. The epithelial cells in the conceptual region spent 1-5 h in the G1 + 1/2 MITOSIS PHASES WHEREAS CELLS IN INTERCONCEPTual regions spent at least 11-5 h in these phases. The average cycle times of cells in conceptual regions was 10 h: in interconceptual regions minimum cycle time was 20 h and the average appeared to be considerably longer. The grain count of the epithelial cells in the conceptual region was rapidly reduced during the 30 h after injection of tritiated thymidine suggesting successive rounds of cell division. In contrast the grain count distribution of cells in interconceptual regions changed only slowly during this time. The percentage of labelled epithelial cells was determined in the animals killed up to 30 h after injection of tritiated thymidine. In both conceptual and interconceptual regions these percentages increased initially as labelled cells produced labelled progeny. In the conceptual region the increase was not maintained after 7 h as cells initially in G1 divided to give unlabelled progeny. In the interconceptual region the increase in the percentage of labelled cells continued for 14 h; thereafter the percentage did not significantly alter. The interpretation of these results is discussed in relation to the differences in the kinetic characteristics of the epithelial cells in the two regions and in relation to the morphology of the epithelium lining the uterus during pregnancy.     

Goal definition by staff consensus: A contribution to the planning, delivery, and evaluation of mental health services.

To provide a basis for the evaluation of VA mental health services, a survey was conducted of staff opinion regarding the importance of several specific goals for these services. Nine goals were formulated and submitted to 6,435 central office and field facility staff to obtain their ratings of each goal's importance, with an "of no importance" rating being possible. The goals dealing with (a) the development of patient skills necessary for being self-supporting, (b) the elimination of psychological disorders, and (c) the protection of patients and others from violence received the highest average ratings. The remaining goals were considered as having some importance although there were substantial differences among the sample about the degree. Interoccupational group differences in importance ratings were statistically significant but small. Although the goals formulated and ratified by staff were general, they were more specific than previous goal statements. It is suggested that because of this relative specificity, they provide useful guidance for planning, managing, delivering, and evaluating mental health services. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuity of care and delivery of ambulatory services to children in community health clinics

This study assesses how continuity of care influences receipt of preventive care and overall levels of ambulatory care among children and adolescents in community health clinics (CHCs). It is a secondary data analysis of the 1988 Child Health Supplement to the National Health Interview Survey. Of 17,110 children in the sample population, the 1465 who identified CHCs as their routine source of care formed the study population. Continuity of site was defined as identification of a CHC as a source of both routine and sick care, and continuity with a clinician was defined as identification of a specific clinician for sick visits. In bivariate analyses both continuity with the CHC and with a specific clinician were associated with increased levels of preventive care and overall ambulatory care. In logistic regression models, continuity of care was associated with nearly a two-fold increase in the odds of receiving age-appropriate preventive care. Alternatively, insurance status was a better predictor of receipt of overall levels of ambulatory care. We conclude that expanding financial access alone is unlikely to sufficiently improve low-income children's access to Community Health Clinics. Additional emphasis on localizing the delivery of both routine and sick care services in a single site or with a specific clinician may be needed to achieve higher levels of both preventive care and overall ambulatory care.     

武汉市区级疾控信息化建设现状调查结果分析

2007-2009年,武汉市政府高度重视疾控机构的建设与发展,投入500万元人民币完善全市公共卫生信息网络,武汉市区疾控中心(CDC)信息网络基础建设得到了较大提升.目前武汉市区级疾控中心的信息化建设人员情况,网络及硬件设备是否到位,信息化资金投入是否合理,尤其是如何合理规划全市疾控系统信息化建设成为急待解决的事情[1],现对武汉市区级疾控系统进行调查,结果如下[2].     

Lay influences on the utilization and provision of health services: A review.

Empirical evidence reveals that the individual seeking and receiving help in our Canadian culture is highly subject to the influence of lay persons in the natural environment. This review of the literature documenting their influence is organized into 2 domains--the Lay Referral Network and the Lay Treatment Network--and is drawn from both the medical and mental health fields. Current knowledge about the nature of the lay community's impact on the health care of persons is summarized, and future research directions and implications for professional practice are presented. (French abstract) (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

高等学校奖助学金评定效率与公平的文化研究

奖、助学金体现党和政府对经济困难学生的关怀,效率和公平不但是评定的关键,而且会影响今后的评定工作和对学生的日常管理。效率和公平的平衡在实际中很难恰到好处。研究发现,这一矛盾背后有文化的因素,中国文化的公平观念决定着学生感觉上的效率高低。因此,奖助学金评定的关键是在过程中让所有学生感受到公平,在心理上认同接受,实现物质帮助和精神提升的双重效果。     

高等学校奖助学金评定效率与公平的文化研究

奖、助学金体现党和政府对经济困难学生的关怀,效率和公平不但是评定的关键,而且会影响今后的评定工作和时学生的日常管理.效率和公平的平衡在实际中很难恰到好处.研究发现,这一矛盾背后有文化的因素,中国文化的公平观念决定着学生感觉上的效率高低.因此,奖助学金评定的关键是在过程中让所有学生感受到公平,在心理上认同接受,实现物质帮助和精神提升的双重效果.     

氧气管网采用煤气柜技术稳压节能效果分析

目前我国空分装置的氧气压缩输送系统的压力一般在1.7～2.9MPa之间波动,而用户要求的压力在1.5MPa左右.从稳定并降低氧气的输送压力的角度出发,提出一种利用煤气柜技术低压储存氧气的氧气输送系统,并评价了新系统的节能效果.     

Impact of Medicaid managed mental health care on delivery of services in a rural state: an AMI perspective

In March 1995 Iowa implemented a statewide mental health carve-out program under a Medicaid Section 1915b waiver. A goal was to provide equal access across counties for Medicaid recipients by introducing a statewide network of service providers. Problems have included the contractor's authorizing only services considered medically necessary for persons with serious mental illness, who also need community supports; contractor staff's lack of knowledge about regional resources and the limited availability of community-based services in most rural areas; clients' difficulty in gaining access to the new system; denial of inpatient hospitalization; untimely provider payments; and lack of education for providers, consumers, and families.