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Studying implementation of dual diagnosis services: a review
- Authors:
- SYLVAIN Chantal, LAMOTHE Lise
- Journal article citation:
- Journal of Dual Diagnosis, 9(2), 2013, pp.195-207.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Over the past 15 years, considerable time and energy has been devoted to implementing integrated services for individuals with dual disorders. While the key factors in the successful implementation of such services have been documented, applying them remains a challenge. In this article the authors attempt to answer question of 'what is missing?' by examining how implementation studies of integrated services have been carried out. The aim is to identify possible avenues for future implementation research. Methods: Update of a recent literature review of published studies on service implementation. Articles written in English and organisation-level factors were included. The reviewed articles were categorised based on two aspects of their methodology: their approach to the implementation process (content- or process-centered) and their objective (descriptive or explanatory). Results: In the 15 studies reviewed, a tendency toward a content-centered approach (n = 9) with a majority having an explanatory objective was observed. Studies that reflected this trend identified the most common determining factors in order to explain the level of implementation achieved within a given period of time. These studies did not examine the sequencing and transformation of the implementation process over time. Such a process-centered approach was used in only six studies. Conclusions: Research exploring the evolutive dynamics of implementation projects should be prioritised to counter the lack of knowledge on the subject. Such studies have the potential to greatly enhance our understanding as well as our capacity to master the implementation of integrated services. (Publisher abstract)
Integrated mental health/substance abuse responses to justice involved persons with co-occurring disorders
- Author:
- OSHER Fred C.
- Journal article citation:
- Journal of Dual Diagnosis, 4(1), 2007, pp.3-33.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Many US offenders with mental health problems have co-occurring substance abuse disorders but treatment has typically been fragmented. Integration at both the service and treatment levels is seen as important for the development of evidence-based practice, and research supporting this approach is examined. Specific evidence-based practices are also reviewed including the modified therapeutic community, integrated dual disorder treatment and assertive community treatment. These can involve each of the points of contact with the justice system including the police, the courts, prisons and community-based corrections services. Although increasing numbers of service and treatment integration models are evidence-based, more needs to be done to encourage their implementation in practice. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Untangling the inter-relatedness within integrated care programmes for community-dwelling frail older people: a rapid realist review
- Authors:
- ANAM Ahmed, et al
- Journal article citation:
- BMJ Open, 11(4), 2021, p.e043280. Online only
- Publisher:
- BMJ Publishing Group
Objective: To identify the relationships between the context in which integrated care programmes (ICPs) for community-dwelling frail older people are applied, the mechanisms by which the programmes do (not) work and the outcomes resulting from this interaction by establishing a programme theory. Design: Rapid realist review. Inclusion criteria: Reviews and meta-analyses (January 2013–January 2019) and non-peer-reviewed literature (January 2013–December 2019) reporting on integrated care for community-dwelling frail older people (≥60 years). Analysis: Selection and appraisal of documents was based on relevance and rigour according to the Realist And Meta-narrative Evidence Syntheses: Evolving Standards criteria. Data on context, mechanisms, programme activities and outcomes were extracted. Factors were categorised into the five strategies of the WHO framework of integrated people-centred health services (IPCHS). Results: 27 papers were included. The following programme theory was developed: it is essential to establish multidisciplinary teams of competent healthcare providers (HCPs) providing person-centred care, closely working together and communicating effectively with other stakeholders. Older people and informal caregivers should be involved in the care process. Financial support, efficient use of information technology and organisational alignment are also essential. ICPs demonstrate positive effects on the functionality of older people, satisfaction of older people, informal caregivers and HCPs, and a delayed placement in a nursing home. Heterogeneous effects were found for hospital-related outcomes, quality of life, healthcare costs and use of healthcare services. The two most prevalent WHO-IPCHS strategies as part of ICPs are ‘creating an enabling environment’, followed by ‘strengthening governance and accountability’. Conclusion: Currently, most ICPs do not address all WHO-IPCHS strategies. In order to optimise ICPs for frail older people the interaction between context items, mechanisms, programme activities and the outcomes should be taken into account from different perspectives (system, organisation, service delivery, HCP and patient). (Edited publisher abstract)
Service integration across sectors in Europe: literature and practice
- Authors:
- VAN DUIJN Sarah, et al
- Journal article citation:
- International Journal of Integrated Care, 18(2), 2018, p.6. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: To meet the needs of vulnerable people, the integration of services across different sectors is important. This paper presents a preliminary review of service integration across sectors in Europe. Examples of service integration between social services, health, employment and/or education were studied. A further aim of the study was to improve conceptual clarity regarding service integration across sectors, using Minkman’s Developmental Model for Integrated Care (DMIC) as an analytical framework. Methods: The study methods comprised a literature review (34 articles) and a survey of practice examples across Europe (44 practices). This paper is based on a more comprehensive study published in 2016. Results: The study demonstrates that although the focus of integration across sectors is often on social services and health care, other arrangements are also frequently in place. The review shows that integration may be either tailored to a particular target group or designed for communities in general. Although systems to monitor and evaluate social service integration are often present, they are not yet fully developed. The study also highlights the importance of good leadership and organisational support in integrated service delivery. Discussion: The study shows that the DMIC can work as a conceptual framework for the analysis of service integration across sectors. However, as this is an exploratory study, further in-depth case studies are required to deepen our understanding of the processes involved in service integration across sectors. (Edited publisher abstract)
Place-based approaches to joint planning, resourcing and delivery: an overview of current practice in Scotland
- Authors:
- BACZYK Monika, et al
- Publisher:
- Improvement Service
- Publication year:
- 2016
- Pagination:
- 129
- Place of publication:
- Livingston
Sets out the current landscape of place-based approaches to joint planning, resourcing and delivery across Scotland’s local authority areas. The report captures current place-based activities within 27 local authority areas and includes a synthesis of published materials on the subject. As well as undertaking a review of the literature on place-based approaches to service delivery in the UK, the Improvement Service conducted interviews with local authority areas to find out more about local approaches. Whilst there is evidence of a wide variety of approaches being undertaken, the research also highlights a range of common principles that feature across most areas. The study found that the majority of place-based approaches are adopting a holistic approach, focused on reducing inequalities and supporting people, families and communities to improve their life outcomes in the round. Others are focusing on a specific theme, such as family support, health inequalities, physical regeneration and access to services. The report includes a practical checklist that summarises key issues that partnerships may wish to consider, either when embarking upon a new place-based initiative or when reviewing existing activities. (Edited publisher abstract)
The development of an evaluation framework for a Hospital at Home service: lessons from the literature
- Authors:
- JESTER Rebecca, et al
- Journal article citation:
- Journal of Integrated Care, 23(6), 2015, pp.336-351.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to share good practice with interested professionals, commissioners and health service managers regarding the development of an evidence-based approach to evaluation of an integrated care service providing acute level care for patients in their own homes in South London called the Guys and St Thomas’ @home service. Design/methodology/approach: A literature review related to Hospital at Home (HH) schemes was carried out with an aim of scoping approaches used during previous evaluations of HH type interventions to inform the development of an evaluation strategy for @home. The results of the review were then applied to the Donabedian conceptual model: Structure; Process; and Outcome and contextualised to the population being served by the scheme to ensure a robust, practical and comprehensive approach to evaluation. Findings: Due to the heterogeneity of the studies it was not possible to conduct a systematic review or meta-analysis. In total, 28 studies were identified that met the inclusion criteria and included both HH to facilitate early discharge and admission prevention across a wide range of conditions. The key finding was there is a dearth of literature evaluating staff preparation to work on HH, models of delivery, specifically integrated care and trans-disciplinary working and few studies included the experiences of family carers. Originality/value: This paper will be of value to those involved in the commissioning and delivery of HH and other models of integrated care services type services and will help to inform evaluation strategies that are practical, evidence based and include all stakeholder perspectives. (Publisher abstract)
Contracting for integrated health and social care: a critical review of four models
- Authors:
- BILLINGS Jenny, DE WEGER Esther
- Journal article citation:
- Journal of Integrated Care, 23(3), 2015, pp.153-175.
- Publisher:
- Emerald
Purpose: Service transformation of health and social care is currently requiring commissioners to assess the suitability of their contracting mechanisms to ensure goodness of fit with the integration agenda. The purpose of this paper is to provide a description and critical account of four models of contracting, namely Accountable Care Organisations, the Alliance Model, the Lead Provider/Prime Contractor Model, and Outcomes-based Commissioning and Contracting. Design/methodology/approach: The approach taken to the literature review was narrative and the results were organised under an analytical framework consisting of six themes: definition and purpose; characteristics; application; benefits/success factors; use of incentives; and critique. Findings: The review highlighted that while the models have relevance, there are a number of uncertainties regarding their direct applicability and utility for the health and social care agenda, and limited evidence of effectiveness. Research limitations/implications: Due to the relative newness of the models and their emerging application, much of the commentary was limited to a narrow range of contributors and a broader discussion is needed. It is clear that further research is required to determine the most effective approach for integrated care contracting. It is suggested that instead of looking at individual models and assessing their transferable worth, there may be a place for examining principles that underpin the models to reshape current contracting processes. Practical implications: What appears to be happening in practice is an organic development. With the growing number of examples emerging in health and social care, these may act as “trailblazers” and support further development. Originality/value: There is emerging debate surrounding the best way to contract for health and social care services, but no literature review to date that takes these current models and examines their value in such critical detail. Given the pursuit for “answers” by commissioners, this review will raise awareness and provide knowledge for decision making. (Publisher abstract)
Tackling homelessness: a rapid evidence review
- Author:
- CARTER Lauren
- Publisher:
- Public Policy Institute for Wales
- Publication year:
- 2015
- Pagination:
- 30
- Place of publication:
- Cardiff
A rapid evidence review aimed to understand the current state of the evidence on homelessness better, both specific to Wales and further afield, and identify where further research might be needed. The review shows that in the last 15 years, the Welsh Government has commissioned over 15 reports related to homelessness, focusing on prevention, housing solutions for specific target groups, the effectiveness of government programmes, improving the health of the homeless, learning from experiences of the homeless and homelessness legislation in Wales. Beyond these publications there exists a multitude of reports on the causes of homelessness, good practice in homelessness prevention and designing services to meet the needs of the homeless. The evidence shows that homelessness is a complex problem. It often has multiple causes that interact with one another in ways that vary at the individual level and require engagement with multiple policy areas. A ‘one-size-fits-all’ approach to tackling homelessness is unlikely to be successful. The review concludes that an individualised, professional support from multidisciplinary, joined-up services is important for tackling homelessness, and would likely bring improvements to other public services too. (Edited publisher abstract)
Horizontal and vertical integration in the UK: lessons from history
- Authors:
- RUMBOLD Benedict, SHAW Sara E.
- Journal article citation:
- Journal of Integrated Care, 18(6), December 2010, pp.45-52.
- Publisher:
- Emerald
Policy makers, practitioners and researchers have increasingly emphasised the need for both vertical and horizontal ‘integration’ and ‘integrated care’. This is not new; since the inception of the NHS wide-ranging policies and programmes have sought to co-ordinate services better. Current UK policy, however, tends to overlook this historical record and, in so doing, ignores potential learning from the past. This article aims to shed light on how the policy of integrated care has developed in the UK and draw out lessons for modern-day policy makers. It draws on an historical analysis of both published and grey literature in the UK, covering sources over the past 100 years. It focuses on two aspects of current integrated care policy: the drive to integrate health and social care (horizontal integration); and the drive to integrate primary and secondary care better (vertical integration). It considers both the drivers for and the impediments to varied UK policy developments in integrating health and allied services. It demonstrates that the thinking behind integrated care has remained fairly static over the past 100 years.
Health and ageing in Slovenia: literature review
- Authors:
- PAHOR Majda, DOMAJNKO Barbara
- Journal article citation:
- Ageing International, 32(4), December 2008, pp.312-324.
- Publisher:
- Springer
- Place of publication:
- New York
The study aims to establish whether professional and scientific literature in Slovenia provides grounds for the integrated approach in care for the elderly. Literature review is used as the method of data collection and analysis. Relevant publications were searched for through the national electronic interdisciplinary bibliographic database. Data was collected twice, for the period from 1994 to 2003 and from 2004 to 2006, to establish the publishing trend. A chart is drawn, based on a distinction among three levels: disciplinary, multi-interdisciplinary and the level of integration. It outlines the conceptualization of elderly people’s health as shaped through selected literature, and another one exposes its changes in time. Results show the prevalent presence of the functionalist theoretical perspective on ageing and the bio-medical model of care for the elderly. The voice of the elderly is poorly acknowledged. Data testify to the lack of literature that would support the implementation of the integrated approach to the health of the elderly.