Depression Remission From Community Coalitions Versus Individual Program Support for Services: Findings From Community Partners in Care, Los Angeles, California, 2010-2016.

Objectives. To explore effects of coalitions (Community Engagement and Planning [CEP]) versus technical assistance (Resources for Services [RS]) for depression collaborative care and the effects of social determinants on long-term remission outcomes. Methods. We randomized 95 health care and community programs in Los Angeles County, California, to CEP or RS. In 2010, 1246 depressed (Patient Health Questionnaire [PHQ-8] ≥ 10) adults enrolled and were invited for baseline and 6-, 12-, and 36-month surveys. Of 598 3-year completers, 283 participated at 4 years (2016). We examined effects of CEP versus RS, social factors (e.g., family income, food insecurity) on time to and periods in clinical (PHQ-8 < 10) and community-defined (PHQ-8 < 10 or PHQ-2 < 3; mental health composite score [MCS-12] > 40, or mental wellness) remission during the course of 3 years, and at 4 years. Results. We found that CEP versus RS increased 4-year depression remission and, for women, community-defined remission outcomes during the course of 3 years. Social factors and clinical factors predicted remission. Conclusions. At 4 years, CEP was more effective than RS at increasing depression remission. Public Health Implications. Coalitions may improve 4-year depression remission, while addressing social and clinical factors associated with depression may hold potential to enhance remission.

The Health Sector Response to the 2015 Earthquake in Nepal.

In April 2015, Nepal experienced an earthquake of a magnitude of 7.6 on the Richter scale that resulted in deaths, morbidities, and infrastructure damage. In the post-earthquake period, 4 different workshops and a national "Lessons Learnt" conference were organized to assess the adequacy of the preparedness and response of the health sector. This article summarizes the main conclusions of these discussions relating to leadership, timely search and rescue, referral operations, medical relief to response activities, awareness campaigns, and support from the national and international levels, and epidemiological surveillance. The earthquake response was channeled through rapid response teams that spanned from the community level to the central level via a cluster coordination approach. Overall, the health sector's response was concluded to be largely satisfactory because it focused not only on emergency medical care, but also on the resumption of basic health services and preventive health care (eg, hygiene, risk communication) equally. Post-disaster disease outbreak did not occur because effective surveillance and outbreak monitoring was one of the priority actions. However, services related to birthing centers, neonatal services, and vaccinations were impeded in some rural areas. Some weaknesses in planning, coordination, and management were also noted. The lessons learned can provide the impetus to strengthen future preparedness and response mechanisms. (Disaster Med Public Health Preparedness. 2018;12:543-547).

Health Care Coalitions as Response Organizations: Houston After Hurricane Harvey.

Health care coalitions play an increasingly important role in both preparedness for, response to, and recovery from large scale disaster events occurring across the United States. The actions taken by the South East Texas Regional Advisory Council (SETRAC) in response to the landfall of Hurricane Harvey, and the consequential flooding that ensued, serve as an excellent example of how health care coalitions are increasingly needed to play a unifying role in response. This paper highlights a number of the strategic planning, operational planning and response, information sharing, and resource coordination and management activities that were undertaken for the response to Hurricane Harvey. The successful response to this devastating storm in the Houston, Texas area serves as an example to other regions across the country as they work to implement the 2017-2022 health care capabilities articulated by the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response. (Disaster Med Public Health Preparedness. 2017;11:637-639).

How a housing advocacy coalition adds health: A culture of claims-making.

Organizations that pursue health advocacy often tackle other issues too. How do these multi-issue organizations articulate and combine health with other issues? We examine how a Los Angeles coalition focused primarily on housing took up health in its 2008-2011 campaign against a residential development. Participant observation and archival data reveal that cultural context influenced how the coalition made claims about health, in two ways. First, advocates shared two major symbolic categories, which oriented the great bulk of their appeals regarding health. Second, advocates crafted rhetorical appeals that reflected their shared sense of social identity and obligation as spokespersons for a distinctive kind of community. These two kinds of cultural context influenced advocates' claims in public, formal settings as well more internal communication. These distinct, cultural influences on claims-making create challenges for socioeconomically diverse coalitions collaborating on health problems.

Utilization of Health Care Coalitions and Resiliency Forums in the United States and United Kingdom: Different Approaches to Strengthen Emergency Preparedness.

The process for developing national emergency management strategies for both the United States and the United Kingdom has led to the formulation of differing approaches to meet similar desired outcomes. Historically, the pathways for each are the result of the enactment of legislation in response to a significant event or a series of events. The resulting laws attempt to revise practices and policies leading to more effective and efficient management in preparing, responding, and mitigating all types of natural, manmade, and technological hazards. Following the turn of the 21st century, each country has experienced significant advancements in emergency management including the formation and utilization of 2 distinct models: health care coalitions in the United States and resiliency forums in the United Kingdom. Both models have evolved from circumstances and governance unique to each country. Further in-depth study of both approaches will identify strengths, weaknesses, and existing gaps to meet continued and future challenges of our respective disaster health care systems.

Contributions of Health Care Coalitions to Preparedness and Resilience: Perspectives From Hospital Preparedness Program and Health Care Preparedness Coalitions.

OBJECTIVE: The purpose of this article was to describe how the Hospital Preparedness Program (HPP) and other health care coalitions conceptualize and measure progress or success and to identify strategies to improve coalition success and address known barriers to success. METHODS: We conducted a structured literature review and interviews with key leaders from 22 HPPs and other coalitions. Interview transcripts were analyzed by using constant comparative analysis. RESULTS: Five dimensions of coalition success were identified: strong member participation, diversity of members, positive changes in members' capacity to respond to or recover from disaster, sharing of resources among members, and being perceived as a trendsetter. Common barriers to success were also identified (eg, a lack of funding and staff). To address these barriers, coalitions suggested a range of mitigation strategies (eg, establishing formal memoranda of agreement). Both dimensions of and barriers to coalition success varied by coalition type. CONCLUSIONS: Currently, the term health care coalition is a one-size-fits-all term. In reality, this umbrella term describes a variety of different configurations, member bodies, and capabilities. The analysis offered a typology to categorize health care coalitions by primary function during a disaster response. Developing a common typology that could be used to specify capabilities or functions of coalitions may be helpful to advancing their development.

Identifying Indirect Benefits of Federal Health Care Emergency Preparedness Grant Funding to Coalitions: A Content Analysis.

OBJECTIVE: This study aimed to identify the indirect benefits of health care preparedness funding as perceived by current and former recipients of the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response's Hospital Preparedness Program. METHODS: This was a qualitative inductive content analysis of telephone interviews conducted with regional stakeholders from several health care coalitions to identify their perceptions of the indirect benefits of preparedness funding. RESULTS: Content analysis of interviewee responses resulted in 2 main categories of indirect benefits of federal health care preparedness funding: (1) dual-use technology and programs and (2) impact of relationships on day-to-day operations. Within the dual-use technology and programs category, 3 subcategories were identified: (1) information systems, (2) clinical technology, and (3) health care operations. Similarly, 3 subcategories relating to the indirect benefits in the impact of relationships on day-to-day operations category were identified: (1) cooperation, (2) information sharing, and (3) sense of community. CONCLUSION: This study identified indirect benefits of federal investment in hospital and health care preparedness in day-to-day operations. Major categories of these benefits included dual-use technology and programs and impact of relationships on day-to-day operations. Coalition members placed a high value on these benefits, even though they were not direct outcomes of grant programs. Further research is needed to quantify the economic value of these indirect benefits to more accurately measure the total return on investment from federal grant funding.

Transforming Health Care Coalitions From Hospitals to Whole of Community: Lessons Learned From Two Large Health Care Organizations.

A health care emergency preparedness coalition (coalition) is a group of health care organizations, public safety agencies, and public health partners that join forces for the common cause of making their communities safer, healthier, and more resilient. Coalitions have been characterized as being focused on hospital systems instead of the health care of the community as a whole. We discuss 2 examples of coalition partners that use a more inclusive approach to planning, response, and recovery. The first is a large health care system spread across 23 states, and the other is a public safety agency in northeast Pennsylvania that took the lead to address the preparedness and response toward a large influx of burn patients and grew to encompass all aspects of community health care.

A Tailored Approach to Launch Community Coalitions Focused on Achieving Structural Changes: Lessons Learned From a HIV Prevention Mobilization Study.

Public health HIV prevention efforts have begun to focus on addressing social and structural factors contributing to HIV risk, such as unstable housing, unemployment, and access to health care. With a limited body of evidence-based structural interventions for HIV, communities tasked with developing structural changes need a defined process to clarify their purpose and goals. This article describes the adaptations made to a coalition development model with the purpose of improving the start-up phase for a second group of coalitions. Modifications focused on preparing coalitions to more efficiently apply structural change concepts to their strategic planning activities, create more objectives that met study goals, and enhance coalition procedures such as building distributed coalition leadership to better support the mobilization process. We report on primary modifications to the process, findings for the coalitions, and recommendations for public health practitioners who are seeking to start a similar coalition.

Strategic planning: how medical practices can succeed in a post-healthcare-reform world.

This article addresses the recent trend of physicians being pressured to sell to hospitals in order to stay in practice. The author utilizes his experience in the healthcare industry to identify causes of this trend and ways in which physician groups can avoid finding themselves in these situations. The author uses real data from an existing medical practice to support his ideas and demonstrate how implementing change now will be beneficial for the success of this medical practice in the future. Objective practice evaluation and the execution of an efficient strategic plan are cited as the most important factors contributing to the financial solvency of medical practices in the current and future healthcare environment.

Organizing communities around care transitions: the community connections experience.

The Community Connections initiative provides an example of building collaboration and partnerships across traditional boundaries--public-private, medical home, and community-based services--to improve care transitions and support for older adults and adults with disabilities. This approach was inspired by the self-governance and community engagement model, with the knowledge, experience, and participation of community stakeholders.