Current and preferred services of specialized professionals in childcare settings in Quebec, Canada: A descriptive survey of childcare administrators' perspectives.

BACKGROUND: Many challenges exist in promoting inclusion in childcare settings. Adequate support from specialized professionals is necessary to create inclusive childcare settings. Understanding which services are being delivered by specialized professionals in childcare contexts is an important first step. The aim of this study was to (1) describe the services currently being delivered by specialized professionals in childcare settings in Quebec (Canada) and (2) seek childcare administrators' perspectives on their preferred services. METHODS: An online province-wide descriptive survey was conducted with childcare administrators (n = 344). Questions focused on 11 service delivery dimensions (e.g. professionals involved, children served). Descriptive statistics were calculated. RESULTS: Childcare settings received services from a median of two specialized professionals (IQR [1-4]). Most services were delivered by early childhood special educators (61.3%), speech-language pathologists (57.6%), psycho-educators (43.6%) and occupational therapists (43.3%). Childcare administrators identified these four services as being particularly supportive. Professionals delivered a median of 0.4 h of service per week in each childcare setting (IQR [0.1-3.0]). A high percentage (91.2%) of administrators reported unmet needs for professional support in at least one developmental domain, with a high percentage (57.3%) of administrators identifying needs in the socio-emotional domain. Most (63.3%) expressed a desire to prioritize services for children without an established diagnosis but identified by early childhood educators as having needs for professional support. Most administrators (71.4%) also preferred in-context services. CONCLUSIONS: Childcare administrators perceive an important role for specialized professionals in supporting inclusion in their settings. Recommendations emerging are based on the four main professional service needs identified: (1) increasing the intensity and stability of services; (2) providing services for undiagnosed children identified by early childhood educators as having unmet needs; (3) ensuring that services encompassing all developmental domains with a focus on the socio-emotional domain; and (4) prioritizing of in-context services.

Civil service organization as a political determinant of health: Analyzing relationships between merit-based hiring, corruption, and population health.

A growing literature finds that the way governments are organized can impact the societies they serve in important ways. The same is apparent with respect to civil service organizations. Numerous studies show that the recruitment of civil servants based on their credentials rather than on nepotism or patronage reduces corruption in government. Political corruption in turn appears to harm population health. Up to this time, however, civil service organization is not a recognized determinant of health and is little discussed outside of political science disciplines. To provoke a broader conversation on this subject, the following study proposes that meritocratic recruitment of civil servants improves population health. To test this proposition, a series of regression models examines comparative data for 118 countries. Consistent with study hypotheses, meritocratic recruitment of civil servants corresponds longitudinally with both lower rates of corruption and lower rates of infant mortality. Results are similar after robustness checks. Findings with regard to life expectancy are more mixed. However, additional tests suggest meritocratic recruitment contributes to life expectancy over a longer span of time. Findings also offer more support for a direct pathway from meritocratic recruitment to population health rather than via changes in corruption levels per se, although this may depend on a country's level of economic development. Overall, this study offers first evidence that civil service organization, particularly the recruitment of civil servants based on the merits of their applications rather than on whom they happen to know in government, is a positive determinant of health. More research in this area is needed.

Improving Human-Service Organizations through Process Mapping: A Tutorial for Practitioners.

Developing and improving organizational processes is an important element for staff satisfaction, effective communication, and ultimately the success of an organization (Rummler & Brache, 2013). Human-service organizations are no exception and, in fact, could greatly benefit from process improvement. This article provides guided steps for using process maps as a means for improving processes in human-service organizations.

Developing and Planning a Protocol for Implementing Health Promoting Animal Assisted Interventions (AAI) in a Tertiary Health Setting.

The Ottawa Charter identifies that multiple levels of government, non-government, community, and other organizations should work together to facilitate health promotion, including in acute settings such as hospitals. We outline a method and protocol to achieve this, namely an Action Research (AR) framework for an Animal Assisted Intervention (AAI) in a tertiary health setting. Dogs Offering Support after Stroke (DOgSS) is an AR study at a major tertiary referral hospital. AAI has been reported to improve mood and quality of life for patients in hospitals. Our project objectives included applying for funding, developing a hospital dog visiting Action Research project, and, subsequent to ethics and governance approvals and finance, undertaking and reporting on the Action Research findings. The Action Research project aimed to investigate whether AAI (dog-visiting) makes a difference to the expressed mood of stroke patients and their informal supports (visiting carers/family/friends), and also the impact these visits have on hospital staff and volunteers, as well as the dog handler and dog involved. We provide our protocol for project management and operations, setting out how the project is conducted from conception to assess human and animal wellbeing and assist subsequent decision-making about introducing dog-visiting to the Stroke Unit. The protocol can be used or adapted by other organizations to try to avoid pitfalls and support health promotion in one of the five important action areas of the Ottawa Charter, namely that of reorienting health services.

The application of the county medical community HCH model in postoperative nutrition management for patients with advanced gastrointestinal carcinoma.

OBJECTIVE: To investigate the application effect of the county medical community Hospital-Community health service organization-Home (HCH) model in nutritional management of patients with advanced gastrointestinal cancer after surgery. METHODS: This is a retrospective study. A total of 100 postoperative malnutrition patients with advanced gastrointestinal malignant tumors admitted to Lanxi People's Hospital from January 2022 to August 2022 were selected as subjects. All patients were divided into an observation group (n=50) or control group (n=50) according to the different methods of intervention. Patients in the observation group underwent care according to our county medical community HCH model, while those in the control group received routine perioperative nutrition management. The nutritional risk screening scores (NRS2002), Patient-Generated Subjective Global Assessment (PG-SGA) scores, body mass index (BMI), triceps skinfold thickness (TSF), upper arm circumference (AC); a well as levels of serum albumin (ALB), prealbumin (PA), transferrin (TRF), retinol binding protein (RBP), creatinine (Cr) and Free fatty acid (FFA); levels of immunoglobulin G (IgG), immunoglobulin M (IgM) and immunoglobulin A (IgA); and the levels of sodium (Na+), potassium (K+), calcium (Ca+) and lactic acid, and quality of life were recorded and compared between two groups. RESULTS: Compared with those before intervention, NRS2002 scores, PG-SGA score, BMI, TSF and AC after intervention were significantly improved in both groups. Compared with those after intervention in the control group, the NRS2002 score, PG-SGA score, BMI, TSF and AC of the patients in the observation group were significantly improved (all P<0.001). Compared with those before intervention, the levels of ALB, PA, TRF, RBP, Cr, FFA, IgG, IgM and IgA in the two groups were significantly higher after intervention. The levels of ALB, PA, TRF, RBP, Cr, FFA, IgG, IgM and IgA after intervention in the observation group were significantly higher than those in the control group (all P<0.05). Compared with those before management, the levels of Na+, K+ and lactic acid in the two groups were significantly decreased and the level of Ca+ was significantly increased after intervention. Compared with those after intervention in the control group, the patients in the observation group had significantly lower levels of Na+, K+ and lactic acid, and higher levels of Ca+ (all P<0.05). Compared with those before intervention, the scores of mental status, appetite, sleep quality, daily life and family understanding and cooperation in patients from the two groups after intervention were significantly higher. Compared with those after intervention in the control group, the patients in the observation group had significantly higher scores of life quality (P<0.05). CONCLUSION: The county medical community HCH model has a good effect in the nutritional management of patients with advanced gastrointestinal cancer surgery. The HCH model can effectively improve the nutritional status, enhance the immune function, and increase the quality of life. Thus it is worthy of clinical application.

Organization of rehabilitation services for youth with physical disabilities and mental health problems: A scoping review.

Introduction: Youth with childhood-onset physical disabilities receiving rehabilitation services often present with many complex needs. Emerging evidence confirms co-occurrence of mental health problems in this population is common, and mental health is often overlooked during rehabilitation for chronic physical conditions. For example, symptoms of depression and anxiety are frequently present in adolescents with physical disability such as spina bifida or Duchenne muscular dystrophy, and access to mental health services is often limited. Addressing mental health concerns for this age group is particularly critical as it encompasses a challenging transition to adulthood. Objectives: Building upon findings from a recent scoping review on the co-occurrence of physical disabilities and mental health problems, this paper synthesizes scientific literature related to the organization and delivery of services for youth with co-occurring childhood-onset physical disabilities (e.g., cerebral palsy, spina bifida) and mental health problems (e.g., depression, anxiety). Methods: A scoping review protocol stemming from Arksey & O'Malley's framework and updated guidelines from the Joanna Briggs Institute was developed. Four databases (Medline, PsycINFO, CINAHL, Embase) were searched. The search was limited to French or English peer-reviewed articles published between 2000 and 2021. Articles included were primary papers addressing: 1) youth aged 15 to 24 with a childhood-onset physical disability, 2) mental health problems, and 3) healthcare service organization or delivery. They were screened by two reviewers and discussed with a third to establish consensus on the inclusion criteria and resolve disagreements. Results: Sixteen articles were retained from the 1,010 screened. Many (9/16) were from the United States. Two models were found: the Biopsychosocial, Collaborative, Agency-Based Service Integration Approach (including psychiatry in a pediatric rehabilitation hospital) and the Client Network Consultation (an interagency collaboration in mental health care for children with complex healthcare needs). Twelve key principles for service organization and delivery were identified and categorized into: collaboration and coordination, training and support, and delivery of care. Conclusion: Identified principles can guide improved service delivery for this population. Highlighted research gaps include the need for developing models of collaborative healthcare delivery and subsequently evaluating their effectiveness.

The lived experiences of rural HIV social workers.

HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels.

Explaining the challenges of hospitals admitting COVID-19 patients from the perspective of managers (a qualitative study).

BACKGROUND: Crises are often unavoidable events that occur around the world. Hospitals play an important role in treating patients and preventing extensive injuries in times of crisis, requiring adequate preparedness. In order to design a proper planning system, it is essential to be aware of the challenges of hospitals during a crisis. The purpose of this study was to explain the challenges of hospitals admitting COVID-19 patients in the city of Mashhad, Iran, from the perspective of their managers. MATERIALS AND METHODS: This study employed a qualitative approach, using the method of conventional content analysis and was conducted from May to July 2020. A purposive sampling method was used to recruit the senior managers of hospitals admitting COVID-19 patients in Mashhad. The interviews were conducted face to face, with open-ended questions following an interview guide based on semi-structured questions, and continued until data saturation was reached. Data were analyzed using Atlas Ti software. RESULTS: After the implementation of the interviews, first 665 initial codes were extracted from the data, and after removing the overlapping sequences, a total of 115 codes were obtained. Three categories (organizational challenges, extra organizational challenges, and challenges related to information domain), 13 sub-categories, and 33 codes were extracted from the content analysis of the interviews. The main themes propounded in the field of challenges of COVID-19 referral hospitals in Mashhad were organizational challenges, extra organizational challenges, and information domain challenges. DISCUSSION: The results of this study showed that the hospitals admitting COVID-19 patients in Mashhad faced many challenges. To improve the quality of services in postcrisis phase, replacing hospitals' equipment, revising curriculums at medical universities, staff retraining, recruiting skilled human resources, and creating a supportive community context are necessary. CONCLUSION: For sure, the COVID-19 crisis will not be the last one, we have to be prepared for the bigger health crisis.

[Inter-laboratory comparison analysis of noise measurement in 91 occupational hygiene technical service organizations].

Objective: To understand the comparability of noise measurement results of various occupational hygiene technical service organizations in Guangdong Province by conducting inter-laboratory comparison of measuring instruments and personnel operation. Methods: In October 2020, the instrument comparison and personnel comparison among 91 occupational hygiene technical service organizations engaged in noise measurement in Guangdong Province were carried out in the form of fixed-point measurement and simulated workplace measurement, and the results were analyzed and evaluated by using the robust z-ratio score. Results: In the instrument comparison, 6 organizations had 1 or 2 outliers in their z-ratio scores, 2 organizations had 2 problematic values in their z-ratio scores, and a total of 8 organizations (accounting for 8.8%) were judged as unqualified; A total of 83 organizations (accounting for 91.2%) with satisfactory z-ratio scores or only one problematic value were judged as qualified. In the personnel comparison, there were 11 organizations with 1 or 2 outliers in the z-ratio score, and 1 organization with 2 problematic values in the z-ratio score. A total of 12 organizations (13.2%) were judged as unqualified and 79 organizations (accounting for 86.8%) with satisfactory z-ratio scores or only one problematic value were judged as qualified. Through comprehensive judgment, 20 organizations (22.0%) were judged as unqualified, and 71 organizations (78.0%) were judged as qualified. There was no statistically significant difference in the qualified rates of instrument comparison results, personnel comparison results and comprehensive evaluation results of non-private organizations and private organizations (P>0.05). There was no significant difference in the qualified rates of instrument comparison results and comprehensive evaluation results of qualified organizations and unqualified organizations (P>0.05), there was significant difference in the qualified rate of personnel comparison results (P<0.05) . Conclusion: The noise measurement results of some occupational health technical service organizations in Guangdong Province are generally comparable. To carry out inter-laboratory comparison of noise instrument performance and personnel operation ability of occupational hygiene technical service organizations, can comprehensively evaluate the testing process of each organization and find out the problems existing in each organization.

Organization of primary care.

Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.

Health-wellness resources on Canadian immigrant service provider organizations' websites: A content, navigability, usability, and credibility analysis towards service & asset mapping.

Background: Immigrant service provider organizations (SPOs) are often immigrants' first point of contact to Canadian systems, such as job, education, health and social care, and housing. Prior research emphasizes the health literacy potential of websites as information infrastructures that can reduce information poverty and improve health outcomes. Yet, whether health-wellness resources are present on immigrant SPOs' websites in a user-friendly manner remains unexplored. Methods: We identified the presence of health-wellness resources on SPOs' websites and analyzed those contents to understand their typology. We also ascertained the navigability, usability, and credibility of those websites regarding the health-wellness resources. Results: Among the 1453 SPO websites identified, only 289 (35.9%) had health-wellness information in their web-contents. Of the websites with health-wellness contents, "lifestyle and wellness resources" were present on 86.5% and "healthcare system resources" were present on 80.6% of the websites. Regarding "navigability", zero to two mouse clicks were required to access health-wellness resources on 94.8% of the websites; however, more than one language option was very limited, available on less than a quarter of websites. Conclusions: As immigrants continue to seek information online, immigrant SPOs' websites hold value in increasing the health literacy and health-wellness of immigrants. This research assessed the current state of immigrant SPOs' websites as information infrastructures and reveals areas for improvement. We recommend SPOs add resources for obtaining healthcare card, accessing primary care, sexual and reproductive, parenting, senior's health, mental wellbeing, and women's health information to their websites. We also recommend websites accommodate ethnic language option to improve navigability for immigrants.

Organization of Rehabilitation Services in Randomized Controlled Trials: Which Factors Influence Functional Outcome? A Systematic Review.

Objective: To identify factors related to the organization of rehabilitation services that may influence patients' functional outcome and make recommendations for categories to be used in the reporting of rehabilitation interventions. Data Sources: A systematic review based on a search in MEDLINE indexed journals (MEDLINE [OVID], Cumulative Index of Nursing and Allied Health Literature, PsycINFO, Cochrane Central Register of Controlled Trials) until June 2019. Study Selection: In total 8587 candidate randomized controlled trials reporting on organizational factors of multidisciplinary rehabilitation interventions and their associations with functional outcome. An additional 1534 trials were identified from June 2019 to March 2021. Data Extraction: Quality evaluation was conducted by 2 independent researchers. The organizational factors were classified according to the International Classification for Service Organization in Health-related Rehabilitation 2.0. Data Synthesis: In total 80 articles fulfilled the inclusion criteria. There was a great heterogeneity in the terminology and reporting of service organization across all studies. Aspects of Settings including the Mode of Service Delivery was the most explicitly analyzed organizational category (44 studies). The importance of the integration of rehabilitation in the inpatient services was supported. Furthermore, several studies documented a lack of difference in outcome between outpatient vs inpatient service delivery. Patient Centeredness, Integration of Care, and Time and Intensity factors were also analyzed, but heterogeneity of interventions in these studies prohibited aggregation of results. Conclusions: Settings and in particular the way the services were delivered to the users influenced functional outcome. Hence, it should be compulsory to include a standardized reporting of aspects of service delivery in clinical trials. We would also advise further standardization in the description of organizational factors in rehabilitation interventions to build knowledge of effective service organization.

Treatment Needs and Rates of Mental Health Comorbidity in Adolescent Patients With ARFID.

The purpose of this paper is to provide a descriptive overview of a single-center ARFID-specific pilot clinic that sought to better understand the specific needs of patients with ARFID including rates of comorbidities, and to gain insight into treatment requirements. A retrospective cohort study was completed on patients meeting criteria for ARFID admitted to a specialized pilot clinic within a tertiary care hospital. Over an 18 month period, a total of 26 patients were assessed and had follow-up data for a 12 month period. Patients presented with heterogeneous manifestations of ARFID and high rates of comorbid mood and anxiety disorders were noted. Treatment plans were tailored to meet individual needs at assessment and over the treatment period. A multidisciplinary approach was most often administered, including a combination of individual therapy, family therapy, medical monitoring, and prescribed medications. Only 30% of patients were treated exclusively by therapists on the eating disorder team. The experiences gained from this pilot study highlight the need for specialized resources for assessment and treatment of patients with ARFID, the importance of a multidisciplinary approach to treatment, and the necessity of utilization of ARFID-specific measures for program evaluation purposes.

Structured headache services as the solution to the ill-health burden of headache: 1. Rationale and description

In countries where headache services exist at all, their focus is usually on specialist (tertiary) care. This is clinically and economically inappropriate: most headache disorders can effectively and more efficiently (and at lower cost) be treated in educationally supported primary care. At the same time, compartmentalizing divisions between primary, secondary and tertiary care in many health-care systems create multiple inefficiencies, confronting patients attempting to navigate these levels (the "patient journey") with perplexing obstacles.High demand for headache care, estimated here in a needs-assessment exercise, is the biggest of the challenges to reform. It is also the principal reason why reform is necessary.The structured headache services model presented here by experts from all world regions on behalf of the Global Campaign against Headache is the suggested health-care solution to headache. It develops and refines previous proposals, responding to the challenge of high demand by basing headache services in primary care, with two supporting arguments. First, only primary care can deliver headache services equitably to the large numbers of people needing it. Second, with educational supports, they can do so effectively to most of these people. The model calls for vertical integration between care levels (primary, secondary and tertiary), and protection of the more advanced levels for the minority of patients who need them. At the same time, it is amenable to horizontal integration with other care services. It is adaptable according to the broader national or regional health services in which headache services should be embedded.It is, according to evidence and argument presented, an efficient and cost-effective model, but these are claims to be tested in formal economic analyses.

Towards standardized reporting of service organization in rehabilitation for clinical trials.

Meta-analysis of clinical trials in rehabilitation is often inconclusive, even when similar interventions are investigated. A possible reason for this is the influence of the settings in which rehabilitation services are delivered. Examples show that factors related to service organization in rehabilitation can influence study outcomes. This, in particular, is relevant, as contextual factors in rehabilitation are known to influence the participation and functioning of persons with disability. The Consolidated Statement of Reporting Trials (CONSORT) group and other initiatives published standards for reporting relevant factors for clinical trials. However, description of the rehabilitation setting of factors related to rehabilitation service provision is under-represented. Systematic reviews show that, on the one hand, these factors are scarcely reported, and only a few studies systematically evaluated the influence of factors related to service organization on rehabilitation outcomes. The International Classification of Service Organization in Rehabilitation (ICSO-R) provides a framework to systematically describe rehabilitation services. It contains 40 categories and sub-categories for the domains "provider" and "service delivery". Therefore, it is important and relevant to develop a minimum reporting set for factors relevant to service organization for rehabilitation trials. This paper sets out a methodological approach for this purpose, including literature reviews, Delphi survey focus group discussion, and consensus conference.

Health service organisation impact on lower extremity amputations in people with type 2 diabetes with foot ulcers: systematic review and meta-analysis.

AIMS: Despite the evidence available on the epidemiology of diabetic foot ulcers and associated complications, it is not clear how specific organizational aspects of health care systems can positively affect their clinical trajectory. We aim to evaluate the impact of organizational aspects of care on lower extremity amputation rates among people with type 2 diabetes affected by foot ulcers. METHODS: We conducted a systematic review of the scientific literature published between 1999 and 2019, using the following key terms as search criteria: people with type 2 diabetes, diagnosed with diabetic foot ulcer, treated with specific processes and care pathways, and LEA as primary outcome. Overall results were reported as pooled odds ratios and 95% confidence intervals obtained using fixed and random effects models. RESULTS: A total of 57 studies were found eligible, highlighting the following arrangements: dedicated teams, care pathways and protocols, multidisciplinary teams, and combined interventions. Among them, seven studies qualified for a meta-analysis. According to the random effects model, interventions including any of the four arrangements were associated with a 29% reduced risk of any type of lower extremity amputation (OR = 0.71; 95% CI 0.52-0.96). The effect was larger when focusing on major LEAs alone, leading to a 48% risk reduction (OR = 0.52; 95% CI 0.30-0.91). CONCLUSIONS: Specific organizational arrangements including multidisciplinary teams and care pathways can prevent half of the amputations in people with diabetes and foot ulcers. Further studies using standardized criteria are needed to investigate the cost-effectiveness to facilitate wider implementation of improved organizational arrangements. Similarly, research should identify specific roadblocks to translating evidence into action. These may be structures and processes at the health system level, e.g. availability of professionals with the right skillset, reimbursement mechanisms, and clear organizational intervention implementation guidelines.

Describing community-based rehabilitation services in Indonesia by using The International Classification of Service Organization in Rehabilitation 2.0.

OBJECTIVE: Describing rehabilitation services in a standardized way is a challenge. The International Classification of Service Organizations in Rehabil-itation (ICSO-R) 2.0 was published for this purpose. The ICSO-R was criticized for being tested mainly in high-income countries, and because the testing in lower-income countries did not include community-based rehabilitation services. Therefore, this study was performed to describe community-based rehabilitation services by using ICSO-R 2.0. METHODS: The ICSO-R 2.0 was used to describe 8 community-based rehabilitation services located in 3 cities in 3 different provinces in Indonesia: 6 community-based rehabilitation services in Bandung, West Java; 1 in Tanah Datar, West Sumatra; and 1 in Gowa, South Sulawesi. RESULTS: All the community-based rehabilitation services were owned by the government, as a public body, and in the context of the community. The 6 community-based rehabilitation services in Bandung, West Java, are under the government city of Bandung, while the other 2, from Tanah Datar and Gowa, are integrated within primary healthcare centres. Social welfare supports all 6 community-based rehabilitation services in Bandung. The other 2 community-based rehabilitation services are supported by their respective primary healthcare centres. CONCLUSION: The ICSO-R 2.0 is a feasible tool to describe rehabilitation services, including community-based rehabilitation.

A multiple case study investigating changes in organizations serving residents with intellectual disabilities and challenging behaviours.

BACKGROUND: the present authors examined changes made in disability service organizations supporting residents with intellectual disabilities and challenging behaviours, because these changes may influence residents' support and subsequently their challenging behaviours. METHOD: In this multiple case study, the present authors collected and qualitatively analysed data (organizational documents, meetings records and focus group reports) on organizational changes made in two specialized Dutch disability service organizations, using ecological theory as a sensitizing framework and the constant comparative method. RESULTS: Themes describing organizational changes in this context were as follows: a messy start to the transition; staff, professionals and managers remain at a distance; staff members' ability to change; clear boundaries between formal and informal caregivers; and staff's feelings of being unheard. CONCLUSIONS: Organizational changes can enhance, but also limit, the quality of residential support services provided to people with intellectual disabilities and challenging behaviours. The change process and impact of organizational changes on residents must be examined closely.

Multi-service prevention programs for pregnant and parenting women with substance use and multiple vulnerabilities: Program structure and clients' perspectives on wraparound programming.

BACKGROUND: In Canada, several community-based, multi-service programs aimed at reaching vulnerable pregnant or parenting women with substance use and complex issues have emerged. These programs offer basic needs and social supports along with perinatal, primary, and mental health care, as well as substance use services. Evaluations of these 'one-stop' programs have demonstrated positive outcomes; nevertheless, few published studies have focused on how these programs are structured, on their cross-sectoral partnerships, and on clients' perceptions of their services. METHODS: The Co-Creating Evidence (CCE) project was a three-year evaluation of eight multi-service programs located in six Canadian jurisdictions. The study used a mixed-methods design involving semi-structured interviews, questionnaires, output data, and de-identified client data. This article focuses on qualitative interviews undertaken with 125 clients during the first round of site visits, supplemented by interview data with program staff and service partners. RESULTS: Each of the programs in the CCE study employs a multi-service model that both reflects a wrap-around approach to care and is intentionally geared to removing barriers to accessing services. The programs are either operated by a health authority (n = 4) or by a community-based agency (n = 4). The programs' focus on the social determinants of health, and their provision of primary, prenatal, perinatal and mental health care services is essential; similarly, on-site substance use and trauma/violence related services is pivotal. Further, programs' support in relation to women's child welfare issues promotes collaboration, common understanding of expectations, and helps to prevent child/infant removals. CONCLUSIONS: The programs involved in the Co-Creating Evidence study have impressively blended social and primary care and prenatal care. Their success in respectfully and flexibly responding to women's diverse needs, interests and readiness, within a community-based, wraparound service delivery model paves the way for others offering pre- and postnatal programming.

Description of health-related rehabilitation service provision and delivery in randomized controlled trials: A topic review.

OBJECTIVE: To determine how health-related rehabilitation services have been described in recently pub-lished randomized clinical trials, using the International Classification System for Service Organization in Health-Related Rehabilitation (ICSO-R 2.0) as a framework. METHODS: Medline was searched for English--language randomized clinical trials (RCTs) published between 1 January 2018 and 31 December 2018. RCTs were eligible if the primary goal was to provide rehabilitation services to targeted patient populations. Two authors independently screened and extracted data, and assessed the methodological quality of eligible trials. Descriptive analysis was used to compare service descriptions between eligible trials and the ICSO-R 2.0 framework (23 categories, 9 categories for provider, 14 categories for delivery). RESULTS: Twenty-nine RCTs, with a wide range of organizational units and target groups, were included. The median number of categories reported in the provider dimension was 4 (range 3-5). The median number of categories reported in the service delivery dimension was 8 (range 6-12). None of the RCTs described all ICSO-R recommended categories. CONCLUSION: Descriptions of service organization in rehabilitation varied widely among recently published randomized clinical trials. Use of the framework for the classification of service organization and standardization of description of services is recommended in future RCTs, to facilitate better comparisons in service research across studies.