Integrated Health and Social Home Care Services in Catalonia: Professionals' Perception of its Implementation, Barriers, and Facilitators.

Introduction: This study aimed to assess the implementation of integrated social and health home care services (HCS) offered by the Government of Catalonia, and to identify the main barriers and facilitators of integrated HCS. Methods: Analysis of the degree of implementation of integrated social and health HCS perceived by social care services (SCS) and primary health care centers (PHCs) between December 2020 and June 2021 in two phases. First, the perception of integration by social workers within SCS and PHCs was assessed using a screening questionnaire. Then, SCS in counties with the highest integration scores received a customized questionnaire for an in-depth assessment. Results: A total of 105 (100%) SCS and 94 (25%) PHCs answered the screening questionnaire, and 48 (45.7%) SCS received a customized questionnaire. The most frequent barrier identified was the lack of shared protocols, with the most frequent facilitator being the recognition of the importance of integrated HCS. Conclusions: Our study showed that the degree of implementation of integrated health and social HCS offered by the Government of Catalonia was perceived as low. The identified barriers and facilitators can be used to facilitate such implementation. Further studies should include professionals other than social workers in PHC assessments.

Implementation of the individual placement and support pilot program in Spain.

OBJECTIVE: This article describes the adoption of Individual Placement and Support (IPS) supported employment between 2013 and 2017 in Catalonia (Spain) in the context of high unemployment and a predominance of traditional preemployment training approaches. It reports the experience of implementing IPS to promote competitive job placement of people with mental disorders. METHOD: The Avedis Donabedian Research Institute (FAD) designed, trained, implemented, and evaluated the project. We used a longitudinal, mixed-methods approach. RESULTS: The demonstration project comprised 7 employment services and 12 ambulatory mental health centers. It followed up programs and participants from October 2013 to December 2017. The project added 1,188 new competitive jobs, increased the rate of competitive employment from 16% to 43%, and improved the fidelity of IPS by 44% on the organizational dimension and by 34% on services dimension. The quality of employment was similar to the overall employment market, with 94% of temporary jobs. The qualitative analysis confirmed several areas of improvement, including the vision of recovery, collaborations between vocational and mental health services, work patterns of practitioners, and views of work as an important treatment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A strong leadership team, consistent training, and commitment to model fidelity have established IPS in the pilot region as an important intervention to obtain and maintain competitive employment and recovery for people with a mental health condition. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Making performance indicators work: the experience of using consensus indicators for external assessment of health and social services at regional level in Spain.

OBJECTIVES: To describe a methodology and the results of projects combining consensus processes for indicator development with methods of external assessment of health and social services. METHODS: Our methodology can be characterized by a four-step approach: (1) stakeholder involvement and creating an enabling environment, (2) using standardized consensus methods for indicator development, (3) using rigorous external evaluation methods to assess results and (4) developing and implementing quality improvement initiatives. We describe each step in detail and discuss factors of success and pitfalls based on our experience of applying the methodology in 648 health/social centres and reviewing overall 68,616 case records. RESULTS: We observe in four sectors (assisted living, elderly health care, care for people with drug abuse problems, and care for abused woman) improvements in overall quality improvement rates, ranging from 9.5% to 65.6%. Improvements in overall rates are accompanied by reduction in range of up to 48.8. CONCLUSIONS: The conscientious setting up of an enabling environment and the systematic involvement of professionals in designing indicators and setting standards is a key to improving performance. Our research may entail lessons for policy makers on the current debate on pay for performance models.

Individual placement and support in Europe.

TOPIC: Individual Placement and Support (IPS) is a psychosocial intervention with a considerable body of evidence for its effectiveness in helping people with severe psychiatric disorders to obtain and maintain competitive jobs. In the last decades several European studies have replicated earlier American outcomes, generating widespread interest about its implementation in Europe. PURPOSE: This article describes and compares details about achievements and challenges of IPS in 4 European countries: the United Kingdom, Italy, The Netherlands, and Spain. SOURCES USED: This description draws from published and nonpublished material about policy, development of services, and services evaluation. RESULTS: In the United Kingdom and in The Netherlands, empirical studies exploring the consistency of results over time and the effectiveness of IPS adaptations to local needs and special population are in course. In the United Kingdom, IPS has become national policy, as well as in some regions of Italy and Spain. Training is quite extensive in the United Kingdom and in The Netherlands, developing well in Italy and Spain. Implementation seems to be less straightforward, mostly because of deeply rooted cultural values regarding both work and mental health care. Strong local leadership is still required. In all countries contingencies related to the current economic crisis seems to have increased interest in IPS. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: With the converging forces of strong local leadership, rapid economic changes, and slow cultural shifts, IPS may soon become a priority intervention in Europe for ensuring that people living with serious mental illnesses are able to obtain competitive employment.

Results of a sector-wide quality improvement initiative for substance-abuse care: an uncontrolled before-after study in Catalonia, Spain.

BACKGROUND: The Health Department of the Regional Government of Catalonia, Spain, issued a quality plan for substance abuse centers. The objective of this paper is to evaluate the impact of a multidimensional quality improvement initiative in the field of substance abuse care and to discuss potentials and limitations for further quality improvement. METHODS: The study uses an uncontrolled, sector-wide pre-post design. All centers providing services for persons with substance abuse issues in the Autonomous Community of Catalonia participated in this assessment. Measures of compliance were developed based on indicators reported in the literature and by broad stakeholder involvement. We compared pre-post differences in dimension-specific and overall compliance-scores using one-way ANOVA for repeated measures and the Friedman statistic. We described the spread of the data using the inter-quartile range and the Fligner-Killen statistic. Finally, we adjusted compliance scores for location and size using linear and logistic regression models. RESULTS: We performed a baseline and follow up assessment in 22 centers for substance abuse care and observed substantial and statistically significant improvements for overall compliance (pre: 60.9%; post: 79.1%) and for compliance in the dimensions 'care pathway' (pre: 66.5%; post: 83.5%) and 'organization and management' (pre: 50.5%; post: 77.2%). We observed improvements in the dimension 'environment and infrastructure' (pre: 81.8%; post: 95.5%) and in the dimension 'relations and user rights' (pre: 66.5%; post: 72.5%); however, these were not statistically significant. The regression analysis suggests that improvements in compliance are positively influenced by being located in the Barcelona region in case of the dimension 'relations and user rights'. CONCLUSION: The positive results of this quality improvement initiative are possibly associated with the successful involvement of stakeholders, the consciously constructed feedback reports on individual and sector-wide performance and the support of evidence-based guidance wherever possible. Further research should address how contextual issues shape the uptake and effectiveness of quality improvement actions and how such quality improvements can be sustained.