RESUMO
OBJECTIVES: Social needs interventions in medical settings aim to mitigate the effects of adverse social circumstances on health outcomes by connecting vulnerable patients with resources. This study examined the relationship between intervention dosage and the success of resource connections using data from a social needs intervention in multiple clinical settings across the US. STUDY DESIGN: The intervention uses a case management approach to connect patients with unmet needs to resources and services in the community. Intervention dosage was conceptualized as the number of contacts between the navigator and the patient, categorized as direct contact (phone vs. in person) and indirect contact (initiated by the navigator vs. patient). Success of the intervention was conceptualized as 'none,' 'partial,' or 'optimal' for each patient, based on the number of social needs the resource connections addressed. METHODS: Administrative data were extracted for 38,404 unique patients who screened positive for unmet resource needs between 2012 and 2017. Owing to the large sample size, statistical corrections were made to reduce type I error. RESULTS: Multinomial logistic regression analyses showed that higher intervention dosage was related to greater success of resource connections, after adjusting for the patient and site characteristics, and the number of needs (odds ratios ranged from 1.62 to 2.89). In-person contact, although received by only 25% of the patients, was associated with the highest probability of optimal success. CONCLUSIONS: This study demonstrates a feasible way to conceptualize an intervention dose for a social needs intervention that uses a case management approach and has implications for how intervention delivery may improve success of resource connections.
Assuntos
Administração de Caso/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Apoio Social , Adulto , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Telefone , Estados Unidos , Populações VulneráveisRESUMO
BACKGROUND: Coping positively and negatively influences psychosocial and other outcomes in multiple sclerosis (MS), but there is conflicting evidence about the use of different coping strategies and their associations with demographic and disease characteristics. Our aims were to examine which coping strategies are used by a large sample of people with MS, then to identify any associations between demographic and disease related factors with use of individual coping strategies. METHODS: Participants in the Trajectories of Outcomes in Neurological Conditions (TONiC) study completed the Coping Orientations to Problems Experienced (COPE60) questionnaire. Relationships between demographic and clinical characteristics and coping strategies were examined by multiple ordinal logistic regression to assess the effect of each potential predictor after adjustment for other possible covariates. RESULTS: From 722 patients, the most commonly used strategy was Acceptance, followed by Active Coping, Planning and Positive Reinterpretation and Growth. All but two strategies showed significant associations with demographic and clinical characteristics. The most marked effects were found for Restraint, with people in employment 2.1 times as likely to utilise this strategy compared to those unemployed, and Seeking of Emotional Social Support and Focus on and Venting of Emotions, which were utilised twice as much by women compared to men. Behavioural and Mental Disengagement were highly associated with greater disability and not being in employment. CONCLUSION: Clinicians should be aware of several disease and demographic characteristics that are associated with use of potentially maladaptive coping strategies.
Assuntos
Adaptação Psicológica , Emprego , Esclerose Múltipla Crônica Progressiva , Esclerose Múltipla Recidivante-Remitente , Índice de Gravidade de Doença , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Emprego/estatística & dados numéricos , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla Crônica Progressiva/diagnóstico por imagem , Esclerose Múltipla Crônica Progressiva/epidemiologia , Esclerose Múltipla Crônica Progressiva/fisiopatologia , Esclerose Múltipla Crônica Progressiva/psicologia , Esclerose Múltipla Recidivante-Remitente/diagnóstico por imagem , Esclerose Múltipla Recidivante-Remitente/epidemiologia , Esclerose Múltipla Recidivante-Remitente/fisiopatologia , Esclerose Múltipla Recidivante-Remitente/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto JovemRESUMO
Recent research suggests that approximately one third of the population of homeless single adults suffer from severe mental illnesses. Despite multiple health, mental health, and social welfare needs, this population is often unable to obtain necessary housing and community-based services. For this reason, since 1982, the National Institute of Mental Health (NIMH) has undertaken a number of federal initiatives to encourage research and assist states and localities in improving services focused on this vulnerable subgroup of the homeless population. This article describes the target population, NIMH research findings, and current mental health service trends--with particular emphasis on two mental health programs established under the Stewart B. McKinney Homeless Assistance Act. Proposed future directions for federal research and evaluation efforts in this area are also discussed.
Assuntos
Serviços Comunitários de Saúde Mental/tendências , Pessoas Mal Alojadas/psicologia , Indigência Médica/tendências , Transtornos Mentais/reabilitação , Previsões , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Estados UnidosRESUMO
The implementation and early outcomes of a large-scale, services-enriched housing program for homeless families are evaluated and examined across nine metropolitan sites. Differing models of case management and service access are described. Early reports on families' residential stability are high across all service models.
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Implementação de Plano de Saúde , Acessibilidade aos Serviços de Saúde , Pessoas Mal Alojadas , Habitação Popular , Adulto , Administração de Caso , Criança , Assistência Integral à Saúde , Feminino , Humanos , Masculino , Dinâmica Populacional , Avaliação de Programas e Projetos de Saúde , Assistência Pública , Apoio Social , Estados UnidosRESUMO
The characteristics and needs of homeless families participating in a large-scale services-enriched housing program are examined. Although not a representative sample, participants constitute one of the largest subsets of homeless families in the literature. Moreover, the sample, which encompasses nine sites, is focused on families with multiple problems who have been recurrently homeless. Differing constellations of needs and implications for service delivery are explored.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pessoas Mal Alojadas/estatística & dados numéricos , Assistência Pública/estatística & dados numéricos , Habitação Popular/estatística & dados numéricos , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Administração de Caso/estatística & dados numéricos , Criança , Pré-Escolar , Assistência Integral à Saúde/estatística & dados numéricos , Coleta de Dados , Definição da Elegibilidade , Características da Família , Feminino , Implementação de Plano de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Avaliação de Programas e Projetos de Saúde , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
The utilization of evaluation results continues to be a great concern among professionals in the field. To increase the potential usefulness of evaluation, the feedback research approach is proposed as a method that is especially helpful in studies that fail to find program effectiveness. Going beyond the bounds of the evaluation framework and studying the problem for which the program was designed to ameliorate, evaluations that incorporate a feedback research component can provide clients with valuable information to guide further program development. This paper provides a description of the approach and an illustration of its use in an evaluation of a major international corporation's health improvement/stress management program.
Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Serviços de Saúde do Trabalhador/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde/métodos , Estresse Psicológico/prevenção & controle , Estudos de Avaliação como Assunto , Retroalimentação , Humanos , Análise de RegressãoRESUMO
To obtain data on the effectiveness of the psychiatric halfway house and to update information about such facilities, 26 recent statistical reports were examined. Only two studies include control group comparisons. In addition to descriptive information, data are reported in terms of employment or school attendance and independent living as contrasted with rehospitalization. Results indicate that a median of approximately 80 per cent of halfway house residents adjusts to community living. Despite differences among halfway houses in resident selection, length of stay, rehabilitative criteria, and nature of follow-up, data suggest that rehospitalization rates are lower after residence in a halfway house. Some cautions are drawn regarding evaluative studies and potential attenuation of halfway house facilities to low-quality custodial care.