American journal of psychiatric rehabilitation最新文献

英文中文

Making Integrated Care a Reality: Lessons Learned From Heartland Health Outreach's Integration Implementation 使综合护理成为现实:从心脏地带健康推广的综合实施中学到的教训

American journal of psychiatric rehabilitation

Pub Date : 2015-01-02 DOI: 10.1080/15487768.2015.1001698

S. Pickett, S. Luther, Ed Stellon, K. Batia

The health care challenges of people experiencing homelessness are complicated and complex. Programs that provide integrated primary and behavioral health care may best treat this population's medical, mental health, and substance use problems. However, these services are often siloed within and across organizations, resulting in uncoordinated care. Using the conceptual framework proposed by Heath and colleagues (2013), we describe the successful primary and behavioral healthcare integration implementation efforts of Heartland Health Outreach, a national leader in health care services for people experiencing homelessness. Factors that help and hinder integration implementation and lessons learned are discussed.

无家可归者面临的保健挑战是复杂而复杂的。提供综合初级和行为卫生保健的项目可能最好地治疗这一人群的医疗、精神健康和物质使用问题。然而，这些服务往往在组织内部或跨组织，导致不协调的护理。使用Heath及其同事(2013)提出的概念框架，我们描述了Heartland Health Outreach成功的初级和行为医疗保健整合实施工作，该机构是为无家可归者提供医疗保健服务的国家领导者。本文还讨论了有助于和阻碍集成实现的因素以及所吸取的经验教训。

引用次数: 1

Together4Health: Integrating Care for Vulnerable Populations 共同健康:对弱势群体的综合护理

American journal of psychiatric rehabilitation

Pub Date : 2015-01-02 DOI: 10.1080/15487768.2015.1001692

R. Frank, Lauren E. Riedel, Colleen L. Barry

Dramatic changes in the design of payment and delivery arrangements for care of some of the nation's more vulnerable populations are being initiated at federal and state levels. This study analyzes early implementation of Together4Health, an innovative partnership among a diverse array of health and social services organizations in Chicago. The impetus for Together4Health was a deliberate effort by policy makers to shift away from the fee-for-service system that rewards providers for delivering more services in an uncoordinated manner toward a system in which a range of services needed to care for a population is coordinated by organizations that are rewarded for efficiency and quality outcomes. Together4Health aims to deliver a full continuum of health and human services to the region's most costly Medicaid enrollees. Six key ingredients were identified as central to Together4Health's early viability: state-level contracting decisions, start-up fund availability, partner agreement about critical organizational design features, developing an IT infrastructure, establishing viable enrollment targets, and developing a sustainable financial model. Going forward, because the environment is changing and many of the innovations being implemented have a limited evidence base, it will be critical for Together4Health to learn quickly and rapidly adjust operating processes to ensure longer term success.

联邦和州两级正在着手对支付和交付安排的设计进行重大改革，以照顾该国一些较为脆弱的人口。本研究分析了“共同健康”的早期实施情况，这是芝加哥各种各样的卫生和社会服务组织之间的一种创新伙伴关系。“共同健康”计划的推动力是政策制定者有意为之的努力，目的是从奖励提供者以不协调的方式提供更多服务的收费服务制度转向一种制度，在这种制度下，照顾人口所需的一系列服务由组织协调，奖励效率和质量结果。“共同健康”计划旨在为该地区医疗补助费用最高的参保者提供全面的健康和人性化服务。确定了六个关键因素是“共同健康”早期可行性的核心:州一级的合同决策、启动资金的可用性、关于关键组织设计特征的合作伙伴协议、开发IT基础设施、建立可行的注册目标以及开发可持续的财务模型。展望未来，由于环境不断变化，而许多正在实施的创新证据基础有限，因此，快速学习并迅速调整操作流程以确保长期成功对“共同健康”至关重要。

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引用次数: 1

Perceptions of Overall Health and Recency of Screenings 对整体健康的认知及最近的筛检

American journal of psychiatric rehabilitation

Pub Date : 2015-01-02 DOI: 10.1080/15487768.2015.1001703

M. Swarbrick, Lois Rockson, C. Pratt, Jay Yudof, Patricia Nemec

People who are served by the public mental health system often live with chronic medical conditions, exhibit many risk factors for metabolic syndrome, and experience high rates of early mortality. This research project assessed the recency of screenings and perceptions of overall health of 148 people served by the public mental health system and attending peer-run, self-help centers in New Jersey. The results underscore existing health risks and the need to assess, educate, and empower people served by the public mental health systems to regularly access screenings and self-monitor health measures, including weight and blood pressure.

接受公共精神卫生系统服务的人往往患有慢性疾病，表现出许多代谢综合征的危险因素，并且早期死亡率很高。本研究项目评估了新泽西州公共心理健康系统和同伴自助中心服务的148人最近的筛查和对整体健康的看法。这些结果强调了现有的健康风险，以及评估、教育和授权公共精神卫生系统服务的人定期接受筛查和自我监测健康措施(包括体重和血压)的必要性。

引用次数: 2

Serving People With Complex Health Needs: Emerging Models, With a Focus on People Experiencing Homelessness or Living in Permanent Supportive Housing 为有复杂健康需求的人服务:新兴模式，重点关注无家可归者或居住在永久性支持性住房中的人

American journal of psychiatric rehabilitation

Pub Date : 2015-01-02 DOI: 10.1080/15487768.2015.1001696

M. Burt

The Affordable Care Act of 2009 (P.L. 111-148) codified into law a strong emphasis on care coordination as an important strategy for improving the performance of the U.S. health care system. This article examines new structures for coordinating care for people with complex, co-occurring health conditions. Within that large group, the article focuses on people who are now or recently were homeless and the importance of including housing as part of coordinating their care. “Care coordination” is used as shorthand for a continuum of strategies and structures being developed to reach the three goals of better health care experience, better health outcomes, and cost savings. Six models are described, ranging from simple in structure—a partnership of one permanent supportive housing program and one community health center—to complex, including a limited liability, for-profit care coordination entity serving Cook County and two county-run programs (in Hennepin County, Minnesota, and Los Angeles County, California). All are works in progress, but show promise of improving care for difficult-to-serve populations.

2009年《平价医疗法案》(P.L. 111-148)将强调医疗协调作为提高美国医疗体系绩效的重要策略写入法律。这篇文章探讨了协调照顾复杂的，共同发生的健康状况的人的新结构。在这个庞大的群体中，这篇文章关注的是那些现在或最近无家可归的人，以及将住房作为协调照顾他们的一部分的重要性。"护理协调"是为实现更好的保健经验、更好的保健结果和节约成本这三个目标而制定的一系列战略和结构的简称。本文描述了六种模式，从简单的结构——一个永久性支持性住房项目和一个社区卫生中心的伙伴关系——到复杂的结构，包括一个有限责任的营利性护理协调实体，服务于库克县和两个县运营的项目(明尼苏达州亨内平县和加利福尼亚州洛杉矶县)。所有这些工作都在进行中，但显示出改善对难以服务的人群的护理的希望。

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引用次数: 3

Connecting Permanent Supportive Housing to Health Care Delivery and Payment Systems: Opportunities and Challenges 将永久性支持性住房与医疗保健服务和支付系统联系起来:机遇与挑战

American journal of psychiatric rehabilitation

Pub Date : 2015-01-02 DOI: 10.1080/15487768.2015.1001690

C. Wilkins

Permanent supportive housing can be an integral part of new models of integrated care for people with complex health and social needs who experience homelessness or institutionalization, producing better outcomes and ending homelessness for vulnerable people, while also contributing to the more appropriate and less costly use of health care services. The expansion of Medicaid eligibility in most states and other changes in health care finance and delivery systems increase opportunities to pay for some of the costs of supportive housing services, but this will require overcoming challenges related to federal and state policies. Medicaid benefits may include behavioral health services that can help people with mental health disorders get and keep housing and achieve recovery goals. Primary care and behavioral health services can be integrated through partnerships that rely on two different Medicaid payment mechanisms. Medicaid managed care plans face incentives to invest in care coordination services that control hospital costs. Some states are exploring other ways to use Medicaid financing to pay for innovative supportive housing programs that can achieve offsetting savings.

永久性支助性住房可以成为为无家可归或被收容的有复杂健康和社会需求的人提供综合护理的新模式的一个组成部分，从而产生更好的结果，消除弱势群体的无家可归现象，同时还有助于更适当和更便宜地使用保健服务。在大多数州扩大医疗补助资格以及医疗保健财政和提供系统的其他变化增加了支付支持性住房服务的一些成本的机会，但这将需要克服与联邦和州政策相关的挑战。医疗补助福利可能包括行为健康服务，可以帮助有精神健康障碍的人获得并保持住房，实现康复目标。初级保健和行为健康服务可以通过依赖两种不同的医疗补助支付机制的伙伴关系进行整合。医疗补助管理医疗计划面临着投资于控制医院成本的护理协调服务的激励。一些州正在探索其他方法，利用医疗补助计划的资金来支付创新的支持性住房项目，以实现抵消储蓄。

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引用次数: 11

Integrated Health Care for People with Psychiatric Disabilities 精神残疾者的综合保健

American journal of psychiatric rehabilitation

Pub Date : 2015-01-02 DOI: 10.1080/15487768.2015.1001689

S. Pickett, K. Batia

A growing body of literature on the physical health problems of people with psychiatric disabilities has emerged in the past decade. Study after study shows that people who suffer from severe mental illness have high rates of cardiovascular disease, diabetes, metabolic syndrome, lung disease, and cancer. Although many of these chronic health conditions are preventable, few people with psychiatric disabilities receive needed medical treatment. There is little surprise, therefore, that this population dies, on average, 25 years earlier than its nondisabled peers. It is perhaps also no surprise to those of us in the field of psychiatric rehabilitation that disparate mental health and medical systems contribute to the poor health and well-being of people with psychiatric disabilities. Coordination of care across the two systems is minimal at best. People with psychiatric disabilities often report difficulty accessing medical care: They do not know where or how to find services, have problems scheduling and getting to

在过去的十年里，越来越多的文献研究了精神残疾者的身体健康问题。一项又一项的研究表明，患有严重精神疾病的人患心血管疾病、糖尿病、代谢综合征、肺病和癌症的几率很高。虽然这些慢性疾病中有许多是可以预防的，但很少有精神残疾患者得到所需的医疗。因此，残疾人比非残疾人平均早死25年也就不足为奇了。对于我们这些从事精神康复领域的人来说，不同的精神健康和医疗系统导致精神残疾患者的健康状况不佳，这也许也不足为奇。两个系统之间的医疗协调充其量也只是微乎其微。患有精神残疾的人经常报告难以获得医疗服务:他们不知道在哪里或如何找到服务，在安排时间和到达服务地点方面存在问题

引用次数: 2

Risk is not a four letter word: social integration and developmental growth. 风险不是一个简单的词:社会融合和发展增长。

American journal of psychiatric rehabilitation

Pub Date : 2015-01-01 Epub Date: 2015-12-11 DOI: 10.1080/15487768.2015.1089801

Barbara Dickey, Norma C Ware

Individuals facing recovery from serious mental illness confront social challenges stemming from discrimination and the structure of our economic safety net. Although research has contributed to significant advances for individuals with the most serious mental illness, questions about the social nature of their world remain largely unasked. How can persons with mental illness move from community isolation to community integration? Building on earlier research, this paper uses qualitative data to address developmental challenges as impediments to community integration for young people with serious mental illness. Sixty transcripts from unstructured, in-depth interviews with psychiatrically disabled persons moving toward social integration were content analyzed to demonstrate possibilities for developmental growth in the context of living-learning communities. Data are organized and presented in three conceptual categories drawn from developmental theory: (1) risk-taking; (2) reciprocal relationships; and (3) self-determination. Based on the results, we suggest that attention to the challenges of developmental growth should complement current evidence-based and best program practices for young adults with mental illness.

面临严重精神疾病康复的个人面临着来自歧视和我们经济安全网结构的社会挑战。尽管研究为治疗最严重的精神疾病患者做出了重大贡献，但有关他们世界的社会本质的问题在很大程度上仍未被提出。精神疾病患者如何从社区隔离走向融入社区?在早期研究的基础上，本文使用定性数据来解决患有严重精神疾病的年轻人融入社区的发展挑战障碍。本研究分析了60份对走向社会融合的精神残疾人士的非结构化深度访谈记录，以证明在生活-学习社区的背景下发展成长的可能性。从发展理论中提取的数据按三个概念类别组织和呈现:(1)风险承担;(2)互惠关系;(3)自决。基于这些结果，我们建议对发育成长挑战的关注应该补充现有的以证据为基础的、针对患有精神疾病的年轻人的最佳项目实践。

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引用次数: 4

Change in AJPR Editors AJPR编辑器的变化

American journal of psychiatric rehabilitation

Pub Date : 2014-10-02 DOI: 10.1080/15487768.2014.987081

引用次数: 0

Pushing, Patience, and Persistence: Peer Providers' Perspectives on Supportive Relationships 推动、耐心和坚持:同伴提供者对支持关系的看法

American journal of psychiatric rehabilitation

Pub Date : 2014-10-02 DOI: 10.1080/15487768.2014.967601

Sarah N. Mourra, W. Sledge, Dave Sells, M. Lawless, L. Davidson

Little is known about the experiences of peer support providers. This report describes a qualitative study of such experiences drawn from a project offering peer support to persons with mental illnesses who had multiple inpatient admissions within an 18-month period. Interviews focused on peer staff's relationships with participants; identifying and exploring participant interests, strengths, and aspirations; use of self-disclosure; and connecting participants to other services. Interviews were transcribed and analyzed using established phenomenological data analytic strategies. Peer staff described a tension between pushing and patience and the need for gentle persistence, the art and value of adopting an accepting and nonjudgmental attitude, and the process of identifying and building on strengths in pursuit of personal goals. The mutual identification between peer supporters and clients represented both an advantage and a potential liability, in that peer staff tied their own feelings of self-worth to the outcomes of their clients' struggles. Rather than viewing the deeply personal nature of peer support as posing risks due to a perceived vulnerability on the part of peer support providers, these findings suggest the need for ways to train peer staff in managing safely the vicarious trauma, frustrations, and inevitable setbacks involved in this work.

我们对同伴支持提供者的经历知之甚少。本报告描述了对这类经验的定性研究，该研究来自一个项目，该项目向在18个月内多次住院的精神疾病患者提供同伴支持。访谈侧重于同行员工与参与者的关系;识别和探索参与者的兴趣、优势和愿望;自我表露的使用;并将参与者与其他服务连接起来。访谈记录和分析使用既定的现象学数据分析策略。同事们描述了在强迫和耐心之间的紧张关系，以及对温和坚持的需求，采取接受和不评判态度的艺术和价值，以及在追求个人目标的过程中识别和建立优势的过程。同伴支持者和客户之间的相互认同既是一种优势，也是一种潜在的缺点，因为同伴员工将自己的自我价值感与客户的挣扎结果联系在一起。这些研究结果表明，与其将同伴支持的深层个人性质视为由于同伴支持提供者感知到的脆弱性而构成的风险，还不如采取措施培训同伴工作人员，使其安全地管理这项工作中涉及的间接创伤、挫折和不可避免的挫折。

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引用次数: 21

Peer Career Implications of an Academic Credential: Report from the Field 学术证书对同行职业的影响:来自实地的报告

American journal of psychiatric rehabilitation

Pub Date : 2014-10-02 DOI: 10.1080/15487768.2014.903876

J. Wolf

Thousands of peer workers are trained, certified, and employed throughout the United States. Although the importance of education in behavioral health career development is well documented, almost no current literature is available on academic peer career development. This article reports on peer and nonpeer educational and employment outcomes following completion of a credit-bearing community college mental health certificate program. Implications and recommendations for peer workforce development are identified. Peer and nonpeer certificate program graduates' employment and educational outcomes were obtained in 1997, 2001, and 2004–06 through surveys and interviews. Peer and nonpeer graduates obtained part-time and full-time employment in a variety of behavioral health and human services positions at a range of salaries. A considerable proportion of all graduates subsequently obtained higher degrees. Peer graduates also reported positive impact on self-esteem. Credit-bearing educational opportunities can assist in peer employment and career development. As increasing numbers of certified peer workers are employed in health and behavioral health settings, higher education opportunities can be an important career development strategy. Coordinated national efforts are recommended to link certification and academic programs. Collaboration among peer training programs, behavioral health providers, and educational institutions is suggested to infuse curricula with recovery-oriented content.

成千上万的同行工作者在美国各地接受培训、认证和就业。虽然教育在行为健康职业发展中的重要性是有据可查的，但目前几乎没有关于学术同伴职业发展的文献。这篇文章报告了同伴和非同伴的教育和就业结果后完成学分的社区大学心理健康证书课程。确定了对同伴劳动力发展的影响和建议。通过调查和访谈获得了1997年、2001年和2004 - 2006年同侪和非同侪证书项目毕业生的就业和教育成果。同辈和非同辈毕业生获得了各种行为健康和人类服务职位的兼职和全职工作，工资范围广泛。相当一部分毕业生后来获得了更高的学位。同辈毕业生也报告了对自尊的积极影响。获得学分的教育机会可以帮助同龄人就业和职业发展。随着越来越多的经过认证的同行工作者受雇于卫生和行为卫生机构，高等教育机会可以成为一项重要的职业发展战略。建议协调国家努力将认证和学术课程联系起来。建议同伴培训计划、行为健康提供者和教育机构之间合作，在课程中注入以康复为导向的内容。

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