Advanced Search Summary We examined efforts to engage marginalized populations in Ontario Community Health Centers CHCswhich are primary health care organizations serving 74 high-risk communities. Qualitative case studies of community participation in four Ontario CHCs were carried out through key informant interviews with CHC staff to identify: The marginalized populations involved in the community participation initiatives studied included Low-German Speaking Mennonites in a rural town, newcomer immigrants and refugees in an urban downtown city, immigrant and francophone seniors in an inner city and refugee women in an inner city.
Oregon, New Jersey, Maryland, Vermont, and New Hampshire, and some Wisconsin counties, have strong programs for self-determination, consumer empowerment, and self-direction.
The original Robert Wood Johnson Foundation self-determination pilots and the original Community Supported Living Amendment states have also provided models for establishing such programs, although some have not been sustained.
The typical design in these programs is that an individual receives an allocation and has control over how that allocation is used. The most innovative service models are those that incorporate the foundational principles of self-determination, including consumer control of their services budget and contribution to community life.
Individualized support does not mean that people spend their time alone. Many individuals share their homes with chosen others and have good relationships with co-workers and fellow citizens. While some states have venues for providing direct funding to consumers, sometimes the roles and structures in such programs are not defined according to or are not true to self-determination principles.
Among the programs listed in Table 1those in England, New Jersey, and some Wisconsin counties follow the self-determination model. Following is a profile of this model as it is applied in New Jersey.
One Model for Self-Determination: About people receive services in this program, which started with persons on the community services waiting list but has since expanded to persons leaving institutions and students transitioning from high school to adult services.
The support coordinator facilitates the plan development, connects the individual and family to community resources, and assists the person to design and purchase individualized support. The person may also get additional assistance to develop a career and to identify and locate the place they would most like to live.
The family and peer mentors are individuals or their family members who are already living on their own in the community and have community careers. This program has a high level of consumer satisfaction. One Model for Individual Allocation Methodology: The formula places a premium on fairness and equity, improves equity of resources within and between populations, and supports the free choice of provider.
One element for increasing consumer choice of case manager is expanding the number of agencies offering case management.
However, simply expanding the number of case management agencies does not ensure real and meaningful choice. More must be done to ensure choice.
Individuals do not necessarily experience real choice by simply being provided a list of potential case management agencies, or being provided the choice of county case management versus one private agency.
Rather they need opportunities to meet potential case managers, to hear from other consumers about different case managers or case management agencies, and also be afforded other means to experience real market choice. Many States operate entirely non-public case management systems and some provide for open enrollment of case management providers in their Medicaid programs, a policy that enhances consumer choice.
With open enrollment, gate-keeping responsibilities for service eligibility are typically maintained by a public entity, while service coordination functions are provided through a variety of agencies.
For example, in the Florida developmental disabilities system, service coordination functions are purchased exclusively from private agencies while the State retains gatekeeping responsibilities. Following is a profile of the model in which consumers choose their case managers, as it is applied in Dane County, Wisconsin also see Table 1.
One Model for Choice of Case Manager: Dane County, Wisconsin One of the innovative models for choice of case manager is the developmental disabilities services system in Dane County, Wisconsin.
All individuals with developmental disabilities in the county are funded on the basis of self-determination principles, and have control over their service dollars and how their services and support are designed and delivered. In addition to implementing and continually expanding its realization of the principles of self-determination, the County also instituted choice of case managers.
Six private agencies provide case management, and there are three case management provider fairs each year for individuals to meet case managers and make a choice. The County recommends that consumers and their families meet at least three different case managers before making a choice.
Consumers indicate that having a choice of case manager is one of the most important features of their support structure, even more important than the size of the services allocation they receive.
In addition, as self-determination was being instituted, some individuals wanted to have a relative or friend serve as their case manager. To honor this choice, a seventh agency was established to provide the administrative support for individuals not licensed as case managers.
This agency and the County play key roles in monitoring the support provided by relatives or friends functioning as case managers. The County retains the functions of screening, eligibility determination, and allocation of service dollars, and county case managers have increased their role in quality assurance.
In addition, a small number of complex cases are retained on county caseloads. Safeguards are in place if individuals seem to be abusing the system by changing case managers too often. Coordinated Database Systems A coordinated system requires a well-designed, consumer-friendly management information and support technology system that can simplify, streamline, and make as comprehensive as possible the process of collecting and using information concerning service recipients.
A comprehensive information management system in which information flows from intake to assessment, to planning, to monitoring, to incident-reporting and quality assurance, which is also linked to service-billing systems, can greatly improve access and ongoing service coordination across all disability groups.
When duplication is reduced, the amount of time that case managers and case aides devote to consumers can be increased.Health Evidence Network (HEN) synthesis report on community based mental health Mental disorders are responsible for about 12 - 15 % of the world’s total disability – more than cardiovascular diseases, and twice as much as cancer.
The Mental Health Division provides an array of opportunities for partners to work together in the spirit of hope toward recovery. This includes programs and services for children, adolescents, young adults, adults, and older adults of Contra Costa County. Root Cause Analysis A Tool for Improvement Wednesday, October 11, North Dakota Health Care Review, Inc.
Center for Rural Health, UND School of Medicine. Analysis of the population health status and/or assessment of community health needs is conducted with participation or input from all partners. Key trends and factors influencing health status outcomes are evaluated and prioritized, with input from.
SWOT analysis is an examination of an organization’s internal strengths and weaknesses, its opportunities for growth and improvement, and the threats the . Strengthened collection, analysis and use of routine health data.
Best Practices in Strengthening Community Health Information Systems. Regional Initiative Health Information Systems Strengthening: Latin America and Caribbean: