Staffing in AIDS service organizations: the volunteer contribution

This article reports results from a survey of AIDS service organizations (ASOs) that provide medical and social services to people with AIDS in the Oakland, California, area. The survey was designed to assess organizational and staffing characteristics of ASOs. Forty two of sixty-seven (62.7% response rate) ASOs responded, providing detailed data on their staffing patterns. ASOs that provided social services reported 48.5 percent of their total full-time equivalents (FTEs) as volunteers while medical organizations reported only 9.5 percent of their total FTEs as volunteers. Among the social service providers, ASOs that self-identified as private, non-profit community-based organizations (CBOs) reported greater than half (50.8 percent) of their total FTEs as volunteer staff. All CBOs that reported utilizing more than five volunteer FTEs were AIDS-specific providers and had designated a full-time, paid staff position as volunteer coordinator/director.     

Staff stress in AIDS prevention and service organizations: implications for health education practice

The purpose of this study was to identify the frequency of staff stressors and their association with programmatic factors in 51 AIDS prevention and service projects funded by the Robert Wood Johnson Foundation. The methodology included both quantitative (i.e. closed-ended survey questions) and qualitative (i.e. in-depth, open-ended interviews) data to identify the important sources of staff stress. The findings suggest that staff working in AIDS prevention and service projects perceive significant levels of stress regardless of project focus. The most frequently reported staff stresses were too much work, rapid organizational growth, burnout, and problems with staff retention and communication. Among the issues rarely reported as a source of staff stress were too little work, discomfort with the target population and personal health risk concerns. The programmatic factor most often associated with staff stress was obtaining additional funding. Health education interventions need to take a comprehensive approach that includes altering the psychosocial-environmental conditions that give rise to stressors and strengthening the individual and organizational factors that may modify the effects of stress on the AIDS workforce.     

Stress and satisfaction among employees in AIDS service organizations in New York

In recent years, employees in AIDS service organizations have witnessed a number of changes and challenges in their work, ranging from shifts in the population primarily affected by HIV disease, treatment advances and its implications, and changes in administrative factors such as cuts in funding, reorganization, and changes in job function. This study examined the motives, stressors, and rewards of employees in AIDS service organizations in New York City. The main reasons for choosing to work in this field were a desire to help and having experienced the loss of some-one to AIDS. A large number of respondents had been working in the AIDS field for 5 or more years and perceived the level of stress to be mild to moderate. They reported that the rewards of this type of work outweighed the stressors, and the level of job satisfaction was very high.     

Interorganizational relationships among HIV/AIDS service organizations in Baltimore: A newtwork analysis

A wide variety of organizations has become involved in providing medical and social services to people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). Although there is much interest among policy-makers, service providers, and clients in coordination among HIV/A IDSservice organizations, few studies have used network analytic tools to examine existing systems of HIV-related care. In an effort to fill this gap, this study used network analysis methods to describe several aspects of the interorganizational relationships among 30 HIV/A IDSservice agencies in Baltimore. Maryland. Client referrals to other organizations, client referrals from other organizations, exchange of information about shared clients, formal written linkage agreements for client referrals, and joint programs were each examined as a distinct type of network tie, with each the basis of a separate network among these 30 organizations. All of the networks except the one based on joint programs were relatively well connected, with most organizations either directly or indirectly linked. Most of the interorganizational collaboration occurred on a rather ad hoc basis for the purposes of meeting the more immediate needs presented by clients. Highly structured coordination involving substantial investment of resources and ongoing interagency activities appeared to be less common. The findings from this study also suggest that the providers in Baltimore tend to work directly with others as client needs arise rather than negotiating through “clearinghouse” types of organizations. Of the 30 HIV/A IDSservice organizations, 5 were highly central in at least four of the five different types of networks. These five organizations—each having a critical role in the continuum of care—may be considered the most central core of the HIV/A IDSservice delivery network in Baltimore. These organizations tend to be those that have been created specifically to provide HIV-related services or that specialize in HIV/A IDScare. This research can help policymakers understand how an HIV-related service delivery network may function and delineate key features of a network. In all communities, this type of assessment is critical to designing interventions to promote collaboration that are feasible within the context of existing interorganizational relationships. This type of data also has implications for informing activities to build the capacity of HIV/A IDSservice organizations.     

Women's Work: Volunteer AIDS Care Giving in Northern Thailand

SUMMARY

Because persons with AIDS in Thailand usually are cared for by their families, and because government AIDS policy relies upon this assistance for the care of the country's sick, the research reported here addressed the questions: Who are the home and community care givers for PWA? What kind of care do they give? And, What is the impact of care giving on the care giver(s)? Informants were drawn in 1998–99 from a long-term birth cohort study of a non-clinical urban population in the country's province of highest AIDS mortality, Chiang Mai. The study was part of a larger, exploratory ethnographic study of the interplay among health, reproduction and development among persons born in 1964 and their mothers that I began in 1973. Findings include that among care-givers, parents, overwhelmingly mothers, and wives considered it their place, duty and moral benefit to care for adult children or husbands sick with AIDS.     

Preferred provider organizations: issues for employers

The preferred provider organization (PPO), an alternative delivery system currently embraced by the employer sector, has been growing at a phenomenal rate for the past few years. It is necessary to examine the issues an employer should consider when deciding whether to offer a PPO option, and to look at organizational issues such as PPO structure, quality, utilization review mechanisms, and benefits design.     

The role of community-based organizations in responding to the AIDS epidemic: examples from the HRSA service demonstrations

This paper considers the role of community-based organizations in providing out-of-hospital services to persons with AIDS, using information collected as part of a case-study evaluation of AIDS service demonstration grants in four cities. Community-based organizations which existed prior to the AIDS epidemic have been reluctant to expand services to persons with AIDS. The widest array of services is provided by new broad-based organizations. Also, exclusive reliance on community-based organizations for service delivery leads to inequities in the delivery system, due to difficulties in developing such organizations in low-income communities.     

我国大中城市社会组织参与艾滋病防治服务能力影响因素研究

目的了解我国大中城市参与艾滋病防治社会组织现状,对其提供公共服务能力的影响因素进行探讨。方法用德尔菲法确定不同的指标反映社会组织服务能力的权重,建立评分体系对社会组织服务能力量化;对社会组织开展问卷调查,应用SPSS16．0建立数据库,进行一般性统计描述及多元线性回归分析等,对组织进行现况及影响因素分析。结果社会组织负责人专职所占的比例为77．46％,组织有完善的规章制度的比例为74．65％;这两个因素对其开展艾滋病防治工作的能力的影响具有显著性（组织负责人专／兼职,P=0．006;是否有完善的规章制度,P=0．001）。结论在未来政府购买社会组织提供艾滋病防治服务中,应重视组织在建立规章制度方面加强组织的能力建设。     

Treating AIDS: the economic issues

It is now clear that AIDS is not only a disease of great social concern, but also has major resource implications. A number of analyses of the costs of caring for AIDS sufferers have already been published, relating mainly to the U.S.A. These present a confusing picture to the policy maker as the estimates vary greatly. In addition, treatment patterns are changing rapidly, with consequent impact on costs. Therefore this paper reviews the evidence on the costs of treating AIDS, comparing European data with those from the U.S.A. It also investigates the reasons for variations in cost estimates, the likely impact of changing treatment patterns and the relative ‘value for money’ from treatment of AIDS, compared with other health care interventions.     

Personality and psychopathology correlates of dropout in an outpatient psychiatric service

AIM: The dropout from care in public psychiatric units is a frequent event and strategies to reduce its incidence are still debated. This study aims to determine which personality and psychopathology dimensions influence the dropout in a psychiatric unit. METHODS: All new patients referred to a public psychiatric outpatient service were tested with self-administered inventories assessing personality traits (TCI), parental bonding (PBI), and psychopathology (SCL-90; BDI; STAXI). Completers were divided into nondropout, late dropout, and early dropout groups which were compared with each other with respect to diagnosis, referral, demographic data and the inventories. Logistic regression was performed between dropout and non dropout subjects with respect to the significantly differing variables. RESULTS: No clinical or demographic characteristic predict dropout. Numerous SCL-90 psychopathology scales, state anger and some TCI personality facets distinguish dropout from in care subjects. Psychoticism and sentimentalism have been evidenced independent predictors of dropout. CONCLUSION: In the present study dropout from the psychiatric unit is more related to personal characteristics than to sociodemographic variables or diagnosis. Dropout is related to personality and psychopathology characteristics which may reduce subject's relational skills and impair therapeutic alliance. These traits may also influence subjects' perception of the service quality and of the assessment procedure. The acknowledgement of such traits as possible determinants of dropout may orient service organization and personnel education to prevent this phenomenon in health care services. Strategies for preventing dropout are discussed.     

非政府组织参与艾滋病防治的资源问题

中国的艾滋病流行仍呈现增长趋势，艾滋病防治工作日益受到各级政府的关注和重视，非政府组织在艾滋病防治工作中的重要作用越来越突现出来。吴仪副总理在2004年全国艾滋病防治工作会议上指出，强调政府的主导作用是必要的，但是，政府主导绝不是包办一切，还要充分利用社会力量和资源，积极引导广大企事业单位，各类社会团体，民间组织，民营企业和众多的志愿者，乃至一些国际组织和机构投入到艾滋病防治工作中来。同时，要调动基层防治人员、公众人物、志愿者、艾滋病病毒感染者和患者的积极性，充分发挥他们在宣传教育工作中的独特作用。     

Diffusion of innovations in service organizations: systematic review and recommendations

This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.     

How service users become empowered in human service organizations: the empowerment model.

This article presents an empowerment model (EM) to be used by service users in human service organizations (HSOs). The EM is a structure for service user input to be integrated within the HSO at various administrative levels through a four-step sequential process. The article fills a distinct void in the literature as there are numerous accounts about the importance of empowerment, but few on processes that need to be defined to operationalize the concept. Implications are directed toward administrators as they need to take leadership in implementing the EM in order to deliver more efficient and relevant services to their clients.