African-Americans in public housing: a traditional social work approach to substance abuse treatment

In recent years, an increased and special emphasis on family issues of public housing residents emerged among social service professionals in northeast Georgia. This emphasis was launched because of the disparity between the number of substance-dependent African-Americans and those who sought and remained in substance abuse treatment programs. The relationship between these factors prompted an examination of preferences for substance abuse treatment among African-Americans in three northeast Georgia public housing complexes. This paper describes the implementation and evaluation of a traditional social work practice approach involving the identification of families where substance abuse was present, the examination of their preferences for substance abuse treatment, and the efficacy of home-based, family-centered practice. The evaluation results support the claim that elements of traditional social work practice, such as community or home-based, family-centered treatment, can be effective in addressing substance abuse issues of African-Americans residing in public housing complexes. In addition, this form of treatment supports the notion that African-American families residing in public housing can be assisted in the resolution of substance abuse issues.     

A Bayesian approach to estimate the prevalence of low height-for-age from the prevalence of low weight-for-age

Victora et al. (1998) proposed the use of low weight-for-age prevalence to estimate the prevalence of height-for-age deficit in Brazilian children. This procedure was justified by the need to simplify methods used in the context of community health programs. From the same perspective, the present article broadens this proposal by using a Bayesian approach (based on Markov Chain Monte Carlo (MCMC) methods) to deal with the imprecision resulting from Victora et al.'s model. In order to avoid invalid estimated prevalence values which can occur with the original linear model, truncation or a logit transformation of the prevalences are suggested. The Bayesian approach is illustrated using a community study as an example. Imprecision arising from methodological complexities in the community study design, such as multi-stage sampling and clustering, is easily handled within the Bayesian framework by introducing a hierarchical or multilevel model structure. Since growth deficit was also evaluated in the community study, the article may also serve to validate the procedure proposed by Victora et al.     

互补还是替代：家庭照料与社区居家养老服务

文章使用国家卫生健康委2014年开展的中国计划生育家庭发展追踪调查数据,采用Probit模型和工具变量方法,实证检验家庭老年照料与社区上门生活护理服务和社区上门医疗服务之间的关系。研究发现：（1）家庭照料会显著减少老年人使用社区上门生活护理服务的概率,二者呈替代关系,但是在高龄和中、重度失能老人中,两者呈互补关系;（2）对于上门医疗服务则存在互补关系,家庭照料会显著增加老年人使用社区上门医疗服务的概率,但是在低收入老年人中,二者存在替代关系。文章建议社区居家养老服务体系建设要注重与家庭照料之间的协调发展,特别要关注高龄、中、重度失能和低收入老年人群体的照料需求,实现家庭照料与社区居家养老服务的优势互补。     

Clinical Pharmacy Services in the Home

Articles on clinical pharmacy services in the home began appearing 3 decades ago but numbers have greatly increased in the last decade. This overview of the English language literature identified 66 reports describing 57 home-based clinical pharmacy programs. Most programs were provided in the context of a time-limited research project. Medication reviews (defined as comprehensive assessment of the appropriateness of the medication regimen) and medication management (defined as assessment and support of medication compliance) were the most common services provided. Primary care, post-hospital discharge, and home healthcare were the typical service contexts, and elderly patients at high risk of medication problems were the primary target population. The early literature predominantly focused on medication management and patient counseling services based in the US; however, since 1991, reports of medication review programs in the UK and Australia have dominated.Barriers to home-based clinical services have been identified at the healthcare system, pharmacy, pharmacist, physician, and patient levels. The most common barriers are lack of (or inadequate) remuneration and the related barriers of community pharmacy or pharmacist time constraints, and the cost and time to attain and maintain pharmacist qualifications. Other important barriers are difficulty in accessing the physician to discuss drug therapy recommendations, and inadequate patient referrals. Additional barriers pertaining to the delivery of the clinical service include inadequate clinical training of community pharmacists, service provision by a pharmacist unknown to the patient, and limited access to patient information for the pharmacist. Patient barriers are lack of awareness, reluctance to accept an intervention from the pharmacist, inaccessibility, and forgetting appointments or refusing the service after initial agreement.The most commonly cited facilitators pertain to the pharmacist-physician relationship; foremost among these is having an established working relationship between the pharmacist and family physician. Others are face-to-face meetings between pharmacist and prescribing physician, and facilitator positions in Divisions of General Practice. A few facilitators of the referral system, pharmacist motivation, and service delivery have also been identified.Evaluative data were provided for 48 programs; 21 programs were evaluated within a randomized controlled trial. Thirteen of these trials found at least one statistically significant difference between groups; however, although important outcomes such as hospitalization and quality of life were often examined, the only parameter that was affected on a consistent basis was medication compliance (four of six trials).The literature on clinical pharmacy services in the home is growing and maturing. While medication review is the most common type of service reported, several other types of clinical services have been explored in this setting. Although evaluation of impact has become more rigorous over time, the overall evidence is limited and many questions remain about optimal practice models and target patient populations. Given the time intensity of home-based services, it is important that more research be conducted to provide firm evidence of value.     

Anthropometric surrogates for screening of low birth weight newborns: a community-based study

In developing countries, where about 75% of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. This study compares various anthropometric surrogates for identification of low birth weight neonates. A longitudinal community based study was done in an urban resettlement colony and 283 singleton neonates within 7 days of birth were examined for the anthropometric measurements such as head, chest, mid upper arm circumference and foot length as a screening tool for low birth weight. Chest circumference measured within 7 days of birth appeared to be the most appropriate surrogate of low birth weight with highest sensitivity (75.4%), specificity (78.4%), and positive predictive value (48.9%) as compared with other anthropometric parameters. Low birth weight neonates in absence of weighing scales can be early identified by using simple anthropometric measurements for enhanced home-based care and timely referral.     

Home First! Identification of Hospitalized Patients for Home-Based Models of Care

ObjectivesTo determine the proportion of hospitalized inpatients suitable for an acute and subacute home-based inpatient bed substitutive service, to examine the ability of treating teams to identify suitable patients for this service, and to examine potential barriers toward inpatients receiving home-based care.DesignProspective point prevalence study over 2 days in April 2019; analysis of responses to survey questionnaires regarding the suitability for home-based care among inpatients with multiday admissions to acute and subacute wards in the Royal Melbourne Hospital (RMH), an Australian metropolitan tertiary referral center.Setting and ParticipantsWard treating teams, clinicians affiliated with the home-based service called RMH@Home, and inpatients who were subsequently identified as being suitable for home-based care.MeasurementsPoint prevalence and characteristics of inpatients suitable for a home-based bed substitutive service; identified by either treating teams or RMH@Home clinicians; and barriers to the provision of home-based care among ward inpatients.ResultsSurvey responses were received for 620 of 635 inpatients [median age 69 years (interquartile range 53–81), 53% male], of which 69 (11.1%) were identified as being suitable for home-based inpatient bed substitution care. Treating team clinicians identified 26 patients, clinicians affiliated with RMH@Home identified a further 43 suitable patients. The most commonly reported barrier (38.1%) toward receiving home-based care was functional disability impeding ability to live at home.Conclusions and ImplicationsA substantial proportion of hospitalized older patients could use home-based inpatient bed substitutive services. Clinicians experienced in home-based care are more skilled than ward-based clinicians in identifying suitable patients for this care model.     

Subgroups Analysis when Treatment and Moderators are Time-varying

Prevention scientists are often interested in understanding characteristics of participants that are predictive of treatment effects because these characteristics can be used to inform the types of individuals who benefit more or less from treatment or prevention programs. Often, effect moderation questions are examined using subgroups analysis or, equivalently, using covariate × treatment interactions in the context of regression analysis. This article focuses on conceptualizing and examining causal effect moderation in longitudinal settings in which both treatment and the putative moderators are time-varying. Studying effect moderation in the time-varying setting helps identify which individuals will benefit more or less from additional treatment services on the basis of both individual characteristics and their evolving outcomes, symptoms, severity, and need. Examining effect moderation in these longitudinal settings, however, is difficult because moderators of future treatment may themselves be affected by prior treatment (for example, future moderators may be mediators of prior treatment). This article introduces moderated intermediate causal effects in the time-varying setting, describes how they are part of Robins’ Structural Nested Mean Model, discusses two problems with using a traditional regression approach to estimate these effects, and describes a new approach (a two-stage regression estimator) to estimate these effects. The methodology is illustrated using longitudinal data to examine the time-varying effects of receiving community-based substance abuse treatment as a function of time-varying severity (or need).     

Breast cancer in West Islip, NY: A spatial clustering analysis with covariates

This paper presents the results of an exploratory spatial analysis of breast cancer clustering in the community of West Islip on Long Island. Using address-level data from a survey of women in West Islip, we analyze the existence and locations of breast cancer clusters among long-term community residents. Statistical and geographical methods are used to first, estimate a logistic regression model of disease as a function of known risk factors and second, analyze spatial clustering among the cases of breast cancer not explained by the modeled risk factors. The method determines the actual locations of clusters so that if there is a potential causal factor in the environment it can be identified for further study. Although little evidence of clustering is uncovered, the methods described here have utility for exploratory spatial analysis in many health contexts.     

Use of Home-Based Formal Services by Adult Day Care Clients with Alzheimer's Disease

OBJECTIVES: To explore the association between adult day care (ADC) attendance and utilization of home-based formal services among people with Alzheimer's Disease (AD). METHODS: Data for this secondary analysis came from a longitudinal parent study of 457 subjects from 16 ADC programs and an Alzheimer's diagnostic center in metropolitan Chicago. We used the method of Generalized Estimating Equations to model the use of home-based formal services over time. RESULTS: Adjusting for relevant covariates, more days of ADC use at each follow-up was associated with decreased use of home-based formal services (coefficient = ?.25, p < .0001). Older, unmarried caregivers who are children of the care recipients had lower use of home-based services. DISCUSSION: Results suggest that ADC services may substitute for specific types of home-based formal services. The projected increase in AD prevalence over the next several decades warrants a clearer understanding of how people with AD use formal services.     

Toward a client-centered understanding of drug treatment

This article reports some of the results of a study of the content of drug treatment in New York City that is being conducted by Health/PAC's Drug Treatment Policy Project and funded by the Robert Wood Johnson Foundation. The research is led by a steering committee made up of clients of drug treatment services, providers and administrators of drug treatment programs, and legal and financial advocates for drug users. This article reflects 20 months of meetings and discussions by the steering committee; over 50 interviews with drug users, advocates, drug treatment providers, and program administrators about the experience, structure, and policies of drug treatment in New York City; and an analysis of the major evaluations of drug treatment services in New York City, supplemented by informal telephone surveys of facilities by staff. The Drug Treatment Policy Project has found services in New York City as a whole to be less than enlightened or adequate. But, in the course of the research, many programs were found to be both helpful and effective, mostly as a result of the efforts and personal risks taken by individuals who filled in gaps or by programs that, because they were community based, went to extraordinary efforts on behalf of their clients to make sure that a variety of options and services were available. We hope to outline these successes in another article.     

Cervical Cancer Screening: Exploring Appalachian Patients’ Barriers to Follow-Up Care

This article describes a community-based Patient Navigation (PN) project conducted to identify potential barriers to seeking follow-up cervical cancer care in southeastern Kentucky. Patient navigators (PNs) were placed in cervical cancer programs within county public health departments where they interviewed patients about their perceived barriers to seeking follow-up care after receiving a positive Pap test result. Participants identified various potential barriers at three levels: the individual/personal level, the health care system level and the community/environmental level. One identified barrier that was unique to this study was a lack of consistency between follow-up recommendations and follow-up guidelines for patients under age 21. Implications are discussed.     

Causal models for randomized trials with two active treatments and continuous compliance

In many clinical trials, compliance with assigned treatment could be measured on a continuous scale (e.g., the proportion of assigned treatment actually taken). In general, inference about principal causal effects can be challenging, particularly when there are two active treatments; the problem is exacerbated for continuous measures of compliance. We address this issue by first proposing a structural model for the principal effects. We then specify compliance models within each arm of the study. These marginal models are identifiable. The joint distribution of the observed and counterfactual compliance variables is assumed to follow a Gaussian copula model, which links the two marginal models and includes a dependence parameter that cannot be identified. This dependence parameter can be varied as part of a sensitivity analysis. We illustrate the methodology with an analysis of data from a smoking cessation trial. As part of the analysis, we estimate causal effects at particular levels of the compliance variables and within subpopulations that have similar compliance behavior.     

社区居家养老服务高质量发展评价指标体系的构建研究

目的：社区居家养老服务对于缓解养老压力和提升老人生活质量具有重要作用,本文结合新时代养老服务高质量发展需求,基于SERVPERF模型,构建社区居家养老服务高质量发展评价指标体系,为社区居家养老服务高质量发展的评价和改进提供参考。方法：通过梳理社区居家养老服务相关政策及文献,结合专家访谈,确定初步指标池;开展两轮德尔菲专家咨询,确定评价指标体系。结果：两轮咨询专家积极系数均为100%,专家权威系数分别为0.79、0.82,专家协调程度逐轮提升;最终确定的评价指标体系包括6个一级指标和36个二级指标。结论：本研究构建的社区居家养老服务高质量发展评价指标体系具有一定科学性和可靠性,可为社区居家养老服务高质量发展的评价、建设和改进提供依据。     

National community health worker programs: how can they be strengthened?

This article is based on a collaborative research study of policy and practice in national community health worker (CHW) programs in developing countries. The study involved a review of the relevant literature, case studies in Botswana, Colombia and Sri Lanka, and an international workshop where the future of such programs was discussed. The findings of this research are discussed under four headings: unrealistic expectations, poor initial planning, problems of sustainability, and the difficulties of maintaining quality. It is clear that existing national community health worker programs have suffered from conceptual and implementation problems. However, given the interest and political will, governments can address these problems by adopting more flexible approaches within their CHW programs, by planning for them within the context of all health sector activities rather than as a separate activity, and by immediately addressing weaknesses in task allocation, training and supervision. CHWs represent an important health resource, whose potential in extending coverage and providing a reasonable level of care to otherwise underserved populations must be fully tapped.     

Principals and tools for evaluating community-based prevention and health promotion programs.

This article is an overview and practical guide for the evaluation of community-based disease prevention and health promotion programs. The article first offers a rationale for evaluating community-based programs, then enumerates five selected principles that are contemporary to community evaluation. The principles are as follows: (1) evaluation of community programs should include an assessment of program theory; (2) evaluation instruments that are used to measure community programs must be contoured to each individual community; (3) evaluation approaches used should be guided by the questions asked and often require both a quantitative and qualitative orientation; (4) evaluation should be informed by social ecology and social system concepts; and (5) community evaluation should involve local stakeholders in meaningful ways. At the end of each principle, an annotated reference list is provided that contains tools for applying the principle to community evaluation.     

Collaborative community empowerment: an illustration of a six-step process

This article illustrates a method used in a community empowerment project where community members and university facilitators collaborated to increase the capacity of the community. The method may have practical uses in collaborations with community groups. The six-step process enabled the community groups to accomplish their short-term community goals: developing effective after-school programs and resolving problems of damaged homes and blighted properties in a relatively short time and continuing on their collaborative work. Having a social ecological model as a conceptual framework was helpful for the community to assess their status and develop action plans. Consistent community meetings, open communication, focused community leadership, community networking, and collaboration of community organizations and a university were the factors that reinforced the empowerment process. Challenges such as maximizing limited resources and generating more participation from the community need to be resolved while the reinforcing factors are cultivated.     

Initial findings from the evaluation of the Alzheimer's Disease Demonstration Grants to States Program

This article describes the initial development and implementation of the Alzheimer's Disease Demonstration Grants to States (ADDGS) program in 15 states. In addition to describing the services delivered and the client populations served, key elements of program development are discussed. Development strategies common to the programs that most successfully used the demonstration as a catalyst for developing services that are likely to continue are identified. Successful community programs were characterized by community commitment fostered by forging new partnerships and expanding public awareness. Success was also linked to the creation of new resources an d flexibility in implementation of the federal program.     

Evaluating program effectiveness using the regression point displacement design

Most health care initiatives are evaluated using observational study designs in lieu of randomized controlled trials (RCT) due primarily to resource limitations. However, although observational studies are less expensive to implement and evaluate, they are also more problematic in determining causality than the RCT. This trade off is most apparent in the initial planning stage of program development. An RCT is generally preferred though the cost of implementing a pilot program using the RCT might outstrip the potential benefit if the desired results are not obtained. This article describes a simple quasi-experimental model called the regression point displacement (RPD) design, which compares the prepost results of a single or multiple treatment groups to that of a control population. This design has shown great potential in evaluating health care pilot programs or demonstration projects-especially those that are community based-due to its relative ease of implementation and low cost of analysis.