Supporting community-based prevention and health promotion initiatives: developing effective technical assistance systems.

As research evidence for the effectiveness of community-based prevention has mounted, so has recognition of the gap between research and community practice. As a result, state and local governments are taking a more active role in building the capacity of community-based organizations to deliver evidence-based prevention interventions. Innovations are taking place in the establishment of technical assistance or support systems to influence the prevention and health education activities of community-based organizations. Several challenges for technical assistance systems are described: (1) setting prevention priorities and allocating limited technical assistance resources, (2) balancing capacity-building versus program dissemination efforts, (3) collaborating across categorical problem areas, (4) designing technical assistance initiatives with enough "dose strength" to have an effect, (5) balancing fidelity versus adaptation in program implementation, (6) building organizational cultures that support innovation, and (7) building local evaluative capacity versus generalizable evaluation findings.     

A network to promote health systems based on primary health care in the Region of the Americas]

OBJECTIVES: To identify the relational components of an international network of organizations that provide technical and financial assistance to promote the development of health systems based on primary health care in the countries of the Region of the Americas; to analyze the linkages that would allow the collaborating partners of the Pan American Health Organization (PAHO) to work together on health issues; and to determine the basic theoretical elements that can help to develop action strategies that support advocacy efforts by a network. METHODS: This was a qualitative and quantitative cross-sectional study based on identifying key informants and on analyzing social networks. Ethnographic and relational information from 46 international organizations was collected through a self-administered semistructured questionnaire. From 46 international health cooperation organizations, 29 decision makers from 29 organizations participated (63.0% response rate). The structure and the strength of the network was evaluated in terms of density, closeness, clustering, and centralization. The statistical analysis was done using computer programs that included UCINET, Pajek, and Microsoft Access. RESULTS: We found a structurally centralized theoretical network, whose nodes were clustered into four central subgroups linked by a shared vision. The leadership, influence, and political interests reflected the formal and technical-cooperation linkages, the formal support for health systems based on primary health care, and the flow of resources being more often technical ones than financial ones. CONCLUSIONS: The interorganizational relational components and the social-action ties that were identified could help in the development and consolidation of a thematic network for advocacy and for the management of technical and financial assistance that supports primary health care in the Americas. The linkages for joint action that were identified could advance international cooperation in developing health systems based on primary health care, once PAHO formulates clear implementation strategies and takes a leadership position in mobilizing financial resources and in creating informal and interpersonal linkages for action.     

A new health system and its quality agenda

This article reviews recent work on healthcare quality, highlights findings and recommendations of the Institute of Medicine (IOM) reports on medical errors and quality, and describes response to the reports to date. In it, Detmer, chair of the IOM's Board of Health Care Services and a member of its Committee on Quality of Health Care in America, identifies implications of the reports for healthcare delivery organizations and professionals and outlines ways organizations and professionals can improve the six dimensions of patient quality defined by the IOM. Sustained efforts at the point of care and in policy development are needed to overcome cultural inertia, realign incentives, support innovation, and address technical and human resource issues. Success requires that healthcare executives embrace the goal of transforming the healthcare sector into a true system and provide leadership for their organizations and communities in this most fundamental of challenges for twenty-first century healthcare.     

Piot: U.S. should play greater role in global effort

UNAIDS executive director Peter Piot called for the United States to do more to support HIV prevention efforts internationally. Speaking at the United States Conference on AIDS, he said that U.S. groups will need to offer more technical assistance and advice to community-based organizations around the world if they ever hope to manage the epidemic. UNAIDS will issue model legislation which other countries can use to pattern their own anti-discrimination laws. Health Canada recently published a guide in which ways that community-based organizations in industrialized countries can assist their counterparts in the developing world are outlined. Information is included for ordering the guide.     

四川省社区组织参与艾滋病防治现状分析

目的了解四川省社区组织参与艾滋病防治的现状,为促进社区组织更好发展提供建议。方法采用目的抽样,日统一设计的问卷对抽取的四川省内16个市州社区组织进行面对面调查。结果44个社区组织分布在16个市州,成了最多（25％）。参与艾滋病防治工作最短2年,最长达12年,平均为5年。7个社区组织无专职人员,63．6％社区组织妄愿者／同伴教育员人数t〉2／3。13个社区组织已经注册,其中民政注册8个。经费来源最主是国际合作项目,其中I条筹资渠道的有3个社区组织,只有1条筹资渠道的有19个社区组织。开展艾滋病防治工作中遇到的首问题是缺子金,其次是志愿者的流动性大。结论四川省社区组织已经初步形成一个网络,但是存在发展不均衡和筹资困难等亟,仍需政府加大资金投入,同时需相关部门提供技术支持和指导。     

Small-grants programs: lessons from community-based approaches to changing nutrition environments

Providing small grants to community organizations can be an effective way to encourage changes in the environment that support better nutrition. This is effective because these organizations can provide insights into their communities, ready-made relationships with community members, and the trust of the community. Small-grants programs are more likely to be successful when they are tailored to the needs of individual communities, led by organizations that have established reputations with the community, fully supported by the lead community organization, and engage local partners that complement the skills and resources of the lead organization. An evaluation of a small-grants program, Grants for Healthy Youth, found that grantees developed unique approaches to improving their community nutrition environments, gained experience and skills in program development, built partnerships, and received recognition for their project work. Grantees faced some common barriers, especially with program evaluation. Small-grants programs can be an effective way to improve community nutrition environments, but granting agencies need to provide effective technical assistance to communities throughout the process.     

2005年全国疾病预防控制机构人力结构现状分析

通过全国系统抽样,获取疾病预防控制机构2005年人力结构基本资料,从年龄、学历、职称和专业四个维度对疾病预防控制机构人员构成进行描述。结果显示,全国疾病预防控制机构在岗人员平均年龄为39.8岁,以大、中专学历为主,本科学历次之,职称集中在初、中级水平,专业化程度较高,并以预防医学和非预防专业的医学专业背景为主。     

Country watch: Brazil

The National STD/AIDS Program (NSAP) of the Brazilian government believes that nongovernmental organizations (NGO) occupy a strategic position in mobilizing the human and financial resources needed to deal with the HIV/AIDS epidemic. NGOs are indeed partners with the state in planning and implementing a national HIV/AIDS strategy, organizations which are highly flexible and determined to deal directly with affected communities. It is especially regarding prevention among vulnerable groups and the implementation of alternative care/support strategies for people living with HIV/AIDS (PHIV) that the NSAP cooperates most directly with NGOs. This cooperation is clearly seen in NSAP funding for NGO projects conducted in 1993-94 in the following areas: the care and support of PHIV, IEC, institutional development and exchange, and behavioral interventions among the most vulnerable population groups. 102 organizations have thus far received financial aid for 170 projects. The funding of NGO projects occurs twice annually, supervised by an external committee. To help NGOs find partners for new proposals, the NSAP published a NGO directory and manual on the formulation and evaluation of community projects. NGOs receiving funding receive further orientation via an NSAP manual on administrative procedures and bookkeeping. Funds are released periodically to projects upon presentation of reports including technical, financial, and qualitative information, with monitoring taking place three times yearly by the projects in collaboration with external consultants.     

The March to Accountable Care Organizations—How Will Rural Fare?

Purpose: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). Methods: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA) makes contracts with ACOs a permanent option under Medicare. This article explores ACA implications, using the literature to describe successful integrated health care organizations that will likely become the first ACOs. Previous research studying rural managed care organizations found rural success stories that can inform the ACO discussion. Findings: Preconditions for success as ACOs include enrolling a minimum number of patients to manage financial risk and implementing medical care policies and programs to improve quality. Rural managed care organizations succeeded because of care management experience, nonprofit status, and strong local leadership focused on improving the health of the population served. Conclusions: Rural provider participation in ACOs will require collaboration among rural providers and with larger, often urban, health care systems. Rural providers should strengthen their negotiation capacities by developing rural provider networks, understanding large health system motivations, and adopting best practices in clinical management. Rural communities should generate programs that motivate their populations to achieve and maintain optimum health status. Policy makers should develop rural‐relevant ACO‐performance measures and provide necessary technical assistance to rural providers and organizations.     

Surfacing the life phases of a mental health support group

Support groups have increased rapidly in number and become a viable alternative to formal treatment in the United States. However, little is known regarding how mental health advocacy or support groups start and develop, or about challenges that can threaten their survival. In this 2 1/2-year ethnography, the author studied the culture of a developing family support program associated with a system of care. Several phases emerged, reflecting an organizational dynamic. The group dynamics and response to challenges have implications for organizers and parent organizations about the need for technical assistance necessary for survival of the group. Participant observation and immersion in the culture of such groups can provide a deeper understanding of the ideologies and values around which they organize and the kinds of tensions that members can experience during the group's cycle.     

Increasing the involvement of national and regional racial and ethnic minority organizations in HIV information and education.

Responding to the facts that (a) the AIDS epidemic is occurring among black and Hispanic populations disproportionately to their percentage of the U.S. population and (b) effective human immunodeficiency virus (HIV) prevention programs are racially, ethnically, and culturally relevant and sensitive, CDC in 1988 initiated a 5-year grant program for HIV prevention efforts by national racial and ethnic minority organizations and regional consortia of racial and ethnic minority organizations. A total of 33 organizations received first-year funds. Of the 32 grants that are ongoing, 15 primarily target blacks, 12 Hispanics, 4 Native Americans and Alaskan Natives, and 1 Asian Americans and Pacific Islanders. Some grants are for more than one racial or ethnic population. Programs may be categorized as (a) education programs within national non-AIDS organizations and their respective affiliate networks to increase their understanding, support, and community out-reach for HIV prevention; for example, National Urban League, Inc.; (b) programs providing specific HIV prevention expertise and technical assistance to community-based and other organizations; for example, National Minority AIDS Council; (c) HIV prevention programs emphasizing communications and media; for example, Hispanic Designers, Inc; and (d) prevention programs targeted to a specific racial or ethnic group within a geographic area; for example, Midwest Hispanic AIDS Coalition. As a result of these grants, substantial resources are being invested in prevention programs developed by and for racial and ethnic minorities. Other overall benefits include an expanded foundation of organizations to address AIDS and other health problems affecting these populations, strengthened interrelationships among HIV-focused and broader-based minority organizations, and extensive collaboration of private sector organizations with Federal and State public health and education agencies.     

Managed care and technical efficiency in outpatient substance abuse treatment units

This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment (OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.     

Managing the transition to integrated health care organizations

Today's successful community hospitals should and will evolve into integrated health care organizations (IHCOs) that will share several common characteristics. IHCOs will have a community--not a membership--orientation, and this will be a distinguishing characteristic and a source of market appeal. The transition to IHCO will be a slow one, and to prosper, the IHCO will have to accommodate both price-oriented markets and traditional ones. Successful IHCOs will expand technical skills and capabilities to control costs and quality. New strategic competencies will have to be developed, and to do this, emerging IHCOs will improve the ability of managers to support decisions and sell them both to the buyers and the public at large. Excellent patient care will rest upon better trained, advised, and informed management teams. Making the change to an IHCO will take time and money, but organizations that make steady progress are likely to succeed.     

Implementing a Multicomponent School-Based Obesity Prevention Intervention: A Qualitative Study

ObjectiveTo explore barriers and facilitators to implementing and sustaining Healthy Choices, a 3-year multicomponent obesity prevention intervention implemented in middle schools in Massachusetts.MethodsUsing purposive sampling, 56 in-depth interviews were conducted with middle school employees representing different positions (administrators, teachers, food service personnel, and employees serving as intervention coordinators). Interviews were recorded and transcribed. Emergent themes were identified using thematic analyses.ResultsState-mandated testing, budget limitations, and time constraints were viewed as implementation barriers, whereas staff buy-in, external support, and technical assistance were seen as facilitating implementation. Respondents thought that intervention sustainability depended on external funding and expert assistance.Conclusions and ImplicationsResults confirm the importance of gaining faculty and staff support. Schools implementing large-scale interventions should consider developing sustainable partnerships with organizations that can provide resources and ongoing training. Sustainability of complex interventions may depend on state-level strategies that provide resources for implementation and technical assistance.     

From Alarm Systems to Smart Houses

The percentage of senior citizens in the Netherlands will rise in coming years. The expected percentage for the year 2010 of persons over age 65 in the total population is 15%. More persons over age 65 than ever before will continue to live in their own environment. Emergency response systems (ERS) can support independent living. The most common type of organization distributing ERS is a small, partly subsidized local alarm organization run by a social welfare office for the elderly. Government subsidy has been reduced in recent years which has motivated small organizations to join together into larger regional organizations in order to get a more solid financial base. On the other hand new semicommercial and cornmercial organizations have come into being. These developments are part of the growing im ortance of home care, leading to more medical applications of ad. User satisfaction with ERS is high. Portable triggers can enhance the_effectiveness of the system. However, many users do not wear the portable trigger when feeling well. Future technical developments will result in multifunctionality of ERS-devices. In the long term the hardware of today will be integrated in a multimedia home terminal replacing the telephone. The portable trigger will remain the only specific hardware at home for ERS.     

From alarm systems to smart houses

The percentage of senior citizens in the Netherlands will rise in coming years. The expected percentage for the year 2010 of persons over age 65 in the total population is 15%. More persons over age 65 than ever before will continue to live in their own environment. Emergency response systems (ERS) can support independent living. The most common type of organization distributing ERS is a small, partly subsidized local alarm organization run by a social welfare office for the elderly. Government subsidy has been reduced in recent years which has motivated small organizations to join together into larger regional organizations in order to get a more solid financial base. On the other hand new semi-commercial and commercial organizations have come into being. These developments are part of the growing importance of home care, leading to more medical applications of ERS. User satisfaction with ERS is high. Portable triggers can enhance the effectiveness of the system. However, many users do not wear the portable trigger when feeling well. Future technical developments will result in multifunctionality of ERS-devices. In the long term the hardware of today will be integrated in a multimedia home terminal replacing the telephone. The portable trigger will remain the only specific hardware at home for ERS.     

Using technical assistance to strengthen tobacco control capacity: evaluation findings from the Tobacco Technical Assistance Consortium

Immediately following the Master Settlement Agreement of 1998 and the corresponding growth of new and existing tobacco control programs, it became clear that tobacco prevention and control organizations required technical assistance to help them carry out their missions. The Tobacco Technical Assistance Consortium (TTAC) was established at the Rollins School of Public Health in 2001 to provide tailored technical assistance services to meet the needs of the expanded workforce and to build tobacco control capacity. To understand whether and how TTAC's technical assistance enhanced capacity, TTAC conducted an evaluation of its services through semi-structured telephone interviews with the primary contacts and one to two additional informants for each of 48 technical assistance services provided over an 18-month period. The majority of respondents reported they had increased knowledge and skills in tobacco control, strengthened leadership skills, developed or strengthened partnerships with other tobacco control organizations, and changed the way they practice tobacco control following the assistance. More modest improvements were noted in the areas of increased organizational support and policy change at the local or state level.     

整体护理的实践与体会

文章全面系统地叙述了开展整体护理全过程的关键环节;观念先行,用全新的护理理念,培养新型护理人才;循序渐进,采取渐进模式全面推广整体护理;健全科学的管理体系,保证整体护理落到实处;形成整体护理支持网络,并将整体护理作为全院的一项系统工程。     

Substance Abuse Treatment Organizations as Mediators of Social Policy: Slowing the Adoption of a Congressionally Approved Medication

Most substance abuse treatment occurs in outpatient treatment centers, necessitating an understanding of what motivates organizations to adopt new treatment modalities. Tichy’s framework of organizations as being comprised of three intertwined internal systems (technical, cultural, and political) was used to explain treatment organizations’ slow adoption of buprenorphine, a new medication for opiate dependence. Primary data were collected from substance abuse treatment organizations in four of the ten metropolitan areas with the largest number of heroin users. Only about one fifth offered buprenorphine. All three internal systems were important determinants of buprenorphine adoption in our multivariate model. However, the cultural system, measured by attitude toward medications, was a necessary condition for adoption. Health policies designed to encourage adoption of evidence-based performance measures typically focus on the technical system of organizations. These findings suggest that such policies would be more effective if they incorporate an understanding of all three internal systems.     

Expanding the reach of health campaigns: community organizations as meta-channels for the dissemination of health information

This study investigates whether, and to what extent, community organizations can serve as viable channels of health information. We use Putnam's (2000) findings on social capital to argue that organizations can serve two major functions in health campaigns: instrumental (e.g., providing material support) and affinity (social support). Through a secondary analysis of data from the Stanford Five-City Project, we find significant support for our predictions about who joins community organizations. Membership in community organizations explains greater variance in health outcomes than that explained by general media use, demographic indicators, and health-specific media use. Implications for health campaigns are discussed.