Academic literature on the topic 'Montana. Home Health Services Program'

This article describes how the Blackfeet Head Start Program in north-central Montana utilized professional to train local residents as screeners and home trainers. The training is structured to provide specific intervention strategies and family support. The numbers of handicapped children and their families who receive services has increased as a result of using local home trainers and teachers as direct care providers.

Despite a decline in GP home visits in Australia, these services remain an important aspect of healthcare access and delivery for the aged population. Home visits can both provide better care and decrease use of ambulance and emergency department (ED) services. The net costs of providing GP visits are complex, depending on the relative costs of home visits and ED attendances, the number of ED attendances saved by GP visits, and the number of services provided per day by a visiting GP. The Australian Capital Territory government created the General Practice Aged Day Service (GPADS) program in March 2011. Using data and information from this program as a basis, we examine the financial aspects of a daytime home-visit program in the Australian context. Whether or not a program is financially viable depends on a range of parameters; if all factors are aligned a program can generate net savings. While there is no information available on the net health benefits of home visits relative to ED attendance, these differences need not be large for the program to be cost-effective.

A cost-analysis of an existing gym-based program was compared with a proposed home-based program for deliveringcardiac rehabilitation services in West Moreton, Queensland. Cost and baseline data were collected on 95 cardiacrehabilitation patients living in Ipswich and West Moreton. Cost data included costs to the program funders andpatients. The average cost per patient rehabilitated was $1,933 in the gym-based program and $1,169 in the home-basedprogram. Adopting the lower cost home-based program would allow the services to be provided to many morepatients. The relevance of home-based rehabilitation programs for rural patients facing barriers accessing traditionalhospital- or gym-based programs is significant.

ABSTRACTThe objective of this study was to compare enhanced access to geriatric assessment and case management to usual home care service provision for the frail elderly. This was a demonstration project, with randomized allocation to control or intervention groups of frail elderly persons who had been referred to the Home Care service in Winnipeg. Of the 164 persons who were randomized, 78 intervention and 74 control patients were evaluated. Intervention subjects received a multidimensional assessment as soon as possible by a specially trained coordinator, who had enhanced access to geriatric medical and day-hospital services; intervention patients were case managed for a 3-month period. Control cases received usual care from home care coordinators. The intervention group received significantly faster assessment and deployment of home services, as well as greater utilization of the geriatric day-hospital services. Utilization of emergency room and hospital services was similar for both groups. Control subjects experienced more prolonged hospital stays and a significantly higher proportion (23%) were designated for long-term care than of intervention clients (9%). We conclude that the SWING program, which facilitated access to geriatric services and case management, reduced or delayed the need for long-term care.

Thesis (M.S.)--West Virginia University, 2000.
Title from document title page. Document formatted into pages; contains vi, 94 p. : ill. (some col.). Includes abstract. Includes bibliographical references (p. 92-93).

Home visits are a required training component of many Family Medicine residency programs in the United States. However, they are becoming less popular due to such factors as increasing resident responsibilities, decreasing reimbursement, and a decline in resident intention to incorporate home visits into future practice. This study’s aims are: (1) to evaluate the current practices of one Family Medicine residency training program’s time and resource expenditure to conduct home visits, and (2) to evaluate resident and faculty experiences of home visits. Residents and faculty in a Family Medicine training program were provided with a 12- question survey immediately after completing a home visit. A total of 19 surveys from residents and faculty were collected and analyzed. Average reported time spent per home visit was 90 minutes (range = 50-180 minutes), and the home visit teams included an average of 4 members (range = 2-6 members). The providers felt that they knew their patients and the patients’ circumstances better after the home visit with a score of 4.1 (on a 1-5 scale with 5 being a positively framed statement). Resident opinions were neutral (average score 3.1 on a 1-5 scale) regarding whether they found home visits to be educational to their residency training in Family Medicine. Residents also had mixed feelings (average score 2.9) regarding whether they would perform more home visits during their residency training if given the opportunity. Most faculty members (5/7) indicated they had done home visits during their residency training and all faculty (7/7) felt that home visits added value to their training in Family Medicine. Finally, qualitative recommendations were collected from respondents which may allow this training program to improve home visits in the future. Overall, significant time is currently being spent conducting home visits, with a difference in perceived efficacy between residents and faculty. Future research may include a cost analysis to quantify financial value, as well as expanding data collection to other Family Medicine residency training programs to improve generalizability.

Thesis (M.P.H.)--Georgia State University, 2007.
Title from file title page. Russ Toal, committee chair; Frank Whittington, Derek Shendell, committee members. Electronic text (83 p.) : digital, PDF file. Description based on contents viewed Jan 15, 2008. Includes bibliographical references (p. 80-83).

This retrospective study examined records of 230 low-income elderly and disabled individuals enrolled in the Georgia Community Care Services Program (CCSP) which provides home health services in the client’s home rather than a nursing facility (NF). This study sought to determine if any common characteristics exist in program enrollees who enter a NF within one year of enrollment. Common factors found could be used to identify those who are at the highest risk for entering an NF. This knowledge could lead to reduced costs for the State of Georgia and better service for CCSP enrollees. Findings associated with NF entry include: age, Medicaid status, and monthly income. Further study is recommended to determine which common factors could be developed into a screening tool used to identify individuals at highest risk for NF entry. Specific care plans could then be developed to avoid or delay NF admission for CCSP enrollees.

The purpose of this project is to support health promotion of children entering foster care, ensure that children receive all health care services needed, prevent the trauma of duplication of immunizations, and reduce disruption of health care as children move through the foster care system.

This study is refered to the meanings attributed to PAD on oneâs eight workers side who joined the interdisciplinary team, active in the refered program established in Fortaleza, CearÃ. The research has theoric basis in the qualitative method and the semi-structured interview. The Dejours ideas, concerning about work psychodynamic, and its connection with the workers psychological pleasure and suffering, based the comprehension of its contents work psychodynamic, and it made real trough. The subjects were male and female, genders ages between 29 and 45 years old, and they joined PAD team for more than a year. The interviews were transcripled and analyzed, highlighting questions according to several dataâs, longing for understand them. His discoveries, that donât apply to generalizations, are abridged on final consideration, where it also highlighted that their results showed, that PAD means to these workers a strategy, of acting that works as inducer agent and life and health, producer in an interdisciplinary approach, that cause the rise of âlivesâ quality under its monitoration, providing the financial costs racionalization to CAFAZ, in a view of current health, hegemonic and centerhospital. The research participants, recognize the existence of situations, that cause pleasure and suffering in the work developed at PAD, and admit that is necessary, to be developed better politics of Human Resources in Organization, that can, intervene in suffering situation of PAD team, to aim at reduce it and potencialize the experiences of pleasure at work.
Este estudo tratou sobre os significados atribuÃdos ao Programa de Atendimento Domiciliar - PAD, da Caixa de AssistÃncia aos FazendÃrios Estaduais - CAFAZ, por parte de oito trabalhadores que integravam a equipe interdisciplinar atuante no citado programa instaurado em Fortaleza, no CearÃ. A pesquisa teve fundamentaÃÃo no mÃtodo qualitativo e na tÃcnica de entrevista semi-estruturada. As idÃias de Dejours, concernentes à psicodinÃmica do trabalho e sua relaÃÃo com o prazer e o sofrimento psÃquico dos trabalhadores, subsidiaram a anÃlise dos dados e fundamentaram a compreensÃo de seus conteÃdos. Os sujeitos foram dos gÃneros masculino e feminino, com idades entre 29 a 45 anos, e integravam a equipe do PAD hà mais de um ano. As entrevistas foram transcritas e analisadas, destacando-se questÃes recorrentes a anÃlise dos fatores de entrave e facilitaÃÃo no trabalho por eles indicados, ao conhecimento das atividades desenvolvidas por esses profissionais, segundo Ãs suas percepÃÃes, e a avaliaÃÃo dos conteÃdos emocionais instigados, por conta do atendimento domiciliar, em meio aos dados plurais, almejando-se decifrÃ-los. Suas descobertas, que nÃo se aplicam a generalizaÃÃes, foram resumidas nas consideraÃÃes finais, onde tambÃm se destacou, que o PAD como um agente idutor e produtor de vida e saÃde, dentro de um enfoque interdisciplinar e que produz a elevaÃÃo da qualidade das "vidas" sob sua monitoraÃÃo, proporcionando a racionalizaÃÃo dos custos financeiros para a CAFAZ. Os resultados do estudo mostraram que existem nexos entre os objetivos especÃficos e as descobertas da pesquisa, como tambÃm, que os membros do PAD consideram, que à preciso desenvolver melhores polÃticas de Recursos Humanos na OrganizaÃÃo, as quais possam minimizar o sofrimento psÃquico destes profissionais e potencializar suas vivÃncias de prazer no trabalho

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In the first article we assessed the utilization of home care by the elderly in Brazil after implementation of the Family Health Strategy (FHS). Data were derived from a crosssectional study in a southern city in Brazil. Using the Chi-square test and a logistic regression with different levels of determination, we tested the hypothesis that the FHS increased the utilization of home care compared with utilization under the Traditional Primary Health Care (TPHC) system. We interviewed 1593 residents aged 60 years and older. Home care utilization under the FHS was 2.7 times the rate of utilization under the TPHC (95% confidence interval=1.5, 4.7; P=.001), and utilization increased among the older group, the less educated, those with history of hospitalization, and those with functional limitations. Improvement in access to care resulted in greater utilization of home care. Our findings have policy implications that include expanding the coverage of the FHS throughout big cities where coverage is limited. These findings are important because the population is aging and the family strategy operates in poorer areas; thus, it can promote equity in access to home health care among the elderly. In the second article the objective was to assess factors associated with home health care for the elderly and its characteristics based on different care models, the Family Health Strategy and Traditional primary care. It also describes the forms of access, the professionals who provide the care, the elderly satisfaction and health status after receiving care. Poisson regression model was used for estimating crude and adjusted prevalence ratios, their related 95% confidence intervals and p-values (Wald test). Home health care was statistically associated with prior history of stroke, signs of dementia and disability in activities of daily living. The family was requested 75% of home care visits. Medical doctors provided most of the care in Traditional primary care settings while nursing staff provided most care within the Family Health strategy. Approximately 78% of the elderly received care within 24 hours after the request and 95% of them positively evaluated the care received. Two thirds of the elderly reported improved health status after receiving home care. The variables associated with home health care were consistent with vulnerability indicators included in the Brazilian National Health Policy for the Elderly, reinforcing the role of this strategy for promoting equitable health care to elderly population. Users satisfaction and the positive impact on their health status support home as a setting for providing care. The objective of the third article was to review the literature in search for tools and indicators proposed for the study of quality assessment of care for the elderly at home. Nineteen articles were selected for inclusion in the analysis. Two instruments are highlighted in the study of quality home care: the Outcome and Assessment Information Set and the Minimum Data Set - Home Care. The hospitalization rate, functional capacity and pain control indicators were used in both instruments to assess quality. This review may help the discussion about the relevance in the development of specific instruments and appropriate indicators to assess home care provided in primary health care, mainly due to the expansion and consolidation of family health strategy.
A Politica Nacional de Saude da Pessoa Idosa preconiza a manutencao do idoso na comunidade, com o apoio dos familiares e o estabelecimento de uma rede social de ajuda. Portanto, o modelo assistencial dos servicos de atencao basica a saude precisa adequar-se a esta nova demanda, identificando precocemente idosos em situacao de fragilidade e resgatando o domicilio como ambiente terapeutico. O objetivo desta tese foi avaliar o desempenho dos servicos de atencao basica no atendimento domiciliar aos idosos, os fatores associados e as caracteristicas do acesso, segundo os modelos de atencao estrategia Saude da Familia e Tradicional. Os dados foram coletados através de um estudo transversal realizado em Bage, no Rio Grande do Sul, no ano de 2008. Um total de 1.593 idosos com 60 anos ou mais de idade responderam ao questionário aplicado por entrevistadores no proprio domicilio. Nas areas cobertas pelas equipes Saude da Familia a utilizacao de assistencia domiciliar foi 2,7 vezes maior comparadas com as areas sob responsabilidade da atencao basica Tradicional (IC95% 1,5-4,7; p=0,001). A utilizacao de assistencia domiciliar foi maior entre os idosos mais velhos, com menor escolaridade, com historia de hospitalizacao no ultimo ano, historia previa de derrame, sinais de demencia e incapacidade para as atividades da vida diaria. O fato da estrategia Saude da Familia operar em areas de maior vulnerabilidade social sugere uma maior equidade no acesso a assistencia domiciliar entre os idosos. Nestas areas, a maior prevalencia de idosos com renda per capita de ate um salario minimo e sem acesso a plano de saude indica que a Saude da Familia permitiu diminuir a desigualdade financeira no acesso aos cuidados domiciliares. As variaveis associadas a utilizacao de assistencia domiciliar reiteram os indicadores de fragilidade destacados na Politica Nacional de Saude da Pessoa Idosa. Estes achados devem servir de estimulo a expansão da cobertura da Saude da Familia nos grandes centros urbanos, locais onde a cobertura ainda e limitada. A familia teve papel central e foi responsavel por 75% das solicitações de cuidado. Nas areas da atencao Tradicional, os medicos responderam pela maior promocao de cuidados, enquanto, nas areas da estrategia Saude da Familia, destacou-se a participacao da equipe de enfermagem. Independente do modelo de atencao, aproximadamente 78% das solicitacoes foram atendidas em ate 24 horas e 95% dos usuarios avaliaram positivamente o cuidado recebido. Dois tercos dos idosos referiram melhora nas condicoes de saude apos atendimento. As avaliacoes positivas realizadas por idosos e familiares, e o impacto na situacao de saude reforcam o domicilio como ambiente terapeutico. A tese tambem contem uma revisao da literatura sobre instrumentos e indicadores utilizados para avaliar a qualidade da assistencia domiciliar. Entre os dezenove artigos que preencheram os criterios de inclusao, a maioria foi realizada na America do Norte e na Europa. Os principais indicadores de qualidade utilizados referem-se a mudancas na capacidade funcional entre a admissao e a alta domiciliar, internacao hospitalar no periodo e as taxas de vacinacao.

Rural communities often face the need to reach out to immigrant groups to help sustain their populations. However, rural communities often lack the necessary support and resources required to meet the needs of immigrant communities. This chapter reports on the role of a participatory education project in meeting the needs of immigrant Old Colony Mennonite women. Building on an existing ESL program in a rural community in Southwestern Ontario, a participatory health literacy pilot project was developed employing an action research format. With the participants, the authors explored the participant identified topic of dealing with the stress of parenting, using metaphors (presentational knowing) and collaborative inquiry. Post-project, in-depth, semi-structured interviews were completed with participants and program staff. Interview data was analyzed using a constant comparison method and five themes are identified and discussed: (1) reconsidering the nature of their children; (2) the power of language to transform; (3) modeling with language; (4) changing parental behaviours; and (5) normalizing what happens at home. The authors then discuss the efficacy of utilizing presentational knowing and collaborative inquiry as a pedagogical strategy for meeting the learning needs of rural immigrants.

One of last great impediments to wide-scale and rapid deployment of the information society is the “last mile” issue. This chapter outlines some of the issues and history of the last mile problem and proposes a research and development program leading to early deployment of extreme high speed Internet access to schools and libraries (GITS), which will then underpin an architectural framework for high speed Internet access to the home-Gigabit Internet to the Home (GITH). The proposed strategy calls for the deployment of a third residential network service operating in parallel with existing telephone and cable delivery mechanisms and thereby avoiding the regulatory and technical hurdles of integrating traditional telephone and cable services into one common delivery mechanism.

Children with special health care needs (SHCNs) live in all communities. They present with a diverse group of diagnoses including complex chronic conditions and diseases; physical, developmental, and intellectual disabilities; sensory, behavioral, emotional, psychiatric, and social disorders; cleft and craniofacial congenital disabilities, anomalies, and syndromes; and inherited conditions causing abnormal growth, development, and health of the oral tissues, the teeth, the jaws, and the craniofacial skeleton. Tooth decay, gum disease, dental injuries, tooth misalignment, oral infections, and other oral abnormalities are commonly seen or reported in the health history of children with SHCNs. Nationally, dental and oral health care ranks as the second most common unmet health need, according to the most recent National Survey of Children with Special Health Care Needs. The State of Minnesota does not have enough dental professionals prepared to meet the demand for care. As a result, children with SHCNs either go untreated or receive inadequate services resulting in treatment delays, the need for additional appointments, poor management of oral pain and dysfunction, adverse dental treatment outcomes and/or a lack of appropriate referrals to needed specialists. Research suggests children with SHCNs are best served when assigned to dental homes where all aspects of their oral health care are delivered in a comprehensive, interdisciplinary, and family-centered way under the direction of knowledgeable, experienced dental professionals working collaboratively with an array of allied health, medical professionals, and community partners. An interdisciplinary team consisting of a pediatric dentist, pediatric physician, and speech-language pathology innovator collaborated to advance current and future dental providers’ knowledge and comfort in providing care for children with SHCNs and was accepted into the Clinical Scholars program. Their interdisciplinary collaborative team project was named MinnieMouths and included the following six methods or critical endeavors to ensure success: 1. Development of a project ECHO site focused on advancing care for children with SHCNs. 2. Creation of a 28-participant web-based professional network of current dental, community health liaisons, family navigators, and medical health providers. 3. Establishment of a 32-participant web-based interface of dental and medical students and residents, including new-to-practice dental providers. 4. Launching an annual conference focused on advancing oral health care for children with SHCN. 5. Build a toolkit aimed at allowing dentists and future leadership teams to launch dental home networks focused on children with SHCN. 6. Building a Dental Homes Network Field Guide for Providers who attended our first in-person conference. Findings from the MinnieMouths project suggest that development of peer networks to advance dental homes for children with SHCNs has merit. Network participants gained skills in collaborating with a range of health care providers, understanding the complexities of working within and among health and dental care systems to coordinate care, and the need to better understand and advocate for a more robust medical and dental reimbursement program when launching dental homes for children with SHCN.

The U.S. population is living longer, placing a demand on long-term care services. In the U.S., Medicaid is the primary player in funding costly long-term care for the aged poor. As a major health reform law, the 2010 Patient Protection and Affordable Care Act, Public Law 111-148, gives financial incentive for states to expand Medicaid, transitioning long-term care services from facilities toward community care. Facing other funding obligations and recent recessions, not all states expanded their Medicaid long-term care program using the financial incentives. Some states continue to spend more dollars on traditional nursing facility care despite legislation. This chapter explores why some states spend more revenue on nursing facility long-term care despite enhanced federal funding to reform, while others are spending more on home and community-based services. Regression analysis and 50 state-level data is used.

Age-related changes in physical health and cognitive functions can negatively affect quality of life as well as increase caregiver burden and societal healthcare costs. While aging services technologies (ASTs) have the potential to facilitate functional independence, they have been underutilized in the aging population due to various factors, including awareness and access. ASTs were defined in the 2009 American Recovery and Reinvestment Act as “health technology that meets the health-care needs of seniors, individuals with disabilities, and the caregivers of such seniors and individuals” (Public Law 111-5). For the purpose of this chapter, tools or devices not discussed in the context of older adult use are referred to as assistive technologies (ATs). Both ATs and ASTs span a spectrum from low-tech to high-tech devices. Low-tech devices are often simple, easy to operate, and economical. Magnifying glasses, pill boxes, daily planners, and canes are all considered low-tech devices. In contrast, high-tech devices are computerized, often require additional training to learn and to operate, and are more costly. Computers, tablets, smartphone software or assistive apps, wearable sensors, and smart homes are some examples of high-tech tools. An assortment of ASTs are available to address both physical changes (e.g., changes in vision or mobility) and cognitive limitations (e.g., memory decline). The devices can be used to address issues that arise from normal aging as well as symptoms associated with neurological disorders, including memory, motor, and autoimmune disorders (Cattaneo, de Nuzzo, Fascia, Macalli, Pisoni, Cardini, 2002; Constantinescu, Leonard, Deeley, & Kurlan, 2007; Padilla, 2011). In a randomized controlled study, Mann and colleagues (1999) recruited older adults who were in need of ASTs (e.g., receiving in-home services, participating in a hospital rehabilitation program) and assigned them to usual standard of care or treatment. Participants in the treatment group received an 18-month intervention that included ongoing functional assessment as well as recommendations for ASTs and home modifications.

This chapter talks about the different medical care programs available in the United States. Medicare and Medicaid were both created in 1965 and are administered by the U.S. Department of Health and Human Services. Medicare is a federally funded program, while Medicaid is funded by both the federal and state governments. Unlike Medicare, Medicaid is managed by individual states based on federal guidelines that stipulate the services that must be provided to specific groups of poor individuals. Medicare has historically been a driving force in U.S. health policy due to its conversion of typical fee-for-service medical reimbursements into a standardized prospective payment system. The differences in state regulations and mandates, as well as specific policy guidelines, mean that private insurance has significant variation. In regard to home health care, home visits are limited and home health agencies must get approval for the number of visits they make. These limitations have significant impacts on care recipients, and they structure the work processes for caregivers and nurses alike. The chapter also talks about the system's complexity and the disparities in coverage among various payer sources. The fragmented nature of payer sources greatly affects patients and caregivers, who often negotiate systems with limited knowledge. A large problem for people interviewed in this book was that they didn't know about waivers and other services that were available to them and didn't apply for them when they could have. Caregivers often found out about waivers from acquaintances, family members, or others. Currently, the multiple-payer system promotes confusion, additional stress, and uncertainty.

The U.S. population is living longer, placing a demand on long-term care services. In the U.S., Medicaid is the primary player in funding costly long-term care for the aged poor. As a major health reform law, the 2010 Patient Protection and Affordable Care Act, Public Law 111-148, gives financial incentive for states to expand Medicaid, transitioning long-term care services from facilities toward community care. Facing other funding obligations and recent recessions, not all states expanded their Medicaid long-term care program using the financial incentives. Some states continue to spend more dollars on traditional nursing facility care despite legislation. This chapter explores why some states spend more revenue on nursing facility long-term care despite enhanced federal funding to reform, while others are spending more on home and community-based services. Regression analysis and 50 state-level data is used.

The evidence suggests that medical care for frail, old people should be interdisciplinary, coordinated, and accessible. Analysis of the current system suggests it should begin with comprehensive assessment of the individual, including physical function, emotional state, degree of social engagement, support system, and medical insurance. Next, the ideal interdisciplinary team should determine the person’s goals of care. Finally, a plan of care should be developed, taking both goals and needs into account. Implementing the plan will require a robust home care program as well as family support. Achievement of such a system will necessitate reforming the complex adaptive system that makes up American health care today. The most promising change agent is the Medicare program itself, which could introduce requirements into medical training programs to assure competence in geriatric medicine and communication skills. With appropriate legislative changes, Medicare could also negotiate with drug companies over price and set reimbursement for medical technology based on cost-effectiveness. Medicare could also develop a new benefit plan for frail elders that offered more intensive home care and other services in exchange for decreased coverage of invasive, expensive, and often non-beneficial hospital-based technology.

ABSTRACT Background: Government support has a role in increasing health program development. Cadre performance is important because they are responsible for implementing the integrated health posts (posyandu) program, especially in monitoring the growth and development of children under five. This study aimed to examine the effect of activity level of the integrated health post on the community health workers performance on child growth and development health services Subjects and Method: A cross-sectional study was conducted at 25 posyandus in Karanganyar, Central Java, from August to September 2019. A sample of 200 cadres was selected by stratified random sampling. The dependent variable was cadre performance. The independent variables were education, employment, knowledge, attitude, training, tenure, posyandu facilities, social support, and village government support. The data were collected by questionnaire and analyzed by a multiple logistic regression run on Stata 13. Results: Posyandu cadre with good performance was 50.50%, had education ≥Senior high school was 63%, and working at home was 88%. Cadre performance on child growth and development health services increased with education ≥Senior high school (b= 1.27; 95% CI= 0.24 to 2.30; p= 0.015), working at home (b= 1.41; 95% CI= 0.39 to 2.42; p= 0.007), high knowledge (b= 1.53; 95% CI= 0.56 to 2.49; p= 0.002), positive attitude (b= 1.41; 95% CI= 0.33 to 2.50; p=0.011), had trained ≥2 times (b= 1.33; 95% CI= 0.37 to 2.29; p=0.007), tenure ≥10 years (b=1.21; 95% CI= 0.25 to 2.18; p= 0.014), good facilities (b= 1.57; 95% CI= 0.54 to 2.59; p= 0.003), strong social support (b= 1.28; 95% CI= 0.28 to 2.29; p= 0.013), and strong village government support (b=1.28; 95% CI= 0.26 to 2.31; p=0.014). Posyandu had strong contextual effect on cadre performance on child growth and development health services with intra-class correlation (ICC)= 27.55%. Conclusion: Cadre performance on child growth and development health services increases with high education, working at home, high knowledge, positive attitude, had trained ≥2 times, tenure ≥10 years, good facilities, strong social support, and strong village government support. Posyandu has strong contextual effect on cadre performance on child growth and development health services. Keywords: cadre performance, child growth and development, integrated health post, multilevel analysis Correspondence: Lidia Ekiq Kurniavie. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: ekiqlkv@gmail.com. Mobile: 085852540575. DOI: https://doi.org/10.26911/the7thicph.04.36

BackgroundCare recipients in care and welfare are increasingly presenting themselves with complex needs (Huber et al., 2016). An answer to this is the integrated organization of care and welfare in a way that personalized care is the measure (Topol, 2016). The reality, however, is that care and welfare are still mainly offered in a standardized, specialized and fragmented way. This imbalance between the need for care and the supply of care not only leads to under-treatment and over-treatment and thus to less (experienced) quality, but also entails the risk of mis-treatment, which means that patient safety is at stake (Berwick, 2005). It also leads to a reduction in the functioning of citizens and unnecessary healthcare cost (Olsson et al, 2009).Integrated CareIntegrated care is the by fellow human beings experienced smooth process of effective help, care and service provided by various disciplines in the zero line, the first line, the second line and the third line in healthcare and welfare, as close as possible (Ettema et al, 2018; Goodwin et al, 2015). Integrated care starts with an extensive assessment with the care recipient. Then the required care and services in the zero line, the first line, the second line and / or the third line are coordinated between different care providers. The care is then delivered to the person (fellow human) at home or as close as possible (Bruce and Parry, 2015; Evers and Paulus, 2015; Lewis, 2015; Spicer, 2015; Cringles, 2002).AimSupport societal participation, quality of live and reduce care demand and costs in people with complex care demands, through integration of healthcare and welfare servicesMethods (overview)1. Create best healthcare and welfare practices in Slovenia, Poland, Austria, Norway, UK, Finland, The Netherlands: three integrated best care practices per involved country 2. Get insight in working mechanisms of favourable outcomes (by studying the contexts, mechanisms and outcomes) to enable personalised integrated care for meeting the complex care demand of people focussed on societal participation in all integrated care best practices.3. Disclose program design features and requirements regarding finance, governance, accountability and management for European policymakers, national policy makers, regional policymakers, national umbrella organisations for healthcare and welfare, funding organisations, and managers of healthcare and welfare organisations.4. Identify needs of healthcare and welfare deliverers for creating and supporting dynamic partnerships for integrating these care services for meeting complex care demands in a personalised way for the client.5. Studying desired behaviours of healthcare and welfare professionals, managers of healthcare and welfare organisations, members of involved funding organisations and national umbrella organisations for healthcare and welfare, regional policymakers, national policy makers and European policymakersInvolved partiesAlma Mater Europaea Maribor Slovenia, Jagiellonian University Krakow Poland, University Graz Austria, Kristiania University Oslo Norway, Salford University Manchester UK, University of Applied Sciences Turku Finland, University of Applied Sciences Utrecht The Netherlands (secretary), Rotterdam Stroke Service The Netherlands, Vilans National Centre of Expertise for Long-term Care The Netherlands, NIVEL Netherlands Institute for Health Services Research, International Foundation of Integrated Care IFIC.References1. Berwick DM. The John Eisenberg Lecture: Health Services Research as a Citizen in Improvement. Health Serv Res. 2005 Apr; 40(2): 317–336.2. Bruce D, Parry B. Integrated care: a Scottish perspective. London J Prim Care (Abingdon). 2015; 7(3): 44–48.3. Cringles MC. Developing an integrated care pathway to manage cancer pain across primary, secondary and tertiary care. International Journal of Palliative Nursing. 2002 May 8;247279.4. Ettema RGA, Eastwood JG, Schrijvers G. Towards Evidence Based Integrated Care. International journal of integrated care 2018;18(s2):293. DOI: 10.5334/ijic.s22935. Evers SM, Paulus AT. Health economics and integrated care: a growing and challenging relationship. Int J Integr Care. 2015 Jun 17;15:e024.6. Goodwin N, Dixon A, Anderson G, Wodchis W. Providing integrated care for older people with complex needs: lessons from seven international case studies. King’s Fund London; 2014.7. Huber M, van Vliet M, Giezenberg M, Winkens B, Heerkens Y, Dagnelie PC, Knottnerus JA. Towards a 'patient-centred' operationalisation of the new dynamic concept of health: a mixed methods study. BMJ Open. 2016 Jan 12;6(1):e010091. doi: 10.1136/bmjopen-2015-0100918. Lewis M. Integrated care in Wales: a summary position. London J Prim Care (Abingdon). 2015; 7(3): 49–54.9. Olsson EL, Hansson E, Ekman I, Karlsson J. A cost-effectiveness study of a patient-centred integrated care pathway. 2009 65;1626–1635.10. Spicer J. Integrated care in the UK: variations on a theme? London J Prim Care (Abingdon). 2015; 7(3): 41–43.11. Topol E. (2016) The Patient Will See You Now. The Future of Medicine Is in Your Hands. New York: Basic Books.

Attention to safety and health are of ever-increasing priority to industrial organizations. Good Safety is demanded by stockholders, employees, and the community while increasing injury costs provide additional motivation for safety and health excellence. Safety has always been a strong corporate value of DuPont and a vital part of its culture. As a result, DuPont has become a benchmark in safety and health performance. Since 1990, DuPont has re-engineered itself to meet global competition and address future vision. In the new re-engineered organizational structures, DuPont has also had to re-engineer its safety management systems. A special Discovery Team was chartered by DuPont senior management to determine the “best practices’ for safety and health being used in DuPont best-performing sites. A summary of the findings is presented, and five of the practices are discussed. Excellence in safety and health management is more important today than ever. Public awareness, federal and state regulations, and enlightened management have resulted in a widespread conviction that all employees have the right to work in an environment that will not adversely affect their safety and health. In DuPont, we believe that excellence in safety and health is necessary to achieve global competitiveness, maintain employee loyalty, and be an accepted member of the communities in which we make, handle, use, and transport products. Safety can also be the “catalyst” to achieving excellence in other important business parameters. The organizational and communication skills developed by management, individuals, and teams in safety can be directly applied to other company initiatives. As we look into the 21st Century, we must also recognize that new organizational structures (flatter with empowered teams) will require new safety management techniques and systems in order to maintain continuous improvement in safety performance. Injury costs, which have risen dramatically in the past twenty years, provide another incentive for safety and health excellence. Shown in the Figure 1, injury costs have increased even after correcting for inflation. Many companies have found these costs to be an “invisible drain” on earnings and profitability. In some organizations, significant initiatives have been launched to better manage the workers’ compensation systems. We have found that the ultimate solution is to prevent injuries and incidents before they occur. A globally-respected company, DuPont is regarded as a well-managed, extremely ethical firm that is the benchmark in industrial safety performance. Like many other companies, DuPont has re-engineered itself and downsized its operations since 1985. Through these changes, we have maintained dedication to our principles and developed new techniques to manage in these organizational environments. As a diversified company, our operations involve chemical process facilities, production line operations, field activities, and sales and distribution of materials. Our customer base is almost entirely industrial and yet we still maintain a high level of consumer awareness and positive perception. The DuPont concern for safety dates back to the early 1800s and the first days of the company. In 1802 E.I. DuPont, a Frenchman, began manufacturing quality grade explosives to fill America’s growing need to build roads, clear fields, increase mining output, and protect its recently won independence. Because explosives production is such a hazardous industry, DuPont recognized and accepted the need for an effective safety effort. The building walls of the first powder mill near Wilmington, Delaware, were built three stones thick on three sides. The back remained open to the Brandywine River to direct any explosive forces away from other buildings and employees. To set the safety example, DuPont also built his home and the homes of his managers next to the powder yard. An effective safety program was a necessity. It represented the first defense against instant corporate liquidation. Safety needs more than a well-designed plant, however. In 1811, work rules were posted in the mill to guide employee work habits. Though not nearly as sophisticated as the safety standards of today, they did introduce an important basic concept — that safety must be a line management responsibility. Later, DuPont introduced an employee health program and hired a company doctor. An early step taken in 1912 was the keeping of safety statistics, approximately 60 years before the federal requirement to do so. We had a visible measure of our safety performance and were determined that we were going to improve it. When the nation entered World War I, the DuPont Company supplied 40 percent of the explosives used by the Allied Forces, more than 1.5 billion pounds. To accomplish this task, over 30,000 new employees were hired and trained to build and operate many plants. Among these facilities was the largest smokeless powder plant the world had ever seen. The new plant was producing granulated powder in a record 116 days after ground breaking. The trends on the safety performance chart reflect the problems that a large new work force can pose until the employees fully accept the company’s safety philosophy. The first arrow reflects the World War I scale-up, and the second arrow represents rapid diversification into new businesses during the 1920s. These instances of significant deterioration in safety performance reinforced DuPont’s commitment to reduce the unsafe acts that were causing 96 percent of our injuries. Only 4 percent of injuries result from unsafe conditions or equipment — the remainder result from the unsafe acts of people. This is an important concept if we are to focus our attention on reducing injuries and incidents within the work environment. World War II brought on a similar set of demands. The story was similar to World War I but the numbers were even more astonishing: one billion dollars in capital expenditures, 54 new plants, 75,000 additional employees, and 4.5 billion pounds of explosives produced — 20 percent of the volume used by the Allied Forces. Yet, the performance during the war years showed no significant deviation from the pre-war years. In 1941, the DuPont Company was 10 times safer than all industry and 9 times safer than the Chemical Industry. Management and the line organization were finally working as they should to control the real causes of injuries. Today, DuPont is about 50 times safer than US industrial safety performance averages. Comparing performance to other industries, it is interesting to note that seemingly “hazard-free” industries seem to have extraordinarily high injury rates. This is because, as DuPont has found out, performance is a function of injury prevention and safety management systems, not hazard exposure. Our success in safety results from a sound safety management philosophy. Each of the 125 DuPont facilities is responsible for its own safety program, progress, and performance. However, management at each of these facilities approaches safety from the same fundamental and sound philosophy. This philosophy can be expressed in eleven straightforward principles. The first principle is that all injuries can be prevented. That statement may seem a bit optimistic. In fact, we believe that this is a realistic goal and not just a theoretical objective. Our safety performance proves that the objective is achievable. We have plants with over 2,000 employees that have operated for over 10 years without a lost time injury. As injuries and incidents are investigated, we can always identify actions that could have prevented that incident. If we manage safety in a proactive — rather than reactive — manner, we will eliminate injuries by reducing the acts and conditions that cause them. The second principle is that management, which includes all levels through first-line supervisors, is responsible and accountable for preventing injuries. Only when senior management exerts sustained and consistent leadership in establishing safety goals, demanding accountability for safety performance and providing the necessary resources, can a safety program be effective in an industrial environment. The third principle states that, while recognizing management responsibility, it takes the combined energy of the entire organization to reach sustained, continuous improvement in safety and health performance. Creating an environment in which employees feel ownership for the safety effort and make significant contributions is an essential task for management, and one that needs deliberate and ongoing attention. The fourth principle is a corollary to the first principle that all injuries are preventable. It holds that all operating exposures that may result in injuries or illnesses can be controlled. No matter what the exposure, an effective safeguard can be provided. It is preferable, of course, to eliminate sources of danger, but when this is not reasonable or practical, supervision must specify measures such as special training, safety devices, and protective clothing. Our fifth safety principle states that safety is a condition of employment. Conscientious assumption of safety responsibility is required from all employees from their first day on the job. Each employee must be convinced that he or she has a responsibility for working safely. The sixth safety principle: Employees must be trained to work safely. We have found that an awareness for safety does not come naturally and that people have to be trained to work safely. With effective training programs to teach, motivate, and sustain safety knowledge, all injuries and illnesses can be eliminated. Our seventh principle holds that management must audit performance on the workplace to assess safety program success. Comprehensive inspections of both facilities and programs not only confirm their effectiveness in achieving the desired performance, but also detect specific problems and help to identify weaknesses in the safety effort. The Company’s eighth principle states that all deficiencies must be corrected promptly. Without prompt action, risk of injuries will increase and, even more important, the credibility of management’s safety efforts will suffer. Our ninth principle is a statement that off-the-job safety is an important part of the overall safety effort. We do not expect nor want employees to “turn safety on” as they come to work and “turn it off” when they go home. The company safety culture truly becomes of the individual employee’s way of thinking. The tenth principle recognizes that it’s good business to prevent injuries. Injuries cost money. However, hidden or indirect costs usually exceed the direct cost. Our last principle is the most important. Safety must be integrated as core business and personal value. There are two reasons for this. First, we’ve learned from almost 200 years of experience that 96 percent of safety incidents are directly caused by the action of people, not by faulty equipment or inadequate safety standards. But conversely, it is our people who provide the solutions to our safety problems. They are the one essential ingredient in the recipe for a safe workplace. Intelligent, trained, and motivated employees are any company’s greatest resource. Our success in safety depends upon the men and women in our plants following procedures, participating actively in training, and identifying and alerting each other and management to potential hazards. By demonstrating a real concern for each employee, management helps establish a mutual respect, and the foundation is laid for a solid safety program. This, of course, is also the foundation for good employee relations. An important lesson learned in DuPont is that the majority of injuries are caused by unsafe acts and at-risk behaviors rather than unsafe equipment or conditions. In fact, in several DuPont studies it was estimated that 96 percent of injuries are caused by unsafe acts. This was particularly revealing when considering safety audits — if audits were only focused on conditions, at best we could only prevent four percent of our injuries. By establishing management systems for safety auditing that focus on people, including audit training, techniques, and plans, all incidents are preventable. Of course, employee contribution and involvement in auditing leads to sustainability through stakeholdership in the system. Management safety audits help to make manage the “behavioral balance.” Every job and task performed at a site can do be done at-risk or safely. The essence of a good safety system ensures that safe behavior is the accepted norm amongst employees, and that it is the expected and respected way of doing things. Shifting employees norms contributes mightily to changing culture. The management safety audit provides a way to quantify these norms. DuPont safety performance has continued to improve since we began keeping records in 1911 until about 1990. In the 1990–1994 time frame, performance deteriorated as shown in the chart that follows: This increase in injuries caused great concern to senior DuPont management as well as employees. It occurred while the corporation was undergoing changes in organization. In order to sustain our technological, competitive, and business leadership positions, DuPont began re-engineering itself beginning in about 1990. New streamlined organizational structures and collaborative work processes eliminated many positions and levels of management and supervision. The total employment of the company was reduced about 25 percent during these four years. In our traditional hierarchical organization structures, every level of supervision and management knew exactly what they were expected to do with safety, and all had important roles. As many of these levels were eliminated, new systems needed to be identified for these new organizations. In early 1995, Edgar S. Woolard, DuPont Chairman, chartered a Corporate Discovery Team to look for processes that will put DuPont on a consistent path toward a goal of zero injuries and occupational illnesses. The cross-functional team used a mode of “discovery through learning” from as many DuPont employees and sites around the world. The Discovery Team fostered the rapid sharing and leveraging of “best practices” and innovative approaches being pursued at DuPont’s plants, field sites, laboratories, and office locations. In short, the team examined the company’s current state, described the future state, identified barriers between the two, and recommended key ways to overcome these barriers. After reporting back to executive management in April, 1995, the Discovery Team was realigned to help organizations implement their recommendations. The Discovery Team reconfirmed key values in DuPont — in short, that all injuries, incidents, and occupational illnesses are preventable and that safety is a source of competitive advantage. As such, the steps taken to improve safety performance also improve overall competitiveness. Senior management made this belief clear: “We will strengthen our business by making safety excellence an integral part of all business activities.” One of the key findings of the Discovery Team was the identification of the best practices used within the company, which are listed below: ▪ Felt Leadership – Management Commitment ▪ Business Integration ▪ Responsibility and Accountability ▪ Individual/Team Involvement and Influence ▪ Contractor Safety ▪ Metrics and Measurements ▪ Communications ▪ Rewards and Recognition ▪ Caring Interdependent Culture; Team-Based Work Process and Systems ▪ Performance Standards and Operating Discipline ▪ Training/Capability ▪ Technology ▪ Safety and Health Resources ▪ Management and Team Audits ▪ Deviation Investigation ▪ Risk Management and Emergency Response ▪ Process Safety ▪ Off-the-Job Safety and Health Education Attention to each of these best practices is essential to achieve sustained improvements in safety and health. The Discovery Implementation in conjunction with DuPont Safety and Environmental Management Services has developed a Safety Self-Assessment around these systems. In this presentation, we will discuss a few of these practices and learn what they mean. Paper published with permission.

This article provides an overview of financing for long-term services and supports (LTSS) in the United States, paying special attention to how it has changed and not changed over the last 30 years. Although LTSS expenditures have increased greatly (like the rest of health care), the broad outline of the financing system has remained remarkably constant. Medicaid—a means-tested program—continues to dominate LTSS financing, while private long-term care insurance plays a minor role. High out-of-pocket costs and spend-down to Medicaid because of those high costs continue to be hallmarks of the system. Although many major LTSS financing reform proposals were introduced over this period, none was enacted—except the Community Living Assistance Services and Supports Act, which was repealed before implementation because of concerns about adverse selection. The one major change during this time period has been the very large increase in Medicare spending for post-acute services, such as short-term skilled nursing facility and home health care. With the aging of the population, demand for LTSS is likely to increase, placing strain on the existing system.

Since the mid-1970s, the Bangladesh national family planning program primarily focused on motivating women to use modern contraceptive methods and encouraging them to seek services from clinics. In addition, female field workers were recruited to deliver contraceptive methods at homes. The program design facilitated women’s access to information and medical care through clinics and home visits. In the process, however, the medical needs of males were marginalized. Men generally seek services from pharmacies, private practitioners, and district hospitals, and often ignore preventive steps and postpone seeking medical care for chronic health conditions. In cases of acute illness, they often resort to self-medication. As noted in this report, the study’s aim was to integrate male reproductive health services within the existing government female-focused health-care delivery system. The study concluded that reproductive health services for men could easily be integrated into the health and family welfare centers without affecting the clinics’ focus on serving women and children.

As part of a Population Council program of research on unwanted pregnancy and induced abortion in Rajasthan, the Council and Ibtada conducted a qualitative exploration of attitudes and behaviors regarding unwanted pregnancy and induced abortion in Alwar district. The study was intended to lay the groundwork for two quantitative studies on abortion undertaken subsequently in six districts of Rajasthan. The qualitative exploration shows that women, particularly those who are poor, turn to largely untrained community-level providers for abortion services. Additionally, women use home remedies in an often unsuccessful attempt to terminate unwanted pregnancies. Women with greater financial means obtain surgical services from a private gynecologist. The remaining women are left with little choice but to avail of services from informal providers that they often recognize to be unsafe and/or to carry unwanted pregnancies to term. This report encourages innovative means to improve access to legal, safe, and effective abortion services at lower levels of the public health system, and suggests that the feasibility of training certain informal providers to offer safe abortion services, particularly at early gestations, should be explored at the policy, program, and research levels.