Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementação de modelos de Intervenção Precoce em Psicose. No entanto, esta organização do serviço não mudou nos últimos 19 anos. Segundo os dados obtidos da utilização do serviço, no período de 1996 -2012 foram atendidos 997 doentes, que tinham um número médio de 89 contactos (IQR: 36-184), com uma duração média de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um número médio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) não necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asiáticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relatório inclui 15 recomendações para orientar as reformas para o serviço e, nomeadamente, delinear a importância de uma visão organizacional e dos seus componentes-chave. As recomendações incluem o reforço da gestão e da liderança numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencialização da comunidade, a educação e deteção precoce, bem como a capacidade de receber referenciações diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa etária alvo atual. A duração do serviço deve ser aumentada para um mínimo de três anos, com a opção de aumentá-la para cinco anos. A proporção de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio não-clínico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um serviço local de prestação de cuidados deve ser desenvolvido com, nomeadamente, intervenções culturais para responder às necessidades da população multicultural de Auckland. A capacidade de investigação deve ser incorporada no Serviço de Intervenção Precoce em Psicoses. Qualquer alteração deverá envolver contacto com todas as partes interessadas, e a Administração Regional de Saúde deve comprometer-se em tempo, recursos humanos e políticos para apoiar e facilitar a mudança do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community.

THE MAKING OF THE IMMIGRANT IDENTITY IN THE PRESS: Constructing the Immigrant Imagined Community

A dissertation submitted in partial fulfilment of the requirements for the degree of Master in Arts

BIWiki - Using a Business Intelligence Wiki to Form a Virtual Community of Practice for Portuguese Master's Students

Web 2.0 software in general and wikis in particular have been receiving growing attention as they constitute new and powerful tools, capable of supporting information sharing, creation of knowledge and a wide range of collaborative processes and learning activities. This paper introduces briefly some of the new opportunities made possible by Web 2.0 or the social Internet, focusing on those offered by the use of wikis as learning spaces. A wiki allows documents to be created, edited and shared on a group basis; it has a very easy and efficient markup language, using a simple Web browser. One of the most important characteristics of wiki technology is the ease with which pages are created and edited. The facility for wiki content to be edited by its users means that its pages and structure form a dynamic entity, in permanent evolution, where users can insert new ideas, supplement previously existing information and correct errors and typos in a document at any time, up to the agreed final version. This paper explores wikis as a collaborative learning and knowledge-building space and its potential for supporting Virtual Communities of Practice (VCoPs). In the academic years (2007/8 and 2008/9), students of the Business Intelligence module at the Master's programme of studies on Knowledge Management and Business Intelligence at Instituto Superior de Estatistica e Gestao de Informacao of the Universidade Nova de Lisboa, Portugal, have been actively involved in the creation of BIWiki - a wiki for Business Intelligence in the Portuguese language. Based on usage patterns and feedback from students participating in this experience, some conclusions are drawn regarding the potential of this technology to support the emergence of VCoPs; some provisional suggestions will be made regarding the use of wikis to support information sharing, knowledge creation and transfer and collaborative learning in Higher Education.

Education in Brazil: A big challenge?

Brazil is an emerging country where community school is being promoted in order to respond to the still significant gap between the poor and the rich population. This paper attempts to analyze one community school. Although other social programs whose scopes are also to enhance education have been implemented, such as the "Bolsa Familia", the impact of community schools need attention as well. Indeed, community schools must be studied due to the relevant positive attributes they can provide. Moreover, by improving the quality of education, studies show an enhancement of a higher-skilled nation and a better qualified labour force for the future. To clearly demonstrate the impacts of these communities, the treatment effect will be measured by using a matching estimator.