Assessing the community needs of mental health residential care service users in Republic of Moldova

RESUMO: Background: Problemas de saúde mental são um grande problema clínico e social na República da Moldávia, representando uma quota significante de deficiência, sendo classificada no top cinco das dez linhas na hierarquia das condições. A taxa de incidência tem sido crescente na República da Moldávia, atingindo cerca de 15.000 por ano (14,655 em 2011), ou seja, 411,4 por 100 mil habitantes, e uma taxa de prevalência de 97.525 pessoas em 2011, ou seja, 2,737.9 por 100 mil habitantes. Sistema de atendimento psiquiátrico fornece serviços de saúde mental escassos a nível da comunidade, visando principalmente terapia hospitalar, centralizada, através de uma rede de três hospitais psiquiátricos, com 1.860 camas e 4 sanatórios psico- neurológicos com 1890 camas, assim alimentando-se a estigmatização do paciente. Objetivos: O objetivo deste estudo foi a avaliação das necessidades individuais dos beneficiários e do seu nível de autonomia dentro de cuidados residenciais, para o planeamento de reformas de saúde mental e desinstitucionalização na República da Moldávia. Este estudo foi encomendado pelo Ministério do Trabalho, Proteção Social e da Família e pelo Ministério da Saúde, com o apoio da Organização Mundial da Saúde, para determinar o cumprimento eficaz do artigo 19 da Convenção da ONU. O estudo tem os seguintes objetivos: Avaliar o nível de autonomia dos residentes nos hospitais psiquiátricos e sanatórios psico-neurológico, usando uma amostra representativa de 10 por ce nto do número total de pacientes/residentes e comparação cruzada; Para avaliar quatro sanatórios psico-neurológicos para adultos e três hospitais psiquiátricos; Para desenvolver recomendações para o planeamento da desinstitucionalização das pessoas com problemas de saúde mental e colocação na comunidade com base nos resultados do estudo. Metodologia e resultados: O estudo fez uso de duas ferramentas globais: questionário para a avaliação individual dos residentes do estabelecimento de saúde mental, e questionário de avaliação institucional. Todos os entrevistados foram divididos em quatro categorias conforme com o grau de dependência e preparação de viver de forma independente na comunidade. Apenas 1,2% dos entrevistados de PNHB eram totalmente dependentes de terceiros ou serviços especializados, tornando-se a categoria 4, que necessitam de cuidados e apoio contínuo. No PH esta categoria de pessoas é ausente. Conclusões: A condição dos entrevistados foi pior em PNBH que em PH. No entanto, ainda, aqueles que estão prontos para ser desinstitucionalizados correspondem com a maior parte dos entrevistados. Todos os hospitais tinham o consentimento do utente para admissão e tratamento, enquanto não houve consentimento qualquer em PNBH. É bastante óbvio que tanto os hospitais como também a sistema de assistência residencial não atingem a sua finalidade, o que significa que a maioria dos utentes pode ser desinstitucionalizados, sem qualquer terapia de suporte.------------------ABSTRACT: Background: Mental health problems are a major clinical and social issue in the Republic of Moldova,accounting for a significant share of disability and ranking in top five of the ten lines in the hierarchy of conditions. The incidence rate has been growing in the Republic of Moldova to reach approximately 15 thousand a year (14,655 in 2011), i.e. 411.4 per 100 thousand population, and a prevalence rate of 97,525 thousand people in 2011, i.e. 2,737.9 per 100 thousand population. Psychiatric care system provides for scanty mental health services at community level, aiming mainly at centralized hospital-based therapy through a network of three psychiatric hospitals tallying up 1,860 beds and 4 psycho-neurological boarding houses with 1,890 beds, thus fuelling up patient stigmatization. Objectives: The purpose of this study was to assess the individual needs of beneficiaries and their level of autonomy within residential care for the planning of mental health system reforms and deinstitutionalization in the Republic of Moldova. This study was commissioned by the Ministry of Labour, Social Protection and Family and by the Ministry of Health, with the World Health Organization support, to provide for effective enforcement of article 19 of the UN CRPD. The study pursued the following goals: To evaluate the level of autonomy of the psychiatric hospital and psycho-neurological boarding house residents by using a representative sample of 10 per cent of the total number of patients / residents and cross-comparison; To evaluate four psycho-neurological boarding houses for adults and three psychiatric hospitals; To develop recommendations for planning the deinstitutionalization of people with mental health problems and community placement based on the study findings.Methodology and results: The study made use of two global tools: questionnaire for individual assessment of mental health facility residents, and institutional assessment questionnaire. All interviewees were divided into four categories by one’s degree of dependence and readiness to live independently in the community. Only 1.2% of respondents from PNHB were fully dependent on a third party or specialized services, making up category 4, requiring continuous care and support. In PH this category of people is absent.Conclusions: The condition of respondents was worse in PNBH than in PH. However, yet, those ready to be deinstitutionalized accounted for most of respondents there. All hospitals had the resident’s consent to admission and treatment, whereas there was no consent in PNBH whatsoever. It is quite obvious that both the hospitals and residential care system do not achieve their intended purpose, meaning that the majority of residents may be deinstitutionalized without any support therapy.

Position Statement Community Needs Assessments & Health Improvement Planning, April 2016

The Iowa Department of Public Health urges hospitals and local boards of health to collaborate in completing a comprehensive community health needs assessment and health improvement plan. The department will be flexible in its reporting requirements for local CHNA & HIP processes to support integration with hospitals.

Community Care Access Centre accountability reforms: executive director perceptions /

The purpose of this study was to explore how four purposefully selected executive directors of Community Care Access Centres (CCACs) understood the idea of accountability, and how they viewed the accountability reforms that had been imposed on their sector of health care over the previous three years. Data were collected through personal interviews and a reflective journal. An analysis of key documents and the reflective journal informed the data analysis. The findings suggest that executive directors perceive that accountability relationships have shifted since reforms have been implemented. They noted that CCACs have become more accountable to the provincial government at the expense of accountability to the local community. From their perspective, the demand for greater standardization and bureaucratization has left fewer opportunities to adapt programs to meet particular community needs and has slowed the ability to respond quickly to community inquiries and concerns.

Current status, uncertainty and future needs in soil organic carbon monitoring

Increasing human demands on soil-derived ecosystem services requires reliable data on global soil resources for sustainable development. The soil organic carbon (SOC) pool is a key indicator of soil quality as it affects essential biological, chemical and physical soil functions such as nutrient cycling, pesticide and water retention, and soil structure maintenance. However, information on the SOC pool, and its temporal and spatial dynamics is unbalanced. Even in well-studied regions with a pronounced interest in environmental issues information on soil carbon (C) is inconsistent. Several activities for the compilation of global soil C data are under way. However, different approaches for soil sampling and chemical analyses make even regional comparisons highly uncertain. Often, the procedures used so far have not allowed the reliable estimation of the total SOC pool, partly because the available knowledge is focused on not clearly defined upper soil horizons and the contribution of subsoil to SOC stocks has been less considered. Even more difficult is quantifying SOC pool changes over time. SOC consists of variable amounts of labile and recalcitrant molecules of plant, and microbial and animal origin that are often operationally defined. A comprehensively active soil expert community needs to agree on protocols of soil surveying and lab procedures towards reliable SOC pool estimates. Already established long-term ecological research sites, where SOC changes are quantified and the underlying mechanisms are investigated, are potentially the backbones for regional, national, and international SOC monitoring programs. © 2013 Elsevier B.V.

Teachers' professional development in a community

The goal of this article was to study teachers' professional development related to web-based learning in the context of the teacher community. The object was to learn in what kind of networks teachers share the knowledge of web-based learning and what are the factors in the community that support or challenge teachers professional development of web-based learning. The findings of the study revealed that there are teachers who are especially active, called the central actors in this study, in the teacher community who collaborate and share knowledge of web-based learning. These central actors share both technical and pedagogical knowledge of web-based learning in networks that include both internal and external relations in the community and involve people, artefacts and a variety of media. Furthermore, the central actors appear to bridge different fields of teaching expertise in their community. According to the central actors' experiences the important factors that support teachers' professional development of web-based learning in the community are; the possibility to learn from colleagues and from everyday working practices, an emotionally safe atmosphere, the leader's personal support and community-level commitment. Also, the flexibility in work planning, challenging pupils, shared lessons with colleagues, training events in an authentic work environment and colleagues' professionalism are considered meaningful for professional development. As challenges, the knowledge sharing of web-based learning in the community needs mutual interests, transactive memory, time and facilities, peer support, a safe atmosphere and meaningful pedagogical practices. On the basis of the findings of the study it is suggested that by intensive collaboration related to web-based learning it may be possible to break the boundaries of individual teachership and create such sociocultural activities which support collaborative professional development in the teacher community. Teachers' in-service training programs should be more sensitive to the culture of teacher communities and teachers' reciprocal relations. Further, teacher trainers should design teachers' in-service training of web-based learning in co-evolution with supporting networks which include the media and artefacts as well as people.

Teachers' professional development in a community

The goal of this article was to study teachers' professional development related to web-based learning in the context of the teacher community. The object was to learn in what kind of networks teachers share the knowledge of web-based learning and what are the factors in the community that support or challenge teachers professional development of web-based learning. The findings of the study revealed that there are teachers who are especially active, called the central actors in this study, in the teacher community who collaborate and share knowledge of web-based learning. These central actors share both technical and pedagogical knowledge of web-based learning in networks that include both internal and external relations in the community and involve people, artefacts and a variety of media. Furthermore, the central actors appear to bridge different fields of teaching expertise in their community. According to the central actors' experiences the important factors that support teachers' professional development of web-based learning in the community are; the possibility to learn from colleagues and from everyday working practices, an emotionally safe atmosphere, the leader's personal support and community-level commitment. Also, the flexibility in work planning, challenging pupils, shared lessons with colleagues, training events in an authentic work environment and colleagues' professionalism are considered meaningful for professional development. As challenges, the knowledge sharing of web-based learning in the community needs mutual interests, transactive memory, time and facilities, peer support, a safe atmosphere and meaningful pedagogical practices. On the basis of the findings of the study it is suggested that by intensive collaboration related to web-based learning it may be possible to break the boundaries of individual teachership and create such sociocultural activities which support collaborative professional development in the teacher community. Teachers' in-service training programs should be more sensitive to the culture of teacher communities and teachers' reciprocal relations. Further, teacher trainers should design teachers' in-service training of web-based learning in co-evolution with supporting networks which include the media and artefacts as well as people.

Teachers' professional development in a community

The goal of this article was to study teachers' professional development related to web-based learning in the context of the teacher community. The object was to learn in what kind of networks teachers share the knowledge of web-based learning and what are the factors in the community that support or challenge teachers professional development of web-based learning. The findings of the study revealed that there are teachers who are especially active, called the central actors in this study, in the teacher community who collaborate and share knowledge of web-based learning. These central actors share both technical and pedagogical knowledge of web-based learning in networks that include both internal and external relations in the community and involve people, artefacts and a variety of media. Furthermore, the central actors appear to bridge different fields of teaching expertise in their community. According to the central actors' experiences the important factors that support teachers' professional development of web-based learning in the community are; the possibility to learn from colleagues and from everyday working practices, an emotionally safe atmosphere, the leader's personal support and community-level commitment. Also, the flexibility in work planning, challenging pupils, shared lessons with colleagues, training events in an authentic work environment and colleagues' professionalism are considered meaningful for professional development. As challenges, the knowledge sharing of web-based learning in the community needs mutual interests, transactive memory, time and facilities, peer support, a safe atmosphere and meaningful pedagogical practices. On the basis of the findings of the study it is suggested that by intensive collaboration related to web-based learning it may be possible to break the boundaries of individual teachership and create such sociocultural activities which support collaborative professional development in the teacher community. Teachers' in-service training programs should be more sensitive to the culture of teacher communities and teachers' reciprocal relations. Further, teacher trainers should design teachers' in-service training of web-based learning in co-evolution with supporting networks which include the media and artefacts as well as people.

Health Care Providers' Training Needs Related to Human Trafficking: Maximizing the Opportunity to Effectively Screen and Intervene

Human trafficking is a complex and multifaceted problem that takes the form of economic, physical and sexual exploitation of people, both adults and children, who are reduced to simple products for commerce. Human trafficking in the United States also has both a domestic and an international aspect. Health care providers are in a unique position to screen for victims of trafficking and may provide important medical and psychological care for victims while in captivity and thereafter. Trafficked persons are likely to suffer a wide spectrum of health risks that reflect the unique circumstances and experiences in a trafficked victim’s life. Although trafficked victims typically have experienced inadequate medical care, once contact is made by the victim with the health care professionals, the opportunity then exists to identify, treat, and assist such victims. The range of services and supports required to appropriately respond to human trafficking victims once identified is broad and typically goes beyond just what is immediately provided by the health care professional and includes safe housing, legal advice, income support, and, for international victims, immigration status related issues. An informed and responsive community is necessary to serve both the international and domestic victims of human trafficking, and needs assessments demonstrated a number of barriers that hindered the delivery of effective services to human trafficking victims. One of the consistent needs identified to combat these barriers was enhanced training among all professionals who might come in contact with human trafficking victims. We highlight the efforts of the Houston Rescue and Restore Coalition (HRRC), a local grassroots non-profit organization whose mission focuses on raising awareness of human trafficking in the Greater Houston Metropolitan area. HRRC responded to the consistent recommendation from various community needs assessments for additional training of front line professionals who would have the opportunity to identify human trafficking victims and supported the design and pilot testing of a health professions training program around human trafficking. Dissemination of this type of training along with careful evaluation and continued refinement will be one way for health care professionals to engage in a positive manner with human trafficking victims.

Implementation progress of mental health services in Rwanda: Bugesera district case

RESUMO: O Ministério da Saúde do Governo do Ruanda identifica a saúde mental como uma área de prioridade estratégica para a intervenção em resposta à alta carga dos transtornos mentais no Ruanda. Ao longo dos últimos 20 anos após o genocídio, o sector público reconstruiu sua Resposta Nacional de Saúde Mental com base no acesso equitativo aos cuidados, através do desenvolvimento de uma Política Nacional de Saúde Mental e novas estruturas de saúde mental. A política de Saúde Mental do Ruanda, revista em 2010, prima pela descentralização e integração dos serviços de saúde mental em todas as estruturas nacionais do sistema de saúde e ao nível da comunidade. O presente estudo de caso tem como objetivo avaliar a situação do sistema de saúde mental de um distrito típico de uma área rural no Ruanda, e sugerir melhorias, incluindo algumas estratégias para monitoras as mudanças. Os resultados do estudo permitirão ao Ruanda reforçar a sua capacidade para implementar o Plano Nacional de Saúde Mental ao nível dos distritos. O relatório também será útil para monitorar o progresso da implementação de serviços de saúde mental nos distritos, incluindo a prestação de serviços de base comunitária e a participação dos usuários, suas famílias e outros interessados na promoção, prevenção, assistência e reabilitação em saúde mental. Este estudo também procurou avaliar o progresso da implementação dos cuidados de saúde mental a nível descentralizado, com vista a compreender as implicações em termos de recursos desses processos. Foi realizada uma análise situacional num local do distrito, baseado em entrevistas com as principais partes interessadas responsáveis, usando o Instrumento de Avaliação de Sistemas de Saúde Mental da Organização Mundial da Saúde (WHO-AIMS). Os resultados sugerem que os recursos humanos para a saúde mental e serviços de base comunitária de saúde mental no distrito continuam a ser extremamente limitados. Os profissionais de saúde mental são adicionalmente limitados na sua capacidade para oferecer intervenções de emergência a pacientes psiquiátricos e garantir a continuidade do tratamento farmacológico a pacientes com condições crônicas. Para planejar efetivamente, de acordo com as necessidades da comunidade, sugerimos que o sistema de saúde mental deve envolver também os representantes das famílias e dos usuários no processo de planificação de modo a melhorar a sua contribuição no processo de implementação das atividades de saúde mental. Este estudo de caso do Distrito de Bugesera oferece a primeira análise de nível distrital dos serviços de saúde mental no Ruanda, e pode servir como uma mais-valia para a melhoria do sistema de saúde mental, incluindo a advocacia para a melhoria da qualidade dos cuidados de saúde mental a este nível, aumentando o financiamento para a implementação de serviços clínicos de saúde mental e os recursos humanos disponíveis para a prestação de cuidados de saúde mental, principalmente a nível dos cuidados primários.--------------------- ABSTRACT: To deal with the high burden of mental health disorders resulting from consequences of the 1994 genocide against Tutsis, the Rwanda Ministry of Health (MoH) considers mental health as a priority intervention. For the last 20 years, Ministry of Health focused on rebuilding a national and equity-oriented mental health program responding to the population needs in mental health. Mental health services are now decentralized and integrated in the national health system, from the community level up to the referral level. This study assessed the situation of mental health services in one rural district in Rwanda. It was aimed at assessing the progress of implementation of mental health care at the decentralized level, focusing on resource implications and processes. This study is based on interviews conducted with key stakeholders, using the World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS). Findings show that human resources for mental health care and community-based mental health services of the assessed district remain extremely limited. Mental health professionals face limitation regarding the ability to provide emergency management of psychiatric patients and to ensure continuity of psychopharmacological treatment of patients with chronic conditions. To improve the implementation process of mental health interventions and activities, a planning process based on community needs and the involvement of representatives of families and users in planning process should be considered. The Bugesera case study on the situation of mental health services can serve as a baseline for improvement of the mental health program in Rwanda, in terms of quality care services, infrastructure and equipment, human and financial resources.

Toward interoperable bioscience data.

To make full use of research data, the bioscience community needs to adopt technologies and reward mechanisms that support interoperability and promote the growth of an open 'data commoning' culture. Here we describe the prerequisites for data commoning and present an established and growing ecosystem of solutions using the shared 'Investigation-Study-Assay' framework to support that vision.

Material and Construction Optimization for Prevention of Premature Pavement Distress in PCC Pavements, September 2004

The chemistry of today’s concrete mixture designs is complicated by many variables, including multiple sources of aggregate and cements and a plethora of sometimes incompatible mineral and chemical admixtures. Concrete paving has undergone significant changes in recent years as new materials have been introduced into concrete mixtures. Supplementary cementitious materials such as fly ash and ground granulated blast furnace slag are now regularly used. In addition, many new admixtures that were not even available a few years ago now have widespread usage. Adding to the complexity are construction variables such as weather, mix delivery times, finishing practices, and pavement opening schedules. Mixture materials, mix design, and pavement construction are not isolated steps in the concrete paving process. Each affects and is affected by the other in ways that determine overall pavement quality and long-term performance. Equipment and procedures commonly used to test concrete materials and concrete pavements have not changed in decades, leaving serious gaps in our ability to understand and control the factors that determine concrete durability. The concrete paving community needs tests that will adequately characterize the materials, predict interactions, and monitor the properties of the concrete.

Housing’s Economic and Social Impacts, April 2007

Housing is an investment in Iowa’s communities and people. This report investigates the following questions: What impact does affordable housing have • on neighborhoods? • on local and state economies? • on expanding and stabilizing Iowa’s labor force? • on meeting social, individual and community needs?