This off-reservation boarding school serves over 600 students in grades 4-12; approximately 85% of the students reside in campus dormitories. After having documented significant improvement on a number of outcomes during a previous High Risk Youth Prevention demonstration grant, the site submitted a Therapeutic Residential Model proposal, requesting funding to continue successful elements developed under the demonstration grant and to expand mental health services. The site received Therapeutic Residential Model funding for school year 2001-2002. Once funds were received, the site chose to shift Therapeutic Residential Model funds to an intensive academic enhancement effort. While not in compliance with the Therapeutic Residential Model initiative and therefore not funded in subsequent years, this site created the opportunity to enhance the research design by providing a naturally occurring placebo condition at a site with extensive cross-sectional data baselines that addressed issues related to current federal educational policies.
This article presents a programme for cardiovascular health for 9 to 12 years old children, called "Healthy Heart" Saint-Louis du Parc and carried out in low socioeconomic and multiethnic part of Montreal, Quebec, Canada. These five years programme targets were more both spheres: school and community (leisure centre, ethnocultural centre, groceries and other places). We develop the objectives, the conceptual models underlying to the programme, the perspective of work, the infrastructure of the programme: its staff and financing, the partnerships and the structure organising. Then we present the various interventions carried out along the period and so a description of many evaluations. At last, we discuss about the programme continuation.
Every year thousands of Canadians must travel far from home to receive specialized medical treatment or diagnosis. For many individuals, funds for air travel are limited. The Mission Air Network removes some of this stress by arranging free flights for patients and family members or escorts, using seats donated by commercial, corporate and government sponsors.
The proportion of older persons is increasing in developed and developing countries: this aging trend can be viewed as a two-edged sword. On the one hand, it represents remarkable successes regarding advances in health care; and on the other hand, it represents a considerable challenge for health systems to meet growing demand. A growing disequilibrium between supply and demand may be particularly challenging within publicly funding health systems that 'guarantee' services to eligible populations. Rehabilitation, including physical therapy, is a service that if provided in a timely manner, can maximize function and mobility for older persons, which may in turn optimize efficiency and effectiveness of overall health care systems. However, physical therapy services are not considered an insured service under the legislative framework of the Canadian health system, and as such, a complex public/private mix of funding and delivery has emerged. In this article, we explore the consequences of a public/private mix of physical therapy on timely access to services, and use the World Health Organization (WHO) health system performance framework to assess the extent to which the emerging system influences the goal of aggregated and equitable health. Overall, we argue that a shift to a public/private mix may not have positive influences at the population level, and that innovative approaches to deliver services would be desirable to strengthening rather than weaken the publicly funded system. We signal that strategies aimed at scaling up rehabilitation interventions are required in order to improve health outcomes in an evolving global aging society.
Little attention has been paid to the need for accountability instruments applicable across all health units in the public health system. One tool, the balanced scorecard was created for industry and has been successfully adapted for use in Ontario hospitals. It consists of 4 quadrants: financial performance, outcomes, customer satisfaction and organizational development. The aim of the present study was to determine if a modified nominal group technique could be used to reach consensus among public health unit staff and public health specialists in Ontario about the components of a balanced scorecard for public health units.
A modified nominal group technique consensus method was used with the public health unit staff in 6 Eastern Ontario health units (n=65) and public health specialists (n=18).
73.8% of the public health unit personnel from all six health units in the eastern Ontario region participated in the survey of potential indicators. A total of 74 indicators were identified in each of the 4 quadrants: program performance (n=44); financial performance (n=11); public perceptions (n=11); and organizational performance (n=8).
The modified nominal group technique was a successful method of incorporating the views of public health personnel and specialists in the development of a balanced scorecard for public health.
During the past century, long-term care in the United States has evolved through five cycles of development, each lasting approximately twenty years. Each, focusing on distinct concerns, produced unintended consequences. Each also added a layer to an accumulation of contradictory approaches--a patchwork system now pushed to the breaking point by increasing needs and financial pressures. Future policies must achieve a better synthesis of approaches inherited from the past, while addressing their unintended consequences. Foremost must be assuring access to essential care, delivery of high-quality services in an increasingly deinstitutionalized system, and a reduction in social and economic disparities.
St. Joseph's Healthcare Hamilton (SJHH) supports a grassroots green team, called Environmental Vision and Action (EVA). Since the creation of EVA, a healthy balance between corporate projects led by corporate leaders and grassroots initiatives led by informal leaders has resulted in many successful environmental initiatives. Over a relatively short period of time, environmental successes at SJHH have included waste diversion programs, energy efficiency and reduction initiatives, alternative commuting programs, green purchasing practices, clinical and pharmacy greening and increased staff engagement and awareness. Knowledge of social movements theory helped EVA leaders to understand the internal processes of a grassroots movement and helped to guide it. Social movements theory may also have broader applicability in health care by understanding the passionate engagement that people bring to a common cause and how to evolve sources of opposition into engines for positive change. After early successes, as the limitations of a grassroots movement began to surface, the EVA team revived the concept of evolving the grassroots green program into a corporate program for environmental stewardship. It is hard to quantify the importance of allowing our staff, physicians, volunteers and patients to engage in changes that they feel passionately about. However, at SJHH, the transformation of a group of people unsatisfied with the organization's environmental performance into an 'engine for change' has led to a rapid improvement in environmental stewardship at SJHH that is now regarded as a success.
A profile of the activities and responsibilities of vice chairs for education is notably absent from the medical education literature. The authors sought to determine the demographics, roles and responsibilities, and major priorities and challenges faced by vice chairs for education.
In 2010, the authors sent a confidential, Web-based survey to all 82 identified department of medicine vice chairs for education in the United States and Canada. The authors inquired about demographics, roles, expectations of and for their position, opinions on the responsibilities outlined for their position, metrics used to evaluate their success, top priorities, and job descriptions. Analysis included creating descriptive statistics and categorizing the qualitative comments.
Fifty-nine vice chairs for education (72%) responded. At the time of appointment, only 6 (10%) were given a job description, and only 17 (28%) had a defined job description and metrics used to evaluate their success. Only 20 (33%) had any formal budget management training, and 23 (38%) controlled an education budget. Five themes emerged regarding the responsibilities and goals of the vice chair for education: oversee educational programs; possess educational expertise; promote educational scholarship; serve in leadership activities; and, disturbingly, respondents found expectations to be vague and ill defined.
Vice chairs for education are departmental leaders. The authors' findings and recommendations can serve as a beginning for defining educational directions and resources, building consensus, and designing an appropriate educational infrastructure for departments of medicine.
Although most long-term care facilities cannot always evaluate and treat their residents during acute, intercurrent illnesses, it is possible to design systems that allow for effective care without transfer.
