This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. AbstractPartnering across health clinics and community organisations, while worthwhile for improving health and well-being, is challenging and time consuming. Even partnerships that have essential elements for success in place face inevitable challenges. To better understand how cross-organisational partnerships work in practice, this paper examines collaborations between six primary care clinics and community-based organisations in the United States that were part of an initiative to address late-life depression using an enhanced collaborative care model (Archstone Foundation Care Partners Project). As part of an evaluation of the Care Partners Project, 54 key informant interviews and 10 focus groups were conducted from 2015 to 2017.Additionally, more than 80 project-related documents were reviewed. Qualitative thematic analysis was used to code the transcripts and identify prominent themes in the data. Examining clinic and community organisation partnerships in practice highlighted their inherent complexity. The partnerships were fluid and constantly evolving, shaped by a multiplicity of perspectives and values, and vulnerable to unpredictability. Care Partners sites negotiated the complexity of their partnerships drawing upon three main strategies: adaptation (allowing for flexibility and rapid change); integration (providing opportunities for multi-level partnerships within and across organisations) and cultivation (fostering a commitment to the partnership and its value). These strategies provided opportunities for Care Partners collaborators to work with the inherent complexity of partnering. Intentionally acknowledging and embracing such complexity rather than trying to reduce or avoid it, may allow clinic and community collaborators to strengthen and sustain their partnerships. K E Y W O R D S collaborative care, depression, evaluating complex interventions, multi-sector collaborations, older adults, qualitative research
Background National guidelines have called for greater integration of primary care and behavioral health services, with more recent attention to social care and community-based services. Under growing resource constraints healthcare organizations have tended to rely on referrals to external entities to address social care needs. Traditional referral models, however, may not be equipped to provide for the complex needs of older adults with depression. The Care Partners Project was designed to strengthen late-life depression care through integrated partnerships between primary care clinics and community-based organizations. We sought to understand how these integrated partnerships, with shared tasks and accountability across organizations, changed the nature of depression care for older adults. Methods We conducted 65 in-depth, semi-structured interviews and six focus groups with service providers involved in the project, including care managers, primary care providers, and psychiatric consultants, and applied inductive and deductive qualitative thematic analysis to develop themes around participants’ experiences with the partnered initiative. Results We found the partnerships established by the Care Partners Project reshaped late-life depression care in two ways: (1) bidirectional communication across organizations facilitated greater recognition among providers of intersecting medical and social needs associated with late-life depression; and (2) depression care became more coordinated and effective as care teams established or strengthened relationships across organizations. Conclusions These findings highlight the ways cross-organizational health and social care partnerships that move beyond traditional referrals can strengthen late-life depression care and enhance organizational capacities.
Background Modifiable risks for dementia are more prevalent in rural populations, yet there is a dearth of research examining life course rural residence on late‐life cognitive decline. Methods The association of rural residence and socioeconomic status (SES) in childhood and adulthood with late‐life cognitive domains (verbal episodic memory, executive function, and semantic memory) and cognitive decline in the Kaiser Healthy Aging and Diverse Life Experiences cohort was estimated using marginal structural models with stabilized inverse probability weights. Results After adjusting for time‐varying SES, the estimated marginal effect of rural residence in childhood was harmful for both executive function ( β = −0.19, 95% confidence interval [CI] = −0.32, −0.06) and verbal episodic memory ( β = −0.22, 95% CI = −0.35, −0.08). Effects of adult rural residence were imprecisely estimated with beneficial point estimates for both executive function ( β = 0.19; 95% CI = −0.07, 0.44) and verbal episodic memory ( β = 0.24, 95% CI = −0.07, 0.55). Conclusions Childhood rurality is associated with poorer late‐life cognition independent of SES.
Backed by decades of empirical research, there has been increasing acknowledgment in policy, practice and research of the importance of neighborhood opportunity in shaping well-being. This has led to the proliferation of opportunity maps in cities throughout the United States with the purpose of identifying low opportunity neighborhoods in need of investment and intervention and high opportunity neighborhoods that can offer access to resources and amenities to disadvantaged population groups. By explicitly linking investment to the identification of neighborhoods that are high or low in opportunity, opportunity indices have the potential to help transform local and regional landscapes of spatial inequality. Despite this common goal, indices rely on varying theoretical conceptualizations, data, variables, and statistical approaches. How much these opportunity definitions overlap has yet to be fully examined. In this study, we compared five approaches to measuring neighborhood opportunity in California. We found low to moderate overlap across the indices, with disagreement higher for low opportunity designations. As with any quantitative analysis, opportunity mapping is not a purely technical exercise and requires a series of subjective decisions. The only way to validate these decisions is for opportunity measures to be constructed transparently and vetted by the research community. This study is a first step in this process.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.