The Challenge of Providing Culturally and Linguistically Accessible Human Services in Rural and Increasingly Diverse Communities

Abstract

This paper uses a case study of one small rural community in New England to educate social workers, other human service professionals on linguistic, cultural accessibility issues with clients who have Limited English Proficiency (LEP). The relevant civil rights law, case law, federal guidelines, which form a framework of protection for persons with LEP are presented, used as a mirror to which human service efforts to meet linguistic, cultural accessibility are held. Finally, strategies for small rural communities with multiple small populations of persons with LEP are presented.     

Culturally and Linguistically Competent Public Services in an Era of English-Only Laws

The concern this study addressed centered around the challenges of delivering culturally and linguistically competent public services to limited English proficiency (LEP) persons in an era marked by growth of English-only measures in the U.S. The article argued that restrictions on public service delivery to LEP communities are laden with negative effects that include impairment of the nation's obligations in international law. It applauded the attempt, evident by Executive Order No. 13166, to address the restrictions, but assessed that order as inadequate. Suggestions for improved access to public service delivery for LEP populations contained in this article include (1) enlarging the scope of Executive Order 13166 beyond access to language services, and (2) upgrading it into an act of Congress.     

Integrating Behavioral Health Care and Primary Care: Application of a Clinical and Economic Model in Culturally Diverse Communities

Although mental illness treatment protocols exist, the organization and financing of screening and treatment services inhibit access. These challenges are compounded for refugees, immigrants, and other groups vulnerable due to their ethnicity, race, or culture. By creating a system-wide, collaborative, integrated model that recognizes and addresses critical clinical and economic aspects in the delivery of services, high quality, evidence-based care can be made available to groups susceptible to the burdens of mental illness. Clinically and financially aligning primary and specialty care offers a viable alternative for improving access and quality of mental health services to vulnerable populations.     

Chapter 11. The Future of Culturally Competent Mental Health Care for Latino Immigrants

Abstract

This chapter underscores the importance of cultural competence in the provision of effective mental health services to Latino immigrants. Culturally competent mental health care must be understood within the context of a social-political-economic framework that is changing on a continual basis. Health and mental health care reform for Latino immigrants must be linked to both practice-based research efforts and timely diffusion of best practice innovations. Cultural competence must be integrated as a valued component of the organizational structure of mental health systems of care.     

Health Care Versus Border Care: Justification and Hypocrisy in the Multilevel Negotiation of Irregular Migrants’ Access to Fundamental Rights and Services

Abstract

Providing—and also not providing—public services to unlawful residents implies a certain cost for host societies, and both inclusion and exclusion involve localized renegotiations of fundamental rights, legitimate needs, and social membership. Based on original qualitative research data, this article compares how, why, and under which conditions irregular migrants are granted or denied access to healthcare services provided in London and Barcelona. From a multi-level perspective and by drawing on organization theory, I highlight key differences in how the responsible governments deal with the underlying contradictions and thereby either help or hinder effective policy implementation.     

Multichannel Delivery of Public Services: A New and Complex Management Challenge

A strategic challenge facing all governments today is how to deliver services effectively and efficiently. At one time, they thought that they could meet this challenge by exploiting technology and going the E-government route with the promise of single-window, integrated, intelligent service delivery. Very quickly, however, they had to accept the fact that they would have to overcome a multitude of obstacles and that individual and corporate clients often preferred to receive service in traditional ways.

As a result, the delivery of public services is becoming increasingly multichannel: over the counter, by mail and telephone, over the Internet, via text and television, etc. There is therefore a need to identify some kind of model for managing this highly complex new phenomenon effectively and efficiently. By conducting research in the field with the help of case studies and international benchmarking, it was possible to identify the main variables in the degree of effectiveness and efficiency of multichannel public service delivery and develop the outline of a model representing the underlying factors.     

Trade Liberalization in Indonesian Health Services: Prospects and Policies

The worldwide increase in demand for health services offers developing countries, like Indonesia, significant opportunities to expand international trade in this area. However, policy aimed at achieving this objective must carefully consider the World Trade Organization's (WTO) General Agreement on Trade in Services (GATS). For signatory nations and those considering becoming signatory nations, the procedural, structural, and other effects of the GATS make it a formidable challenge for national health policy alongside its impact on trade liberalization. Invoking the four GATS health care trade modes, this article develops possible approaches to Indonesian health services in the context of trade liberalization.     

Collaborating for Mental Health Services in Wales: A Process Evaluation

The need for inter-agency collaboration between managers of mental health services has long been recognized, as has the difficulty of achieving and maintaining such relationships. Hudson et al . (1999) have developed a model for collaboration in the public sector and the current research has tested the model against attempts to achieve and maintain inter-agency collaboration between mental health managers in Wales. We find Hudson's model a useful analytical framework but our evidence suggests that it needs to be amended by giving greater emphasis to the importance of 'uninterrupted . . . opportunities for interaction' between key managers. Forthcoming changes to NHS structures in Wales (for example, the abolition of Health Authorities and the conversion of Local Health Groups into Local Health Boards) will not necessarily facilitate collaboration if the Local Health Boards are given the role of planning and commissioning mental health services without having the necessary 'critical mass' of knowledge, expertise and dedicated staff capacity for planning and commissioning mental health services.     

Local Council Development Areas and Local Service Delivery: How a Fourth-tier Government Unit is Improving Access to Primary Health Care and Education Services in Lagos,Nigeria

ABSTRACT

Emerging accidentally from an array of political and legal contestations is a fourth-tier government unit in Lagos state – Local Council Development Areas (LCDAs). The LCDAs have survived almost two decades of existence without the ’traditional’ monthly federal allocation, which has been the mainstay of the existing 774 LGAs in Nigeria. This study attempts an explanation of this apparent survival by examining the institutional structure of the LCDAs vis-à-vis their service delivery performance. Different from earlier studies that have examined service delivery using final outcomes, the study examines accessibility as an intermediate output; dimensioned as availability, adequacy and affordability. Using a mixed-methods research design, the study shows that Lagos LCDAs’ inclusive operational structure is significantly improving access to primary health care and education services. Thus, the study finds evidence within the operational structure of Lagos LCDAs for Acemoglu and Robinson’s theory of inclusive and extractive institutions.     

Public Sector Commissioning: Experiences of Voluntary Organizations Delivering Health and Social Services

The perceived benefits to users and beneficiaries of voluntary organizations delivering public sector services have been well documented and include the engagement with parts of society that the state cannot reach, personalized service delivery, and improved services. There is a lack of clarity, however, as to whether these perceived benefits are being realized. This article presents the experiences of voluntary sector organizations involved in public sector commissioning. The research suggests that the public sector is limiting the voluntary sector's engagement in service design and performance monitoring. These findings raise questions about the role of the voluntary sector in public service provision.     

Planning,Budgeting, and Health Care Performance in Ukraine

Abstract

The Government of Ukraine has not pursued health care reforms now commonplace in the rest of Europe and Central/Eastern Europe that rely less upon centralized, state delivery of services and more on decentralized operational responsibilities and competition for services that increase patient choice. The Ukrainian health sector suffers from personnel overspecialization and facility overcapacity, resulting in high-cost, low productivity services. Budget funds are unavailable for operations and maintenance resulting in poor quality services. The state provides health care as a constitutionally-protected monopoly, relying on the traditional command and control model which ignores cost/quality competition options and responsibilities to patients. Overall, the system which produces these results is over-centralized, requiring achievement of physical service norms without providing sufficient funds. The centralized system does not monitor or evaluate services beyond narrow financial accountability and control requirements. The health care system is paradoxically over-centralized but unable to regulate or control local health care official decisions to ensure compliance with national standards. Needed are reforms in the health care policy and operational areas to produce the supply of services needed for national economic recovery. In the short-term, the budgetary framework can be improved as an operational/management guide through development of comparative information on results. Most of this information can be based on the economic classification consistent with the chart of accounts. Funding stability can be increased to improve expenditure control by implementing a new fiscal transfer formula that provides discretion (i.e., block grants) and performance criteria (i.e., outcome measures). In the medium-term, building on the technical foundation of physical norms and statistical reporting, the health care budgeting and financial management system should shift emphasis to: program planning, policy and management analysis, and public communications. The results of these reforms should lead to decentralized health care operations, service analysis, and delivery responsibilities. At the same time, the reforms should lead to proper centralization of responsibilities for strategic policy decisions, safety regulation, national standards, and program evaluation.     

The New Public Management Theory and the Reform of European Health Care Systems: An International Comparative Perspective

The New Public Management (NPM) Theory is a rhetorical construction with diverse intellectual roots. That diversity means that it is open to reinterpretation and shifts in implementation across countries (Sahlin-Andersson, 2001 Sahlin-Andersson, K. 2001. “National, international and transnational constructions of New Public Management”. In New Public Management—The transformation of ideas and practice, Edited by: Christensen, T. and ægreid, P. L. 43–72. Aldershot, , UK: Ashgate.  [Google Scholar]; Smullen, 2007 Smullen, A. 2007. Translating agency reform: Rhetoric and culture in comparative perspective, Rotterdam, , The Netherlands: PhD Dissertation, Erasmus University.  [Google Scholar]). This overview article critically investigates NPM application in various EU health care systems. NPM led to a greater focus on market forces and competition and improved information sharing and cooperation among health care networks, and changed the way care is delivered. This article also identifies significant misfits between policy announcements and NPM implementation. NPM has taken root much more substantially in the United Kingdom (UK) than in France and Germany. The variety of capitalism and institutional systems provides an explanation for divergences in NPM implementation.     

Evaluating Health Care Reform: the Case of the NHS Internal Market

The NHS internal market, introduced in an atmosphere of controversy, continues to generate much disagreement. This article examines the evidence on the impact of this policy with regard to a range of criteria, including efficiency, accountability, effective planning and co-ordination, patient choice and service quality, equity, and the culture of the NHS. It explores the different ways in which this evidence is perceived and seeks to make explicit the assumptions and biases of those involved in the debate about the reforms. The article also examines the policy process behind the reforms and the extent to which it has added to the problems of evaluation. By way of conclusion, the implications for future health care reform are considered and a number of procedural changes suggested.