The concept—and reality—of continuity of care crosses disciplinary and organisational boundaries. The common definitions provided here should help healthcare providers evaluate continuity more rigorously and improve communication 

Patients are increasingly seen by an array of providers in a wide variety of organisations and places, raising concerns about fragmentation of care. Policy reports and charters worldwide urge a concerted effort to enhance continuity,1–3 but efforts to describe the problem or formulate solutions are complicated by the lack of consensus on the definition of continuity. To add to the confusion, other terms such as continuum of care, coordination of care, discharge planning, case management, integration of services, and seamless care are often used synonymously. This synthesis was commissioned by three Canadian health services policy and research bodies. The aim was to develop a common understanding of the concept of continuity as a basis for valid and reliable measurement of practice in different settings.

We searched academic and policy literature for documents in which the principal focus was continuity of patient care or continuity. We searched electronic databases (Medline, HealthSTAR, Embase, CINAHL, Current Contents, PsychINFO, AIDSLINE, CancerLit, Cochrane Library, Dissertation abstracts, Papers1st (conferences and paper abstracts), Web of Science, WorldCat) as well as web library catalogues, peer reviewed internet sites, internet search engines, and several in-house databases. The search included documents dated from 1966 to November 2001 written in English, French, or Spanish. The reviewers (RJR, JLH, RMcK) used a data abstraction form to summarise relevant documents from every health discipline, and all reviewers read key documents.

We presented the results of an initial review of 314 documents to participants of a workshop on continuity held in Vancouver in June 2001. We obtained structured feedback to a discussion paper, problem based scenarios, and expert presentations. Participants validated the common themes …

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Continuity of care: a multidisciplinary review

Program integrity in primary and early secondary prevention: are implementation effects out of control?

Postmemory describes the relationship of the second generation to power- ful, often traumatic, experiences that preceded their births but that were never- theless transmitted to them so deeply as to seem to constitute memories in their own right. Focusing on the remembrance of the Holocaust, this essay elucidates the generation of postmemory and its reliance on photography as a primary medium of transgenerational transmission of trauma. Identifying tropes that most potently mobilize the work of postmemory, it examines the role of the family as a space of transmission and the function of gender as an idiom of remembrance. The guardianship of the Holocaust is being passed on to us. The second genera- tion is the hinge generation in which received, transferred knowledge of events is being transmuted into history, or into myth. It is also the generation in which we can think about certain questions arising from the Shoah with a sense of living

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The Generation of Postmemory

More than two decades after E. E. Werner and R. S. Smith (1982), N. Garmezy (1983), and M. Rutter (1987) published their research on protective mechanisms and processes that are most likely to foster resilience, ambiguity continues regarding how to define and operationalize positive development under adversity. This article argues that, because resilience occurs even when risk factors are plentiful, greater emphasis needs to be placed on the role social and physical ecologies play in positive developmental outcomes when individuals encounter significant amounts of stress. Four principles are presented as the basis for an ecological interpretation of the resilience construct: decentrality, complexity, atypicality, and cultural relativity. These 4 principles, and the research upon which they are based, inform a definition of resilience that emphasizes the environmental antecedents of positive growth. This framework can guide future theory development, research, and the design of interventions that promote well-being among populations who experience environments that inhibit resilience-promoting processes.

The social ecology of resilience: addressing contextual and cultural ambiguity of a nascent construct.

We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

/pdf/models-of-community-care-for-severe-mental-illness-a-review-1v610n37t5.pdf

Models of community care for severe mental illness : A review of research on case management

Continuous casting process for the production of hollow ingot using an improved direct chill casting equipment having a molding system comprising a hollow mold and a movable platform, wherein at least one core and a pipe for introducing outer air are provided, said core being made from a refractory material unwettable with a molten metal and having a convergent taper at the side and an air runner for introducing outer air, which is packed with an air-permeable material, at the bottom, and said pipe for introducing outer air extending upwards from the air runner and passing through the core. The continuous casting process comprises continuously pouring a molten metal into a space surrounded with the hollow mold and the core of the above equipment; cooling the molten metal only at the side wall of the hollow mold without cooling at the side of the core; thereby solidifying the molten metal to form an ingot having a hollow, wherein the interface of the frozen metal and the liquid metal is present at the position around the core; and continuously lowering the ingot thus formed while introducing spontaneously outer air into the hollow part via the pipe for introducing outer air and the air runner of the core.

Regarding the Pain of Others

1. Envisioning a Trauma--Informed Service System: A Vital Paradigm Shift Maxine Harris, Roger D. Fallot 2. A Trauma--Informed Approach to Screening and Assessment Roger D. Fallot, Maxine Harris 3. Trauma--Informed Inpatient Services Maxine Harris, Roger D. Fallot 4. Trauma--Informed Approaches to Housing Richard B. Bebout 5. Designing Trauma--Informed Addictions Services Maxine Harris, Roger D. Fallot 6. Trauma--Informed Services and Case Management David W. Freeman 7. Defining the Role of Consumer--Survivors in Trauma--Informed Systems Laura Prescott 8. Care of the Clinician Ellen Arledge, Rebecca Wolfson

Using trauma theory to design service systems.

With the recognition that large numbers of men and women receiving services in the mental health and addictions systems are the survivors of sexual and physical abuse, practitioners need to become informed about the dynamics and the aftermath of trauma.

Maxine Harris

Papers

Regarding the Pain of Others

Using trauma theory to design service systems.

Envisioning a trauma-informed service system: A vital paradigm shift.

Between Voice and Silence: Women and Girls, Race and Relationship

The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization