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Introduction: In spite of nationwide approaches to reducing serious harm falls in the older frail population in New Zealand over a number of years, the hospital admission rates continued to increase for serious fall-related injuries in this group. In 2012 when a nationwide approach ended, a new multi-level integrated system approach to community falls prevention was introduced by the Canterbury Clinical Network. The programme was co-designed with consumers, clinicians and falls researchers to reduce serious harm falls in the community. This new approach to home-based interventions across the network was specifically designed to reduce the growing hospital "falls admission rates" for this vulnerable group. Method: An evidence-based strength and balance exercise programme, modified to align with new ways of working, was delivered in people's homes for those meeting specific validated criteria.The intervention, delivered within a restorative framework, included a home hazard check and review of general health/function while fostering integration with the patient's clinical and home care support team. A quality improvement methodology was adopted to capture a wide range of quantitative and qualitative process and outcome metrics for clients, clinicians, services and the health system. Linked NHI data was collected for falls-related emergency department visits, admission to hospital and number of hip fractures for this local population. This data, collected over three years since programme introduction, was then retrospectively compared to preprogramme falls rates. The data was used to establish the serious harm fall trend (pre/post programme). Key findings: Over three years more than 5000 people (15% of local age cohort) were referred to the service. Based upon growth pathway trends for serious harm falls there have been 1083 fewer falls presenting to ED, 373 fewer hip fractures and 86 fewer deaths at 180 days post discharge for hip fracture patients.. The system level outcome metrics suggest a financial return on investment of greater than $5 return for every $1 invested in the programme. Highlights: Falls prevention interventions targeting strength and balance exercise in people's homes, while building clinician cross sector relationships, improves the quality and length of life for older people. Previous research establishes the effectiveness of community falls prevention for frail older people but these approaches have not been well integrated into health care systems. This programme has established a clear value proposition at many levels. Conclusion: There are significant savings both socially and financially when people stay independent and active at home and therefore do not require hospital level care as a result of a fall. Effective approaches to falls prevention need to be integrated into a range of services for frail older people to maximise patient outcomes and reduce health system fragmentation and costs.Integrated care networks that invest in preventative healthcare for those most at risk in the community and capture relevant process and outcome metrics at many levels, are more likely to continue to support these programmes. There are significant opportunities for cross agency integration and the adoption of a nationwide approach when there are mutual benefits of keeping older frail people safe from falling at home. [ABSTRACT FROM AUTHOR]

Access to healthcare impacts in health, and for its importance it has been conceptualized by different theoretical models. Theories tackling social barriers have been established too. Nevertheless, a lack of theorization about healthcare access of immigrants exists, and there is no theory able to integrate all the scientific literature on this and its impact on the health of immigrants. In order to study the factors relating to the access of immigrants and to guide the development and evaluation of public health interventions, an integrative approach is needed. In this regard, from an ecological perspective healthcare access of immigrants would be shaped by interrelated factors in different layers in a hierarchical system. This study is not aimed to re-invent the wheel, this is a proposal to re-organize the factors playing a role in the access to healthcare for immigrants and modelling them to propose an integrative framework to guide future research and policies. A qualitative design based on four focus groups were being carried out in Valencia (Spain). In the focus groups, 28 agents involved in healthcare provision participated. Based on the ecological model five-levels have guided a heuristic analysis: 1) Patient-level, 2) The relationship between patient-health professionals level, 3) Institutions influencing the healthcare access level, 4) Connectedness between services, community organisations and social networks level, 5) Sociopolitical Level. The results are presented by level: 1) Patient-level: the factors determining a role in healthcare access are gender inequities, country of origin, language proficiency, health literacy and acculturation process. 2) The relationship between patient-health professionals level: The cultural competence, racist attitudes and willingness to provide care of health professionals are determinants of healthcare access. 3) Institutions influencing the healthcare access level: The availability of resources as public culturally adapted information and interpreters and cultural mediators facilitate access to care. 4) Connectedness between services, community organisations and social networks level: how the service is integrated into the community, developing and providing services plays a key role to guarantee the accessibility. 5) Socio-political Level: Racism are cultural elements that promote the inclusion or exclusion of immigrants, influencing the rest of levels presented. The legislation establishes definitions of who is beneficiary of the healthcare, giving rights or not. Also, policies define the kind of service that is provided to whom and the co-payment. This study brings to light the harmony among the different scientific literature that would have been focused on comparing factors from one single level without taking into consideration the differences among all the rest of levels. The ecological framework also suggests that to guarantee access to health services, it is necessary to act through multiple levels of the model at the same time. Further research is needed to explore the relationship between different factors to design more integrative policies and interventions to guarantee equality in healthcare access. Also, the relationship among both origin and host health systems should be explored in order to recognise the factors influencing fully healthcare access of immigrants such as sharing personal medical records. [ABSTRACT FROM AUTHOR]

1. The life expectancy gap for people living with severe mental illness is 15-25 years less than the general population, due to physical health co-morbidities and preventable illness. 2. Living Well Living Longer is a district wide strategy delivering physical health care to this population in Sydney Local Health District (SLHD) through a new and integrated approach to physical health screening and treatment 3. The program has integrated pathways to care, new workforce models, workforce development strategies, and the use of technology to engage consumers in their health care. The program has been built on strong partnerships between clinical streams, and external partners 4. People living with severe and enduring mental illness, who are care co-ordinated bySLHD mental health service. Key stakeholders include SLHD clinical streams, Central & Eastern Sydney Primary Health Network, non government organisations, carer and consumers representatives and research partners. 5. The program was funded for 3 years through a NSW Health Innovator grant, and became permanently funded in June 2017 6. Living Well Living Longer model of care improved health outcomes through demonstrated practice change in monitoring, screening, referral and treatment of physical health in the target population improved collaboration in the establishment and facilitation of shared care between mental health services and primary health providers the integration of the health peer support workers as care navigators into mental health clinical teams technology to assist consumers set and achieve health goals workforce development embedding the principles of early intervention and prevention into clinical care provision 7. The program is dynamic and evolving, and demonstrates ongoing improvement in service integration 8. The model is transferrable across health settings, and is designed to improve physical health care co-ordination between mental health services and primary health service providers 9. The program has met its aims of establishing integrated care systems of service delivery designed to improve physical health outcomes. Practice change has been sustained over time, and new models of care developed and implemented. The program has improved the capacity of services to respond in partnership to identified population needs and work together to close health inequity gaps 10. The program has successfully implemented systems which address contributors to physical morbidity. The program places the consumer at the centre of care, and has integrated new models of care, innovative digital technology, guidelines and health pathways to support clinical outcomes, and established a new workforce of health peer support workers, exercise physiologists and dieticians to support a holistic approach to mental health service delivery 11. Investment in getting integrated care right takes time, and requires ongoing collaboration and consultation from a wide range of stakeholders. Partnerships are a priority and require sensitive management, which is helped by dedicated liaison positions to assess and manage multiple competing agendas and priorities, and maintain communication. Having a system of communication and feedback from consumers, service streams and sectors allowed us to incorporate what we learnt into planning and program development and implementation. Practice change takes time and ongoing clinical workforce support. [ABSTRACT FROM AUTHOR]

Introduction: In China, dementia is one of the most devastating illnesses for patients and their caregivers living at home. As the disease progresses, many patients' cognitive, behavioral and psychological symptoms get severe and so do the burdens of caregivers. Lack of community health resources and social service provision in China, the complex care needs of dementia patients and their caregivers are often ignored. There is thus a need for innovative approaches to solve the problem and to improve quality of life for both dementia patients and their caregivers. Aim & Method: This study aimed to present an innovation approach that integrate music therapy with social work practice in a home-based program of dementia care in China. Previous researches on music therapy and social work practice for home-based dementia care were reviewed. A participatory action research approach was applied and actions included meetings and discussing with stakeholders, participating in the caseworks and making suggestions for the program implementation. Four cases were explored in depth by social workers, doctors, nurses and researchers together(n=7). Results: An approach of integrating music therapy and social work practice has been developed. Detailed framework and implementation process, including methods of integrated assessment, intervention and evaluation are discussed. Conclusion: The paper concludes with a discussion that how to further integrate music therapy with social work practice based on the principles of person-centredness in working with dementia patients and their caregivers at home in China. Potential theoretical issues behind the relationship between music therapy and social work practice and the implication for integration of social and health care in home-based dementia care is highlighted. [ABSTRACT FROM AUTHOR]