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Droughts are often long-lasting phenomena, without a distinct start or end and with impacts cascading across sectors and systems, creating long-term legacies. Nevertheless, our current perceptions and management of droughts and their impacts are often event-based, which can limit the effective assessment of drought risks and reduction of drought impacts. Here, we advocate for changing this perspective and viewing drought as a hydrological–ecological–social continuum. We take a systems theory perspective and focus on how "memory" causes feedback and interactions between parts of the interconnected systems at different timescales. We first discuss the characteristics of the drought continuum with a focus on the hydrological, ecological, and social systems separately, and then we study the system of systems. Our analysis is based on a review of the literature and a study of five cases: Chile, the Colorado River basin in the USA, northeast Brazil, Kenya, and the Rhine River basin in northwest Europe. We find that the memories of past dry and wet periods, carried by both bio-physical (e.g. groundwater, vegetation) and social systems (e.g. people, governance), influence how future drought risk manifests. We identify four archetypes of drought dynamics: impact and recovery, slow resilience building, gradual collapse, and high resilience–big shock. The interactions between the hydrological, ecological, and social systems result in systems shifting between these types, which plays out differently in the five case studies. We call for more research on drought preconditions and recovery in different systems, on dynamics cascading between systems and triggering system changes, and on dynamic vulnerability and maladaptation. Additionally, we advocate for more continuous monitoring of drought hazards and impacts, modelling tools that better incorporate memories and adaptation responses, and management strategies that increase societal and institutional memory. This will help us to better deal with the complex hydrological–ecological–social drought continuum and identify effective pathways to adaptation and mitigation. [ABSTRACT FROM AUTHOR]

Droughts are often long lasting phenomena, without a distinct start or end, and with impacts cascading across sectors and systems, creating long-term legacies. Nevertheless, our current perception and management of droughts and their impacts is often event-based, which can limit the effective assessment of drought risks and reduction of drought impacts. Here, we advocate for changing this perspective and viewing drought as a hydro-eco-social continuum. We take a systems theory perspective and focus on how "memory" causes feedback and interactions between parts of the interconnected systems at different time scales. We first discuss the characteristics of the drought continuum with a focus on the hydrological, ecological, and social systems separately; and then study the system of systems. Our analysis is based on a review of the literature and a study of five cases: Chile, the Colorado River Basin in the US, Northeast Brazil, Kenya, and the Rhine River Basin in Northwest Europe. We find that the memories of past dry and wet periods, carried by both bio-physical (e.g. groundwater, vegetation) and social systems (e.g. people, governance), influence how future drought risk manifests. We identify four archetypes of drought dynamics: Impact & recovery; Slow resilience-building; Gradual collapse; and High resilience, big shock. The interactions between the hydrological, ecological and social systems result in systems shifting between these types, which plays out differently in the five case studies. We call for more research on drought pre-conditions and recovery in different systems, on dynamics cascading between systems and triggering system changes, and on dynamic vulnerability and maladaptation. Additionally, we argue for more continuous monitoring of drought hazards and impacts, modelling tools that better incorporate memories and adaptation responses, and management strategies that increase social and institutional memory to better deal with the complex hydro-eco-social drought continuum and identify effective pathways to adaptation. [ABSTRACT FROM AUTHOR]

The paper presents a piloting project aimed to set up a new service delivery model for people with physical disabilities, either acquired or inherited, named "Bridge". The service can be defined as a personalised care plan PCP placed at intermediate care level, time-limited and home based, and based on a multi-disciplinary approach and care team. Bridge's objectives are to support these frail persons by assessing their multiple needs and provide a PCP, which is conceived as complementary to the health and social care services they should already receive, and enhance their reablement and social inclusion. The project has been developed by Spazio Vita, a social enterprise aka a Community Interest Company that derives from a hospital's patient association for people with Spinal Cord Injury. The paper provides an in-depth analysis on tools developed and results achieved for organising the service delivery model, based on the data collection from the 50 patients enrolled in the first pilot one year. The multi-disciplinary team is made up of clinicians, phycologists, social workers, occupational therapists OT, peer-counsellor and other therapists with different specialisations delivering creative laboratories art or music therapies, informatics and computing, pet therapies, mindfulness etc. Eligible patients could be identified either from the Spinal Unit of the adjunct hospital either from other care units of the Metropolitan area of Milan or from community services or directly from the patients' communities surrounding Spazio Vita. Eligible patients are screened by an integrated need assessment through a newly scale that joins up clinical, psychological, social, functional and individual factors to assess the beginning condition against a score from 0 to 30. The latter evaluation allows to value the patients' enrolment and assign a care level based on the severity of the condition low, mild or high and the PCP for a limited period from 6 months to 1 year. The PCP plan is supported by a personalised case manager: based on the major needs in fact the case manager could be the psychologist or the social worker or the OT. PCP have been build up on a different mix of three care packages: clinical and OT, psychological and social, and social inclusion. Patients enrolled vary from 0 to almost 70 years, while families and carers have been involved based on individual needs. Results show the relevance of this service and all objectives were achieved: from avoiding clinical exacerbations at home, reducing hospitalisation, enhance reablement and selfmanagement up to improve socialisation and individual psychological and social inclusion. Patient Report Outcome measures quality of life scale SF36 and PACIC questionnaire were completed for all cases, at the entrance and closure of any individual project. Finally, the piloting project allows to design the service delivery model in order to identify detailed tools assessing scale, evaluating criteria and scores, outcome measures, care packages, the role and intervention of each professional, and an economic evaluation and estimation of the PCP based with bundle payments relying on the severity level assigned and the mix of care packages. [ABSTRACT FROM AUTHOR]