Community Health Outcomes and Evaluation Essay Example | Topics and Well Written Essays - 1750 words

Community Health Outcomes and Evaluation - Essay Example The intervention plan is depression screening for the elderly promoted as a public policy model that seeks to combine and integrate mental health and primary medical services in one delivery intervention framework. The essential elements of the framework will be outlined and addressed. A scheme of integrating depression screening in primary nursing gerontology care will be proposed by reviewing studies dealing with depression in the elderly population and outlining how mental health can be integrated in primary care by suggesting specific training processes for nurses that will enable them to identify and address depression and its conditions in the elderly. Forming part of the public policy intervention plan, evaluation of the proposal will be addressed along with its application to the intervention scheme. Evaluation will be a repeated-measures design for both the nursing population under training and the client population. Limitations will be discussed as well as how the public po licy project may be sustained over time. Public policy models entail changes not in one institution but structural changes across the larger model of social delivery processes affecting the wider population. The elderly population will be increasing at greater rates over the next two decades. The current public political climate reflects an increasing unwillingness of local governments to improve responsibility for the safety net provisions required by the elderly. Public policy must be influenced to standardize an intervention framework that would integrate depression screening into primary general care for the elderly. This study will adapt an intervention model after a review of other integration models. It will then produce an evaluation strategy based on Reedy et al who demonstrate how program evaluation indicators could be adopted into implementation strategies as essential evaluation models of public health services. Literature Review Luchins argues that depression screening as far as it is operative as a quality indicator falls more under the purview of the administrator that that of the clinician. This would make depression screening a policy declaration or requirement mapped to some department goal. As a quality indicator and not as a practice guideline, depression screening would then demand a different kind of evidence evaluation, evidence based on a "chain of assumptions underlying the decision" for its use and application (p. 108). Quality indicators are administrative rules, or guidelines. They may affect different groups of patients than clinical screening for specific illnesses may affect. It has been demonstrated that physicians in general seem to ignore diagnostic information from other staff. Luchins main point is that depression screening many not be effective in the absence of other interventions. The one intervention in which it has shown to be effective is that of collaborative care (Gilbody). Luchins view of collaborative care comprise s three elements. They are a case manager, the primary care physician, and input from a specialist (p. 111). A more adaptable view of the model explains collaborative care as structured where by nonmedical specialists play a greater role in augmenting primary care (Gilbody). The management of depression in primary care has proven evasive (Seekles, 2009). Seekles et al proposes a stepped care model