Case Studies
CASE STUDY ONE
Client: Non-profit organisation focussed on providing education and mentoring for disadvantaged youths at risk of entering the juvenile criminal system. The program receives grants to provide tailored person-focussed service for its clients.
Background: The organisation had been in business for 24 months and has seen some success but required a program evaluation and to understand how to increase participation.
Objectives: To conduct a needs assessment and evaluation and recommendations for program improvement.
Methodology: We recommended a mixed methods approach, including quantitative and qualitative data collection and analysis. We conducted surveys and interviews with program participants and focus groups with community members and staff. We analysed attendance rates, academic performance and participant feedback.
Findings: Results indicated the program was generally well received by the community but we identified several areas of improvement. Participants wanted more one on one guidance and mentoring and needed the program to address mental ill health and substance use issues - identified as the main barriers to engagement. There were also issues with transportation for some young people. Most of the young people had poor academic attendance and performance.
Our Recommendations:
Hiring staff with specific mental health training and counselling qualifications and suggestion of a big-brother / big-sister mentoring program.
The provision of a vehicle that offers transportation to and from the centre.
The implementation of an academic performance tracking system in order to provide academic support for the young people who are facing challenges.
Liaison with local organisations and businesses to provide more opportunity for community engagement.
Outcomes:
A the 6 month service review there was an increase in participation with the availability of the transport vehicle. The centre now employed a psychologist. Young people were regularly attending counselling sessions. The psychologist commenced weekly education sessions on the topics of mental health and drug and alcohol use. Young people were volunteering and were given opportunities for work experience at several local business working with the NGO.This exposed them to environments where they were able to be responsible and build self confidence and operate as part of teams while learning new skills.
CASE STUDY TWO
Setting: Inpatient Rehabilitation service
Background: This organisation provided an interdisciplinary rehabilitation service for people after acute serious injury. A study was endorsed to explore how to improve patient-practitioner therapeutic relationships and increase patient-centred care to enhance patient long term outcomes.
Objectives: To explore what factors increased therapeutic alliances and subsequently patient-centred care.
Methodology: A qualitative study was conducted with in-depth interviews with both patients who were admitted and receiving rehabilitation and staff across the interdisciplinary team including doctors, nurses, social workers, physiotherapist and occupational therapists and other members of the allied health team.
Findings: After data analysis several factors were uncovered as important to building strong alliances between patients and health practitioners, of which some are listed:
Continuity of identity: was significant for patients and that therapeutic alliances were strong where practitioners worked to protect pre-injury identity.
Dignity of risk - that patients wanted to take informed risks and that practitioners needed to give patients the dignity to take risks they chose to.
Hand power over - that practitioners who held more power as hospital professionals needed to recognise this and hand power over to patients. This may be allowing patients to speak and that patient desires are respected and heard and actioned. Patients desired to retain control of their bodies and their lives.
Hope and realism - practitioners needed to allow patient hope and not destroy it while maintaining realism at the same time. A balance of both was required.
That patient-centred care was an organic outcome where strong therapeutic alliances existed.
Our Recommendations:
A model of the therapeutic alliance has been formally developed and has been recommended for implementation.
Training for all health practitioners to be able to build strong therapeutic alliances based on the model proposed.
Outcomes: We are currently writing multiple scientific articles based on this study which will be submitted for publishing. Given the results of this study, the model may be transferable across rehabilitation settings across the world which offer a similar type of service.