Administrators of health and human services are increasingly asked to build “healthy communities” while managing fragmented systems, constrained budgets, and growing mental health needs. Community mental health is central to this agenda, yet many territorial systems remain organised around institutional logics and siloed programmes rather than integrated networks. This commentary reflects on the experience of the Italian mental health reform and proposes the RISMe-T (Integrated and Stepped Territorial Mental Health Network) model as a pragmatic framework for administrators who seek to organise territorial mental health and related human services in support of healthy communities. Grounded in international guidance from the World Health Organization (WHO) and the OECD, as well as Italian policy developments on territorial care and Case della Comunità, the model structures mental health and human services into four levels of care intensity, supported by cross-cutting functions of multilevel governance, information systems, and co-production. This commentary argues that RISMe-T can help administrators move from abstract principles of community-based, rights-oriented care to concrete design choices about governance arrangements, resource allocation, workforce roles, and performance indicators. The commentary highlights three administrative priorities: investing deliberately in lower-intensity, community-anchored levels of care; treating mental health departments as network administrators across health and human services; and embedding co-production as a managerial principle rather than an optional add-on. This commentary concludes with a call to action for administrators, policymakers, and scholars to use system-level models such as RISMe-T as heuristic tools for redesigning territorial mental health networks, evaluating their performance, and aligning them with broader healthy community strategies.
Mental illness and homelessness intersect to form a wicked problem. So wicked that contemporary solutions are little better than they were 300 years ago when towns relied on jails to provide meals and a bed to those whose behavior was “strange” and their families would not or could not care for them. Current estimates are that two-thirds of those who are unhoused need supportive living facilities and mental health care. From reliance on jails, to the establishment of state-operated psychiatric hospitals, to deinstitutionalization, to reliance on jails and camping on the street, the problem has come full circle.
This commentary introduces the Liberatory Public Service (LPS) framework as a transformative, trauma-informed, and equity-driven approach to reimagining health and human services administration. Focusing on the structural inequities revealed by the COVID-19 pandemic and the persistent barriers faced by LGBTQIA+ communities, it demonstrates how LPS can guide systemic change grounded in healing, justice, and inclusion. By centering those most marginalized, LPS offers a bold and practical path for advancing health equity in the United States.
This study examines the intersection of extreme heat, mobility, and daily routines in the lives of unsheltered people experiencing homelessness (PEH). As climate change intensifies, the increasing frequency and severity of extreme heat events pose significant health risks, particularly for PEH who rely on public spaces and transit systems to meet their basic needs. Utilizing qualitative research methods, including in-depth interviews with 41 PEH in Broward County, this study explores the unique challenges they face in managing extreme heat, maintaining mobility, and structuring their day-to-day activities. The findings highlight the profound effects of heat on both physical and mental health, as well as the ways in which mobility constraints exacerbate these impacts. This research underscores the urgent need for targeted interventions, such as accessible cooling resources and flexible transit options, alongside more inclusive public policies that account for the lived realities of this vulnerable population.
The utilization of healthcare services involves a complex decision-making process influenced by various factors. Among these factors, it is crucial to understand the diverse knowledge, attitudes, and behaviors of individuals working in the healthcare sector and their impact on Traditional and Complementary Treatments (TCT). This study aimed to examine the knowledge, attitudes, and behaviors of healthcare professionals in Northern Cyprus regarding Traditional and Complementary Treatment. The control group consisted of individuals outside the healthcare sector. The findings revealed that the majority of healthcare professionals in Northern Cyprus use TCT practices and hold a positive attitude toward them, although their level of knowledge is relatively low. This study presents comprehensive insights from existing literature on the knowledge, attitudes, and behaviors of healthcare professionals in relation to TCT, as well as the reasons highlighting the significance of TCT within the Northern Cyprus community. Informing healthcare workers about TCT practices and providing them with detailed training can contribute to safer healthcare outcomes.
The present study examines the background, nature of work, and skills necessary for the successful management of continuing care retirement communities in the United States. Results from a survey of not-for-profit continuing care retirement communities’ chief executive officers are given and compared to the last similar survey given 30 years prior. We discuss implications of these findings and provide recruitment strategies which may be of interest to scholars, practitioners, residents, and policy makers.
During the height of the COVID-19 pandemic, public servants globally were faced with resource scarcity, ever-changing science, and stalled global supply chains. Like healthcare counterparts, deathcare public managers had to adapt to unknowns, including body storage issues, personnel safety when handling potentially virulent bodies, and mental health struggles from excess deaths. Based on interviews with 30 public sector death managers throughout the U.S., we employ the dynamic capabilities approach to understand how these managers responded to the ongoing pandemic, challenges they faced, and the introduction of a new dynamic capability: dirty work knowledge. Implications for the study reach beyond deathcare and into public service dirty work and stigma.
Vaccination is considered a prosocial behavior, protecting both the individual and society at large. However, many Americans choose to remain unvaccinated for multiple reasons relating mainly to religious and personal autonomy. To assess individual readiness for COVID-19 vaccination, this quantitative study includes a survey of a nationally representative sample of adults in the United States ( n = 992) to explore willingness to engage in vaccination as a prosocial behavior. This study operationalizes prosocial behavior using the indicators empathic concern, monetary donations, and volunteering as predictors. Using ordinal and logistic regression models, the findings indicate that individual prosocial behavior is positively associated with vaccination and vaccination intent. Further, findings show that COVID-19 vaccination is positively correlated with the demographics of age, income, and education level, demonstrating that older adults (over 65), individuals with higher incomes, and the college-educated have higher vaccination intent. Vaccination intent was found to be the highest among African-Americans who were twice as likely to be vaccinated, and lowest among female participants.
United States Air Force Security Forces members face unique hazards associated with law enforcement and security duties similar to civilian law enforcement agencies. They also balance combat training requirements and rigorous physical conditioning that creates a high propensity for musculoskeletal injuries. The literature shows that awareness and education of contributing hazards can reduce the rate of injury among at-risk populations. This study explored the experience of Security Forces (SF) veterans to understand how actions on the job, training, and other key factors significantly contributed to their musculoskeletal injuries and chronic conditions. The research employed a phenomenological qualitative method to understand the workplace implications that may contribute to SF injury. We interviewed ten Security Forces veterans, five male and five female, to gain their insights and perspectives on their injuries and preventative measures that took place. The results showed a high rate of injury occurring on the job and a low rate of prevention. Participants described how their injuries were compounded by organizational culture and the hesitance to seek care options based on an underlying stigma. We introduce three considerations for practice to improve the musculoskeletal injury incidence rate among Security Forces: (1) developing a law enforcement-centric educational awareness program that places emphasis on physical conditioning, flexibility, and endurance to withstand occupational duties, (2) focusing on building core strength to reduce lower back and correlating injuries, (3) apply a top-down approach to remove negative stigma with seeking medical treatment for injuries.
A wealth of research has documented the detrimental consequences of health illiteracy and its impact on a multitude of health-related issues. Scholars across various disciplines have consistently shown that individuals with higher educational attainment, those born in the United States, and those with greater English proficiency, are more likely to exhibit higher levels of health literacy. However, the extent to which these individuals adhere to established health guidelines remains an understudied area. Therefore, we analyzed data from one of the largest cities impacted by COVID-19 in the United States, to determine whether traditional predictors of high health literacy levels translated into higher levels of vaccination intentions and vaccination doses, to protect themselves and their communities from COVID-19 related illness and death. The results indicated that individuals with high health literacy levels do not necessarily exhibit higher levels of compliance, thus challenging conventional wisdom.
Despite established disparities in serious illness prevalence among formerly homeless people living in permanent supportive housing, there is a dearth of research aimed at promoting and enhancing palliative care service delivery in this setting. This paper describes current practices, perceived barriers, and recommendations in permanent supportive housing for residents living with serious illness through a thematic analysis of interviews with cross-sector stakeholders ( n = 30) from the Research and Supportive Care at Later-life for Unhoused People (RASCAL-UP) study. Themes identified across resident care, program collaboration, and policy and environment areas included: (1) unique resident care needs; (2) on-site relationships; (3) adaptation of aging, disability, and healthcare services for residents; (4) internal implementation barriers; (5) preparing the environment for serious illness; and (6) missing levels of care. From these results, we put forth recommendations for future collaborative care intervention development, supportive housing policy, and capacity-building efforts for healthcare and housing providers alike.
Increasingly, the non-profit sector is expected to provide services for which the state previously took responsibility, and plays a vital role in providing key supports, such as those related to literacy and building social capital. In a jurisdiction of Ontario, Canada, local funding for literacy programs ceased without warning. In this qualitative study, stakeholders consisting of program users ( n = 72), staff ( n = 11), and program leads ( n = 8) shared their experiences regarding the goals, activities, impacts, and needs of the programs through interviews and focus groups. Findings illuminate both challenges and recommendations for future implementation in three themes: (1) Identifying and reconciling funding gaps and restrictions; (2) requiring supports for human resources; and (3) communicating, cooperating, and collaborating to survive. The challenges faced by financially strapped, non-profit entities highlight a fundamental contradiction within neoliberal ideology: Neoliberal-induced funding scarcity within the non-profit sector can undermine the capacity of community organizations to promote neoliberal ideals related to self-reliance and resilience.
In Malawi’s healthcare system, a significant doctor shortage compels clinical officers who are mid-level health professionals, to shoulder responsibilities traditionally reserved for medical doctors. This study delves into the unintended consequences of functional reviews within Malawi’s health sector. The research, employing a qualitative case-study approach across five public hospitals, investigated how the functional reviews triggered an identity crisis among clinical officers. The findings revealed that the implemented changes caused an identity crisis among clinical officers. This identity crisis, demonstrably exacerbated occupational stress among clinical officers. To address this unforeseen consequence and safeguard the well-being of clinical officers in particular and healthcare workers in general, this paper proposes the incorporation of psychosocial risk assessments before implementing functional reviews in the health sector. This proactive approach can help identify potential threats to social identity and mitigate the risk of increased stress among healthcare workers. Ultimately, this research contributes to the growing body of knowledge that underscores the intricate link between social identity and the impact of large-scale workplace changes within the healthcare system.
Providing access to adequate and culturally competent healthcare in the United States has been an ongoing challenge with healthcare access barriers impacting the quality of care received by racially and ethnically diverse populations. Despite the preventative measures taken to halt the spread of the COVID-19 pandemic, vulnerable populations and diverse communities were disproportionately represented in COVID-19 transmission and mortality rates. Through a review of the available literature and a quantitative analysis of COVID-19 surveillance data, this study addresses how culturally competent intervention strategies impacted COVID-19 mortality and fatality rates. This paper discusses how community leadership addressed vaccine distribution gaps and delayed government responses for diverse populations were addressed by the community leadership and provides examples of culturally competent solutions to healthcare emergencies. This cross-sectional study contributes to the current literature by exploring the impact of culturally competent healthcare interventions in North Carolina during the COVID-19 pandemic and makes the case for culturally competent practices to reduce the impact on diverse populations.
Workplace-based supervision within human services is an organizational resource with potential to support practitioners, delivery of services, client outcomes, and organizations. However, little is known about the practice of supervision in organizational settings. This paper reports on a cross-sectional, descriptive study that explored supervision in practice within human services in Ontario, Canada ( N = 375). Web-based surveys were completed by frontline practitioners ( n = 263), supervisors ( n = 85), and leaders ( n = 27) employed in human service organizations. Descriptive statistics present a broad picture of supervision, with differences between employee groups highlighted. A third of frontline practitioners reported their supervision encompassed all supervisory functions (i.e., support, administration, professional development, and quality of care). Using the MCSS-26, 46% of practitioners reported their supervision was effective. Findings emphasize the need for dedicated funding, organizational policies, enhanced training, and feedback mechanisms. Addressing these areas may improve the effectiveness of supervision, supporting staff well-being and in turn, client outcomes.
Human rights are the legal claims that individuals have on society on the basis of being human. It is surprising then that water, a basic necessity to life, has only been explicitly recognized as a human right since 2002 by the Committee on Economic, Social, and Cultural Rights (CESCR) and since 2010 by the United Nations General Assembly. Recognition as a human right makes its fulfillment a duty of the state to its citizens, obligating steps towards implementation accountable to international law. Access to safe drinking water, adequate sanitation, and hygiene (WASH) would alleviate 10% of the global disease burden. The magnitude of its effect on health is seen clearly in Ethiopia where 60% to 80% of communicable diseases are attributable to limited access to WASH. Ethiopia has achieved MDG 7c for access to clean water supply and has made good progress on ending open defecation. However, its progress on handwashing lags far behind despite its cost-effectiveness. This is partly because of the differences in the codification of the rights to water, sanitation, and hygiene individually. This paper will examine the implications of the international law framework for WASH implementation in Ethiopia.
A central mission of a healthcare organization is to provide equal access and excellent health outcomes to all populations, regardless of race and ethnicity. However, in the everyday practice of healthcare, organizations have fallen short of this primary tenant. Healthcare disparities in the Black community are well-documented in the literature. Although the reasons are multi-faceted, racial bias contributes to healthcare disparities, and eliminating those disparities should be a chief focus in improving the health and well-being of every community. This paper discusses healthcare disparities in the Black community and the complex cycle that enables gaps to persist despite best efforts among healthcare professionals, policymakers, and the general public. It concludes with a presentation of the Looking Glass Framework; an innovative onboarding and continuing education program using virtual reality and computer-based educational modules to reduce healthcare disparities within clinics, hospitals, and health systems.
Health and human services administration is a broad tent with ample opportunity to embrace emerging scholars and help them to frame new ideas. The Journal of Health and Human Services Administration aims to continue elevating the visibility of this broad tent, which exists under the even larger tent of public administration. Public service encapsulates an incredibly diverse range of disciplines and management concerns. Yet, the academy can be a challenging arena to navigate. In our efforts to carve out space for new insights we are charged with striking the best balance in our scholarship. In introducing this first issue of our emerging scholars, we have created space for thoughtful reflection about the nature of our discipline and how we welcome, or not, unique and less represented perspectives. Our discipline strives for inclusivity, transparency and relevance. This must extend to our publishing outlets, particularly in terms of peer review and citations. Learning to scan the new literature and diversifying the journals from which we cite our references may result in leveling the citation game. How we engage effectively in building meaningful studies may be argued to require a degree of reflexivity. In other words, the ability to examine one’s own perspectives and assumptions and consider how these impact research study design and implementation from both a personal and functional angle. In reviewing the articles in this issue, I urge you to grow your opportunities to identify new scholars, practitioners and students and mentor them, guide them, and cite their work.
