ABSTRACT
Stepped care models are a mental healthcare delivery framework in which a continuum of support allows selection of a range of interventions to match a client's evolving needs and preferences. Currently in use in multiple settings worldwide, stepped care has the potential to provide a needed advance for the development of comprehensive mental health systems. However, definitions of stepped care lack consistency, resulting in differing interpretations reflected in variable implementation, ultimately limiting its replicability, utility and potential for impact. To help foster greater alignment in research and practice, we propose a set of principles for stepped care which can provide guidance on how to bridge multiple mental health services together, reduce fragmentation, and respond to the full breadth of mental health needs along a continuum of care in diverse settings. We hope that articulating these principles will foster discussion and spur mental health stakeholders to translate them into actionable standards.
Subject(s)
Mental Disorders , Mental Health Services , Humans , Mental Health , Mental Disorders/therapyABSTRACT
Production and use of compost is an effective means to reduce wastes, and offers a large potential as growth substrates and source of nutrients. The objective of this study was to determine the physical and chemical characteristics of duck excreta enriched wood shavings (DMC) and source-separated municipal solid waste (MSW) composts and separates, and to assess the physical characteristics of growth substrates made from these two composts and selected substrates. MSW compost separates were the following sizes: F1 > 4 mm diameter, 2 mm < F2 < 4 mm, 1 mm < F3 < 2 mm and F4 < 1 mm. Growth substrates were prepared by mixing DMC and F2 and F3 MSW separates (M/M ratios). Growth substrates A-E consisted exclusively of 10-60% DMC and 20-60% of MSW separates F2 and F3. Growth substrates F-J, and K-O were the same as substrates A E, with 15% M/M brick fragments or shredded plastic added as porosity agents, respectively. Growth substrates (BE/S) made of black earth (BE) and sandy loam soil (Ls) in a 1:4 (M/M) ratio, commercially available peat substrate (Pr) and an in-house sphagnum peat-based substrate (Gs) were used for comparison. Principal component analysis (PCA) showed that DMC was a better material than MSW with respect to porosity and water field capacity. MSW compost and separates differed by their relatively high levels of water-soluble and HCl-hydrolyzable N and increased advantageous water retention capacity. PCA also showed that substrates A-E exhibited porosity and water field capacity similar to those of Pr. Substrates F-J had porosity and water field capacity similar to those of BE/S, whereas substrates K O were more similar to Pr and to substrates A and B. The presented data indicate that DMC and MSW separates were complementary in providing good physical and chemical characteristics to the growth substrates.
