Development and evaluation of a patient-rated version of the Camberwell Assessment of Need short appraisal schedule (CANSAS-P)

[The Standardised Recording of Psychosocial Help Needs within Psychiatric Acute Treatment in a Socio-Educational Counselling Context]

People with mental illness often have complex social problems. Up to now, there has been no systematised/standardised recording of social assistance needs in acute psychiatric care. One reason for this is the lack of adequate instruments and the increasing workload. The review analyses established needs assessment instruments with regard to their suitability for addressing the question. It becomes clear that these instruments are insufficiently suitable for a structured assessment of the need for psychosocial support. This results in the need for the development of a short and standardised instrument for the assessment of psychosocial support needs, which can be used as part of multiprofessional diagnostics within psychiatric care.

Randomized Controlled Trial of Self-Directed Care for Medically Uninsured Adults With Serious Mental Illness

OBJECTIVE

Self-directed care (SDC) is a treatment model in which recipients self-manage funds designated for provision of services. The model is designed to cost no more than traditional services while achieving superior participant outcomes. The authors examined the model's impact on outcomes, service costs, and user satisfaction among medically uninsured, low-income individuals with serious mental illness.

METHODS

Adults in the public mental health system (N=42) were randomly assigned (1:1) to receive SDC or services as usual and were assessed at baseline and 6- and 12-month follow-ups. Outcomes included perceived competence for mental health self-management, met and unmet needs, degree of autonomy support, self-perceived recovery, and employment. Mixed-effects random regression analysis tested for differences in longitudinal changes in outcomes between the two study conditions. Differences in service costs were analyzed with negative binomial regression models.

RESULTS

Compared with individuals in the control condition, SDC participants reported greater improvement in perceived competence, met and unmet needs, autonomy support, recovery from symptom domination, and employment. No differences were found between the two groups in total per-person service costs or costs for individual services. The most frequent nontraditional purchases were for medical, dental, and vision services (33%) and health and wellness supports (33%). Satisfaction with SDC services was high.

CONCLUSIONS

Mental health SDC services achieved participant outcomes superior to treatment as usual, with equivalent service use and costs and high user satisfaction. This model may be well suited to the needs of uninsured adults with low income who receive public behavioral health care.

Needs Assessment of Clients Accessing a Community Mental Health Crisis Stabilization Unit

This study aimed to examine the needs of clients accessing a community mental health crisis stabilization unit (CSU) in Winnipeg, Canada. Sociodemographics, service connections, and need were assessed among CSU clients. The Camberwell Assessment of Need Short Appraisal Schedule - Patient (CANSAS-P) was administered to differentiate need domains that were met and unmet. An ordinal regression examined sociodemographics and level of total unmet need; client characteristics were correlated with unmet need. In total, 271 questionnaires were analyzed. On average, respondents had 6.2 areas of unmet need, with "psychosocial distress" (n = 186, 68.6%), "safety to self" (n = 140, 51.7%), "company" (n = 139, 51.3%), and "physical health" (n = 124, 45.8%) being reported most often. Higher level of unmet need was predicted by disability income and absence of income. Overall, CSU clients had high rates of unmet need reflecting important determinants of health. This information can inform community mental health crisis service delivery to positively impact mental health recovery.

Epistemic injustice amongst clinical and non-clinical voice-hearers: A qualitative thematic analysis study

OBJECTIVES

Research has suggested people who hear voices may be at risk of epistemic injustice. This is a form of discrimination whereby someone is unfairly judged to be an unreliable knower (testimonial injustice) or is unable to contribute to, and therefore access, concepts that make sense of their experience within mainstream society (hermeneutical injustice). Voice-hearing occurs both in people who are mental health service users and in the general population (clinical and non-clinical voice-hearers, respectively). The degree of distress and impairment associated with voices has been shown to relate to how individuals make sense of their experiences and how others respond to their identity as a voice-hearer. The aim of this study was to explore people's experiences of epistemic injustice in relation to voice-hearing and to understand how these may differ between clinical and non-clinical voice-hearers.

DESIGN

A qualitative design was used.

METHOD

Eight clinical and nine non-clinical voice-hearers partook in semi-structured interviews, which were analysed using thematic analysis.

RESULTS

Three pairs of themes related to (i) identity, (ii) relationships and (iii) power and position were constructed across the clinical and non-clinical groups, and two shared themes within both groups were created relating to testimonial and hermeneutical injustice.

CONCLUSION

Both clinical and non-clinical voice-hearers described experiencing epistemic injustice in wider society. The presence of a 'safe haven' (e.g. spiritualist churches) for non-clinical voice-hearers ameliorated the impact of this to some degree, by allowing people to make connections with others with similar experiences within a non-judgemental and accepting community.

The Pathways to Participation (P2P) Program: A Pilot Outcomes Study

Research has consistently found that people with mental illness (known as consumers) experience lower levels of participation in meaningful activities, which can limit their opportunities for recovery support. The aim of this study was to describe the outcomes of participation in a group program designed to address all stages of activity participation, known as Pathways to Participation (P2P). A descriptive longitudinal design was utilized, collecting data at three time points. Outcomes were measured by the Camberwell Assessment of Need Short Appraisal (CANSAS), Recovery Assessment Scale-Domains and Stages (RAS-DS), Behavior and Symptom Identification Scale (BASIS-24), Living in the Community Questionnaire (LCQ), and time-use diaries. All data were analyzed using descriptive statistics and Chi-square analyses. A total of 17 consumers completed baseline data, 11 contributed post-program data, and 8 provided follow-up data. Most were female (63.64%) and had been living with mental illness for 11.50 (±7.74) years on average. Reductions in unmet needs and improvements in self-rated recovery scores were reported, but no changes were identified in either time use or psychosocial health. The findings indicate that the P2P program may enable consumers to achieve positive activity and participation outcomes as part of their personal recovery.

Deinstitutionalization from the perspective of community-dwelling adults with a severe mental illness in Amsterdam: a cohort study protocol

Background

People with a severe mental illness (SMI) increasingly receive ambulatory forms of care and support. The trend of deinstitutionalization accelerated in the Netherlands from 2008 and onwards without sufficient understanding of its consequences. The study protocol herein focuses on deinstitutionalization from the perspective of adults with an SMI living within the community in Amsterdam and aims at delivering better insight into, amongst others, their recovery, quality of life, societal participation and needs for care and support.

Methods

A cohort design will be used. A representative sample of community-dwelling adults with an SMI, including those in care (n = 650) and not in care (n = 150), will be followed over time. During a two-year time period, participants will be interviewed twice using a wide-ranging set of validated instruments. Interview data will be matched with administrative data about the care process, as retrieved from their patient files. Primary outcomes are changes over time in recovery, societal participation and quality of life, controlled for the occurrence of adverse life-events during follow-up. Additionally, prevalence estimates of and associations between social functioning, safety and discrimination, substance use and health indicators will be investigated.

Discussion

The study protocol aims at delivering a comprehensive insight into the needs of community-dwelling adults with an SMI based on which ambulatory care and support can best be provided to optimally promote their social recovery and well-being.

What if children with psychiatric problems disagree with their clinicians on the need for care? Factors explaining discordance and clinical directions

BACKGROUND

Children and adolescents in mental healthcare often perceive their care needs and necessary treatment differently from their clinicians. As such discordance between young patients and clinicians may obstruct treatment adherence and compromise treatment outcomes, it is important to understand the factors associated with it. We therefore investigated the factors associated with patient-clinician discordance with regard to care needs in various areas of functioning.

METHODS

A cross-sectional study involving 244 children/adolescents aged 6-18 participating with their clinicians in treatment at a specialized mental healthcare center. As a previous study conducted by our research group had found the greatest patient-clinician discordance in three CANSAS care needs-"mental health problems," "information regarding diagnosis and/or treatment," and "making and/or keeping friends"-we used univariable and multivariable statistics to investigate the factors associated with discordance regarding these three care needs.

RESULTS

patient-clinician discordance on the three CANSAS items was associated with child, parent, and family/social-context factors. Three variables were significant in each of the three final multivariable models: dangerous behavior towards self (child level); severity of psychiatric problems of the parent (parent level); and growing up in a single-parent household (family/social-context level).

CONCLUSIONS

To deliver treatment most effectively and to prevent drop-out, it is important during diagnostic assessment and treatment planning to address the patient's care needs at all three levels: child, parent and family/social context.

Unmet care needs of children with ADHD

Background

Non-compliance to, or drop-out from treatment for childhood ADHD, result in suboptimal outcome. Non-compliance and drop-out may be due to mismatches between patients' care needs and treatments provided. This study investigated unmet care needs in ADHD patients. Unmet needs were assessed in two different treatment settings (general outpatient setting versus youth-ACT). Youth-ACT treatment is an intensive outreach-oriented treatment for patients with severe psychiatric and psychosocial problems. Comparison of a general outpatient sample with a youth-ACT sample enabled us to assess the influence of severity of psychiatric and psychosocial problems on perceived care needs.

Methods

Self-reported unmet care needs were assessed among 105 ADHD patients between 6 and 17 years of age in a general outpatient (n = 52) and a youth-ACT setting (n = 53).

Results

ADHD patients most frequently reported unmet needs regarding mental health problems, information on diagnosis/treatment, and future prospects. Outpatients differed from youth-ACT patients with respect to 30% of the unmet care needs that were investigated. Outpatients perceived more unmet needs regarding information on diagnosis/treatment (p = 0.014). Youth-ACT patients perceived more unmet needs concerning medication side effects (p = 0.038), quality and/or quantity of food (p = 0.016), self-care abilities (p = 0.016), regular/suitable school or other daytime activities (p = 0.013), making and/or keeping friends (p = 0.049), and future prospects (p = 0.045).

Conclusions

Focusing treatment of ADHD patients on unmet needs may reduce non-compliance and drop-out. In clinical practice, systematic assessment of unmet care needs in all ADHD patients may be warranted, e.g. using the CANSAS questionnaire during the screening/intake phase.

Employment Rates in Flexible Assertive Community Treatment Teams in The Netherlands: An Observational Study

We determined the proportions of clients treated in Flexible Assertive Community Treatment teams who were unemployed and gained employment and who were employed and lost employment. Secondly, we explored the demographical and clinical factors associated with employment. Data were collected during routine outcome monitoring. We calculated differences in employment rates over a year and explored differences in demographic characteristics at baseline between patient groups. Logistic regression analysis was used to estimate the role of clinical predictor variables on employment status. Over time, 10% remained employed, 5% lost their employment, 3% gained employment and 82% remained unemployed. Clients who found employment were younger, more often male, and had significantly fewer psychosocial problems and a higher subjective quality of life during follow-up than those who remained unemployed. Problems with motivation for treatment at baseline were related to losing employment or remaining unemployed. Better implementation of vocational services is very important for increasing the number of clients gaining employment.

Trajectories of patients with severe mental illness in two-year contact with Flexible Assertive Community Treatment teams using Routine Outcome Monitoring data: An observational study

OBJECTIVE

Using outcome data collected routinely over a continuous two-year treatment period, we wished to distinguish homogeneous subgroups of patients with a severe mental illness whose psychosocial problems followed a similar pattern over time. By identifying the effectiveness of health services for different patient groups, this approach allowed us to identify patients at risk of deterioration and those recovering from their symptoms.

METHODS

In total we included 2,660 patients who were in two-year continuous contact with a Flexible Assertive Community Treatment team (FACT). We collected outcome data on psychosocial functioning, needs for care and quality of life. We performed a latent class growth analysis (LCGA).

RESULTS

The LCGA identified six homogenous patient subgroups using trajectories of HoNOS scores. On the basis of the patterns of patients' psychosocial problems over time, we labelled these as follows: 1) stable at a low problem-severity level (N = 709; 27%); 2) stable at a low medium problem-severity level (N = 1,208; 45%); 3) stable at a high medium problem-severity level (N = 528; 20%); 4) stable at a high problem-severity level (N = 116; 4%); 5) amelioration of problems (N = 42; 2%); and 6) deterioration of problems (N = 57; 2%). Patients with stable and a high severity of psychosocial problems had more practical and somatic unmet needs than those in other subgroups, and also had the fewest decrease in the number of unmet needs.

DISCUSSION

After linking patient subgroups with clinical features such as the need for care, we found that, over two years, most patients remained relatively stable in terms of psychosocial functioning, but that their unmet needs decreased over time. However, in terms of needs for treatment during two years of contact with a FACT team, patients in the subgroup with a stable and high problem-severity level tended to derive little or no benefit.

Perception of unmet needs and association with benzodiazepine misuse among patients on a methadone maintenance treatment programme

Aims and method

To examine patients' perceptions of unmet needs during methadone maintenance treatment (MMT), and to explore the relationship between co-occurring benzodiazepine misuse and severity of needs. A cross-sectional survey was carried out at an MMT programme in Dublin, Ireland. All patients were invited to participate on a voluntary basis. Of the 191 eligible patients, 107 agreed to participate and completed the Camberwell Assessment of Need questionnaire.

Results

Unmet needs for substance misuse treatments, daytime activities, socialisation, money management and psychological distress were high. Fifty-two respondents (49%) reported using non-prescribed benzodiazepines during the past month. Compared with non-users of benzodiazepines, benzodiazepine users reported higher ratings of total and unmet needs (P < 0.05). The number of days using benzodiazepines predicted the severity of needs.

Clinical implications

The findings highlight the importance of addressing coexisting psychological needs, and further support enhancing treatment interventions for benzodiazepine misuse or dependence among patients on MMT.

Assessment of Needs: Differences between male and female patients with schizophrenia needs in psychiatric hospitals in Baghdad city

BACKGROUND

Gender differences are one of the most important and crucial subjects in evaluating the nursing care as well as mental health care system for psychiatric patients especially patients with schizophrenia.

AIMS

We aimed to identify differences in needs of male and female patients with schizophrenia in psychiatric hospitals in Baghdad city and its relationship with some variables.

METHOD

A descriptive, analytical design that was carried out by using Camberwell needs assessment, short appraisal schedule, self-report version (CANSAS-P) after translating to Arabic.

RESULTS

Results indicated that there were a lot of unmet needs of male and female patients with schizophrenia, according to the entire CANSAS-P domains especially psychological symptoms. Differences were found in types of needs as the majority of men have more social needs while females was found to be more occupied with their fears and need safety.

CONCLUSION

there were differences in types of need between male and female patients with schizophrenia; needs were affected by some variables such as educational level, first 10 days of admission and family visiting.

The Score Family Assessment Questionnaire: A Decade of Progress

This paper reviews a decade of research (2006-2016) on a family assessment instrument called the Systemic Clinical Outcome and Routine Evaluation (SCORE). The SCORE was developed in Europe to monitor progress and outcome in systemic therapy and has been adopted by the European Family Therapy Association as the main instrument for assessing the outcome in systemic family and couple therapy. There are currently six main versions of this instrument: SCORE-40, SCORE-15, SCORE-28, SCORE-29, Child SCORE-15, and Relational SCORE-15. It has also been translated into a number of European languages. Fifteen empirical studies of the SCORE "family of measures" have been conducted. Most have aimed to establish psychometric properties of these instruments in English and other languages. Others have used the SCORE to document the level of family adjustment in clinical samples or evaluate outcome in treatment trials. There is now sufficient evidence for the reliability and validity of the SCORE to justify the use of brief versions of this instrument to monitor progress and outcome in the routine practice of systemic therapy.

Helping Alliance and Unmet Needs in Routine Care of People With Severe Mental Illness Across Europe: A Prospective Longitudinal Multicenter Study

The helping alliance (HA) refers to the collaborative bond between patient and therapist, including shared goals and tasks. People with severe mental illness have a complex mixture of clinical and social needs. Using mixed-effects regression, this study examined in 588 people with severe mental illness whether an increase in the HA is associated with fewer unmet needs over time, and whether change in the HA precedes change in unmet needs. It was found that a reduction in unmet needs was slower in patients with higher HA (B = 0.04, p < 0.0001) only for patient-rated measures. Improvement in both patient-rated and staff-rated HA over time was associated with fewer subsequent patient-rated (B = -0.10, p < 0.0001) and staff-rated (B = -0.08, p = 0.0175) unmet needs. With positive changes in the HA preceding fewer unmet needs, findings provide further evidence for a causal relationship between alliance and outcome in the treatment of people with severe mental illness.

Recovery and decision-making involvement in people with severe mental illness from six countries: a prospective observational study

BACKGROUND

Clinical decision-making is the vehicle of health care provision, and level of involvement predicts implementation and satisfaction. The aim of this study was to investigate the impact of decision-making experience on recovery.

METHODS

Data derived from an observational cohort study "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR). Adults (aged 18-60) meeting standardised criteria for severe mental illness were recruited from caseloads of outpatient and community mental health services in six European countries. After consenting, they were assessed using standardised measures of decision-making, clinical outcome and stage of recovery at baseline and 1 year later. Latent class analysis was used to identify course of recovery, and proportional odds models to investigate predictors of recovery stage and change.

RESULTS

Participants (n = 581) clustered into three stages of recovery at baseline: Moratorium (N = 115; 19.8%), Awareness/Preparation (N = 145; 25.0%) and Rebuilding/Growth (N = 321; 55.2%). Higher stage was cross-sectionally associated with being male, married, living alone or with parents, and having better patient-rated therapeutic alliance and fewer symptoms. The model accounted for 40% of the variance in stage of recovery. An increased chance of worse outcome (change over 1 year to lower stage of recovery) was found for patients with active involvement compared with either shared (OR = 1.84, 95% CI 1.15-2.94) or passive (OR = 1.71, 95% CI = 1.00-2.95) involvement. Overall, both process (therapeutic relationship) and outcome (symptomatology) are cross-sectionally associated with stage of recovery.

CONCLUSIONS

Patient-rated decision-making involvement and change in stage of recovery are associated. Joint consideration of decision practise within the recovery process between patient and clinician is supposed to be a useful strategy to improve clinical practice (ISRCTN registry: ISRCTN75841675. Retrospectively registered 15 September 2010).

The Impact of Sex Upon Needs and Quality of Life Within a Population on Methadone Treatment

BACKGROUND

Best practice models are calling for a holistic, needs-led, and sex-informed treatment approach to substance misuse treatment. To date, research into the impact of sex on needs and quality of life within methadone-treatment populations using validated research tools is limited.

OBJECTIVES

The aim of the study was to evaluate the impact of sex upon self-rated unmet need and quality of life among people on methadone treatment.

METHODS

Cross-sectional survey of adults attending a specialist methadone treatment clinic, in Dublin, Ireland. Participants completed the Camberwell Assessment of Need Short Appraisal Schedule, Patient Version and the WHO Quality of Life-Brief Version. Ongoing drug use was determined using the Maudsley Addiction Profile and weekly supervised urine toxicology screens. A linear regression analysis was conducted.

RESULTS

One hundred eight of 190 eligible service-users (57%) participated. No significant differences existed between the participants and the nonparticipants on demographic variables or measures of drug use. Among them, 33% were women. Women demonstrated lower levels of ongoing opiate use. Linear regression analysis indicated that women had a greater number of unmet needs (P = 0.02) and lower quality of life in the domains of physical health (P = 0.003), psychological well being (P < 0.001), environmental well being (P = 0.03), and social relationships (P = 0.007). When the Bonferroni adjustment was applied to account for multiple testing, the relationship between psychological well being and female sex remained statistically significant.

CONCLUSIONS

Our study suggests that female sex may be associated with greater self-rated needs and poorer quality of life within a methadone-treated population, in particular, in the domain of psychological well being. Further research in this area is warranted to discover if these findings can be replicated and confirmed in larger samples.

Patients' Needs for Care in Public Mental Health: Unity and Diversity of Self-Assessed Needs for Care

PURPOSE

Needs assessment is recognized to be a key element of mental health care. Patients tend to present heterogeneous profiles of needs. However, there is no consensus in previous research about how patients' needs are organized. This study investigates both general and specific dimensions of patients' needs for care.

METHODS

Patients' needs were assessed with ELADEB, an 18-domain self-report scale. The use of a self-assessment scale represents a unique way of obtaining patients' perceptions. A patient-centered psychiatric practice facilitates empowerment as it is based on the patients' personal motivations, needs, and wants. Four seventy-one patients' profiles were analyzed through exploratory factor analysis.

RESULTS

A four-factor bifactor model, including one general factor and three specific factors of needs, was most adequate. Specific factors were (a) "finances" and "administrative tasks"; (b) "transports," "public places," "self-care," "housework," and "food"; and (c) "family," "children," "intimate relationships," and "friendship."

CONCLUSION

As revealed by the general factor, patients expressing urgent needs in some domains are also more susceptible to report urgent needs in several other domains. This general factor relates to high versus low utilizers of public mental healthcare. Patients also present specific needs in life domains, which are organized in three dimensions: management, functional disabilities, and familial and interpersonal relationships. These dimensions relate to the different types of existing social support described in the literature.

Clinical decision making and outcome in the routine care of people with severe mental illness across Europe (CEDAR)

AIMS

Shared decision making has been advocated as a means to improve patient-orientation and quality of health care. There is a lack of knowledge on clinical decision making and its relation to outcome in the routine treatment of people with severe mental illness. This study examined preferred and experienced clinical decision making from the perspectives of patients and staff, and how these affect treatment outcome.

METHODS

"Clinical Decision Making and Outcome in Routine Care for People with Severe Mental Illness" (CEDAR; ISRCTN75841675) is a naturalistic prospective observational study with bimonthly assessments during a 12-month observation period. Between November 2009 and December 2010, adults with severe mental illness were consecutively recruited from caseloads of community mental health services at the six study sites (Ulm, Germany; London, UK; Naples, Italy; Debrecen, Hungary; Aalborg, Denmark; and Zurich, Switzerland). Clinical decision making was assessed using two instruments which both have parallel patient and staff versions: (a) The Clinical Decision Making Style Scale (CDMS) measured preferences for decision making at baseline; and (b) the Clinical Decision Making Involvement and Satisfaction Scale (CDIS) measured involvement and satisfaction with a specific decision at all time points. Primary outcome was patient-rated unmet needs measured with the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS). Mixed-effects multinomial regression was used to examine differences and course over time in involvement in and satisfaction with actual decision making. The effect of clinical decision making on the primary outcome was examined using hierarchical linear modelling controlling for covariates (study centre, patient age, duration of illness, and diagnosis). Analysis were also controlled for nesting of patients within staff.

RESULTS

Of 708 individuals approached, 588 adults with severe mental illness (52% female, mean age = 41.7) gave informed consent. Paired staff participants (N = 213) were 61.8% female and 46.0 years old on average. Shared decision making was preferred by patients (χ 2 = 135.08; p < 0.001) and staff (χ 2 = 368.17; p < 0.001). Decision making style of staff significantly affected unmet needs over time, with unmet needs decreasing more in patients whose clinicians preferred active to passive (-0.406 unmet needs per two months, p = 0.007) or shared (-0.303 unmet needs per two months, p = 0.015) decision making.

CONCLUSIONS

Decision making style of staff is a prime candidate for the development of targeted intervention. If proven effective in future trials, this would pave the ground for a shift from shared to active involvement of patients including changes to professional socialization through training in principles of active decision making.

Child maltreatment and adult psychopathology in an Irish context

One-hundred-ninety-nine adult mental health service users were interviewed with a protocol that included the Childhood Trauma Questionnaire, the Structured Clinical Interviews for Axis I and II DSM-IV disorders, the Global Assessment of Functioning scale, the SCORE family assessment measure, the Camberwell Assessment of Need Short Appraisal Schedule, and the Readiness for Psychotherapy Index. Compared to a U.S. normative sample, Irish clinical cases had higher levels of maltreatment. Cases with comorbid axis I and II disorders reported more child maltreatment than those with axis I disorders only. There was no association between types of CM and types of psychopathology. Current family adjustment and service needs (but not global functioning and motivation for psychotherapy) were correlated with a CM history. It was concluded that child maltreatment may contribute to the development of adult psychopathology, and higher levels of trauma are associated with co-morbid personality disorder, greater service needs and poorer family adjustment. A history of child maltreatment should routinely be determined when assessing adult mental health service users, especially those with personality disorders and where appropriate evidence-based psychotherapy which addresses childhood trauma should be offered.

In search of an integrative measure of functioning

International trends towards people-centred, integrative care and support require any measurement of functioning and disability to meet multiple aims. The information requirements of two major Australian programs for disability and rehabilitation are outlined, and the findings of two searches for suitable measures of functioning and disability are analysed. Over 30 current measures of functioning were evaluated in each search. Neither search found a generic measure of functioning suitable for these multibillion dollar programs, relevant to a wide range of people with a variety of health conditions and functioning experiences, and capable of indicating support needs, associated costs, progress and outcomes. This unsuccessful outcome has implications internationally for policy-relevant information for disability, rehabilitation and related programs. The paper outlines the features of an Integrative Measure of Functioning (IMF) based on the concepts of functioning and environmental factors in the International Classification of Functioning, Disability and Health (ICF). An IMF would be applicable across a variety of health conditions, settings and purposes, ranging from individual assessment to public health. An IMF could deliver person-centred, policy-relevant information for a range of programs, promoting harmonised language and measurement and supporting international trends in human services and public health.

Changes in individual needs for care and quality of life in Assertive Community Treatment patients: an observational study

BACKGROUND

It is largely unknown which unmet needs in the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) need to be resolved in order to improve a patients' subjective quality of life (QoL). We therefore investigated the pattern of individual unmet needs over time and its relation to QoL over time.

METHODS

Using data gathered from 251 patients in a Routine Outcome Monitoring procedure in Assertive Community Treatment (ACT) teams, we used paired samples tests to analyze differences in QoL total scores and the number of unmet needs between baseline and follow-up data. Ordinal regression was used to analyze the relationship between outcome in individual unmet needs and QoL.

RESULTS

As well as small improvements in QoL over time in patients in contact with ACT, we found a small to moderate decrease in unmet needs over time. While a decreasing number of unmet needs was associated with an increase in QoL, outcomes in QoL and individual unmet needs were weakly related (r ≤ .165). Ordinal regression analysis showed that a better outcome in individual unmet needs related to accommodation and day-time activities was weakly related to a better outcome in QoL.

CONCLUSIONS

Patients receiving ACT make small improvements in their QoL and ACT may help to solve some of their needs. QoL benefits from reducing needs for care, in particular the need for appropriate housing and meaningful daytime activities.

Measuring the needs of mental health patients in Greece: reliability and validity of the Greek version of the Camberwell assessment of need

BACKGROUND

Evaluation of mental health services based on patients' needs assessments has never taken place in Greece, although it is a crucial factor for the efficient use of their limited resources.

AIM

To examine the inter-rater and test-retest reliability and the concurrent/convergent validity of the Greek research version of the Camberwell Assessment of Need-Research (CAN-R).

METHOD

A total of 53 schizophrenic patient-staff pairs were interviewed twice to test the inter-rater and test-retest reliability of the Greek version of the CAN-R. The World Health Organization Quality of Life-Brief Form (WHOQOL-BREF) and World Health Organization Disability Assessment Schedule-2.0 (WHODAS-2.0) were administered to the patients to examine concurrent validity.

RESULTS

The inter-rater and test-retest reliability of patient and staff interviews for the 22 individual items and the eight summary scores of the instrument's four sections were good to excellent. Significant correlations emerged between CAN scores and the WHOQOL-BREF and WHODAS-2.0 domains for both patient and staff ratings, indicating good concurrent validity.

CONCLUSION

Our results suggest that the Greek version of the CAN-R is a reliable instrument for assessing mental health patients' needs. Moreover, it is the first CAN-R validity study with satisfactory results using WHOQOL-BREF and WHODAS-2.0 as criterion variables.

The CANSAS self-report for screening of needs in outpatients with schizophrenia and schizoaffective disorders

The importance of needs assessment for service development has been widely recognized. In this study we examined the agreement between the Camberwell Assessment of Need Short Appraisal Schedule self-report version (CANSAS-P) and the Camberwell Assessment of Need interview-based scale in 100 outpatients with schizophrenia and schizoaffective disorders. We found equivalent number of met, unmet, and no needs for most of the domains of the two instruments. Both intraclass correlations and Kappa reliability coefficients were high for most need domains. The high agreement between the two instruments suggests that the CANSAS-P can be used as a screening tool to detect unmet needs in both clinical routine practice and research surveys in mental health outpatient settings.

Changes in motivation for treatment in precontemplating dually diagnosed patients receiving assertive community treatment

In a population of dually diagnosed patients receiving assertive community treatment we used the theoretical framework of the transtheoretical model to establish (a) the proportions and characteristics of patients who were not motivated for treatment for psychiatric symptoms and substance use, (b) the proportion of patients who moved towards behavioral change after about 1 year, and examine how this change was related with clinical outcome; and (c) the sequence of change processes. Chi square tests and T tests were used to compare the patient characteristics and outcomes of patients who remained in precontemplation with those who progressed. During follow-up, 47 % of the patients came out of the precontemplation phase for treatment of psychiatric symptoms and 38 % for substance use behavior. Those who remained in precontemplation benefited less from treatment. Of those who did move forward, most appeared to become motivated for psychiatric treatment before becoming motivated to reduce substance use.

Assessment of need of patients with schizophrenia: a study in Vellore, India

BACKGROUND

and aims: There is a dearth of studies investigating the prevalence and factors associated with unmet needs in people with schizophrenia from low- and middle-income countries. We aimed to study prevalence and risk factors for unmet need.

METHOD

A case-control study design was employed. One hundred and one (101) consecutive patients attending a psychiatric hospital were assessed using Camberwell Assessment of Need Short version (CANSAS) and Positive and Negative Syndrome Scale (PANSS). Multivariate analysis was employed to adjust for confounders.

RESULTS

The majority of patients had many unmet needs. These unmet needs were significantly associated with lower education, poverty and persistent psychopathology on multivariate analysis.

CONCLUSION

Unmet needs are associated with poverty, lower education and persistent psychopathology. There is a need to manage unmet needs, in addition to addressing psychopathology and poverty.

Generating personalized advice for schizophrenia patients

The results of routine patient assessments in psychiatric healthcare in the Northern Netherlands are primarily used to support clinicians. We developed Wegweis, a web-based advice platform, to make this data accessible and understandable for patients.

OBJECTIVE

We show that a fully automated explanation and interpretation of assessment results for schizophrenia patients, which prioritizes the information in the same way that a clinician would, is possible and is considered helpful and relevant by patients. The goal is not to replace the clinician but rather to function as a second perspective and to enable patient empowerment through knowledge.

METHODS

We have developed and implemented an ontology-based approach for selecting and ranking information for schizophrenia patients based on their routine assessment results. Our approach ranks information by severity of associated schizophrenia-related problems and uses an ontology to decouple problems from advice, which adds robustness to the system, because advice can be inferred for problems that have no exact match.

RESULTS

We created a problem ontology, validated by a group of experts, to combine and interpret the results of multiple schizophrenia-specific questionnaires. We designed and implemented a novel ontology-based algorithm for ranking and selecting advice, based on questionnaire answers. We designed, implemented, and illustrated Wegweis, a proof of concept for our algorithm, and, to the best of our knowledge, the first fully automated interpretation of assessment results for patients suffering from schizophrenia. We evaluated the system vis-à-vis the opinions of clinicians and patients in two experiments. For the task of identifying important problems based on MANSA questionnaires (the MANSA is a satisfaction questionnaire commonly used in schizophrenia assessments), our system corresponds to the opinion of clinicians 94% of the time for the first three problems and 72% of the time, overall. Patients find two out of the first three advice topics selected by the system to be relevant and roughly half of the advice topics overall.

CONCLUSIONS

Our findings suggest that an approach that uses problem severities to identify important problems for a patient corresponds closely to the way a clinician thinks. Furthermore, after applying a severity threshold, the majority of advice units selected by the system are considered relevant by the patients. Our findings pave the way for the development of systems that facilitate patient-centered care for chronic illnesses by automating the sharing of assessment results between patient and clinician.

Needs assessment of individuals with serious mental illness: can it help in promoting recovery?

Needs of individuals with serious mental illness (SMI) must be understood in order to promote recovery. This study examined the needs of 206 individuals with SMI and compared their perceptions with those of their professional caregivers. Needs were reported in the areas of accommodations, psychotic symptoms, daytime activity, intimate relationships, and psychological distress. Caregivers reported more met needs, while individuals themselves reported more unmet needs. Results suggest that in order to promote recovery, services for persons with SMI should be developed in accordance with patients' most prominent needs, specifically in the social and personal areas of intimate and sexual relationships.

Factor structure in the Camberwell Assessment of Need-Patient Version: the correlations with dimensions of illness, personality and quality of life of schizophrenia patients

AIM

To investigate the factor structure underlying the Camberwell Assessment of Need-Patient Version (CANSAS-P) items in schizophrenia and schizoaffective disorder.

METHOD

Factor, correlation and regression analyses were performed for dimensions of CANSAS-P, illness, personality and quality of life (QOL) related variables in 95 stabilized patients with chronic schizophrenia and schizoaffective disorder.

RESULTS

Exploratory factor analysis revealed a four-factor model that explains 50.4% of the total variance of the 20 CANSAS-P items. The factors 'Social disability', 'Information processing disability', 'Emotional processing disability', and 'Coping disability' showed acceptable internal consistency (Cronbach's α coefficient 0.67-0.77). The CANSAS-P subscale scores positively correlated with severity of symptoms, distress (r ranged from 0.34 to 0.45), while negatively associated with general functioning (r = -0.34), friend (r = -0.46) and family support (r = -0.41), satisfaction with medicine (r = -0.35), general activities (r = -0.40), and general QOL (r = -0.35) (all P < 0.001). Severity of illness, symptoms, emotional distress and emotion-oriented coping were positive predictors; friend support, QOL general activities, life satisfaction and satisfaction with medicine were negative predictors of the CANSAS-P subscale scores. The effect size (f(2)) for these predictors ranged from medium to quite large (f(2) = 0.28-1.13), and they explain from 23% to 46% of the variability in CANSAS-P subscales.

CONCLUSIONS

A four-factor structure mode, including social and cognitive functioning, emotion responsivity and coping with daily challenges, appears to fit CANSAS-P items. These subscales may contribute to research and improve treatment of psychiatric patients.

Self-rated assessment of needs for mental health care: a qualitative analysis

This study explored perceived mental health-related needs and barriers to meeting them in primary and mental health care settings. Fifty-one participants completed the Perceived Need for Care Questionnaire and an interview to qualitatively explore the meanings behind self-identified needs for medication, information, counselling, practical help, and skills development. Qualitative content analysis indicated perceived needs for care are multifaceted. Dissatisfaction with taking medication may coexist with perceiving medication needs as met; information needs predominantly concerned wanting to better understand one's illness; and communication was the main perceived barrier to meeting these needs. Counselling-related needs included being listened to, supported or assisted with problem-solving, with service attitudes, staff expertise or cost seen as limiting access. Needs for practical help and skills development were described as unmet or addressed by family, and help-seeking for these needs constrained by efforts to self-manage, insufficient information, and affordability. Collaborative care and information-sharing appear important to better meet mental health-related perceived needs.

Subjective well-being, hope, and needs of individuals with serious mental illness

Hope, as a basic resource in human life, may affect individuals' perceptions of subjective well-being (SWB). Further, understanding individuals' needs is essential to improving their SWB. It is unclear how the impact of hope on SWB may be mediated by needs. The current study aimed to examine a mediation model for the relation between hope and SWB among individuals with serious mental illness (SMI). Face-to-face structured interviews were conducted with 172 individuals with SMI. Instruments included the Personal Wellbeing Index, the Hope Scale, and the Camberwell Assessment of Needs. Hope and needs were predictive of 40% of the variability in SWB, with hope being a stronger predictor. Having no needs was positively predictive of SWB, while total number of needs was negatively predictive of SWB. Path analyses revealed a strong direct effect of hope on SWB and a weaker, though still strong, indirect effect mediated through needs. The results underscore the importance of hope in improving SWB and, consequently, enhancing the recovery process of individuals with SMI. Therefore, mental health services should focus on hope-building.

Instruments for comprehensive needs assessment in individuals with cognitive complaints, mild cognitive impairment or dementia: a systematic review

OBJECTIVE

In recent years, it has become more common to complement the objective assessment of symptoms with an assessment of individual needs patterns that are created by the individual pattern of symptoms. However, little is known on needs patterns in individuals with subjective cognitive impairment, mild cognitive impairment and dementia. Thus, on the basis of an analysis of the development of needs in the course of cognitive decline, we provide an overview of the existing needs assessment instruments with respect to feasibility, validity and reliability.

METHOD

We conducted a literature search in PsycINFO and PubMed including all publications up to September 2009. We included needs assessment instruments for use in older individuals with mental or cognitive disorders and dementia.

RESULTS

We identified 17 needs assessment instruments for individuals with mental disorders, cognitive impairment or dementia. The analysis of selected articles demonstrated a wide range of needs indicators within different subgroups. Validity and reliability range between moderate and good.

CONCLUSIONS

Even though a wide range of needs assessment instruments is available, most instruments assess the needs of individuals with subjective cognitive impairment, mild cognitive impairment and dementia on a general level rather than on a more concrete level that may serve better to inform interventions for this growing population. In addition, we suggest basing the development of instruments firmly on an adequate theoretical framework and standardised procedural guidelines.

Collaborative care for patients with bipolar disorder: a randomised controlled trial

BACKGROUND

Bipolar disorder is a severe mental illness with serious consequences for daily living of patients and their caregivers. Care as usual primarily consists of pharmacotherapy and supportive treatment. However, a substantial number of patients show a suboptimal response to treatment and still suffer from frequent episodes, persistent interepisodic symptoms and poor social functioning. Both psychiatric and somatic comorbid disorders are frequent, especially personality disorders, substance abuse, cardiovascular diseases and diabetes. Multidisciplinary collaboration of professionals is needed to combine all expertise in order to achieve high-quality integrated treatment. 'Collaborative Care' is a treatment method that could meet these needs. Several studies have shown promising effects of these integrated treatment programs for patients with bipolar disorder. In this article we describe a research protocol concerning a study on the effects of Collaborative Care for patients with bipolar disorder in the Netherlands.

METHODS/DESIGN

The study concerns a two-armed cluster randomised clinical trial to evaluate the effectiveness of Collaborative Care (CC) in comparison with Care as usual (CAU) in outpatient clinics for bipolar disorder or mood disorders in general. Collaborative Care includes individually tailored interventions, aimed at personal goals set by the patient. The patient, his caregiver, the nurse and the psychiatrist all are part of the Collaborative Care team. Elements of the program are: contracting and shared decision making; psycho education; problem solving treatment; systematic relapse prevention; monitoring of outcomes and pharmacotherapy. Nurses coordinate the program. Nurses and psychiatrists in the intervention group will be trained in the intervention. The effects will be measured at baseline, 6 months and 12 months. Primary outcomes are psychosocial functioning, psychiatric symptoms, and quality of life. Caregiver outcomes are burden and satisfaction with care.

DISCUSSION

Several ways to enhance the quality of this study are described, as well as some limitations caused by the complexities of naturalistic treatment settings where not all influencing factors on an intervention and the outcomes can be controlled.

TRIAL REGISTRATION

The Netherlands Trial Registry, NTR2600.

Evaluating the CANSAS self-report (CANSAS-P) as a screening instrument for care needs in people with psychotic and affective disorders

We examined agreement between the CANSAS self-report version (CANSAS-P) and the Camberwell Assessment of Need (CAN) interview in 200 long-term patients with affective and psychotic disorders. Intra-class correlations were fair to good for unmet needs. Overall, more unmet needs were reported on the CANSAS-P than in the CAN interview. No differences were found for patients with psychotic versus affective disorders. We conclude from this that the CANSAS-P is a promising screening instrument to detect unmet needs in people with severe mental illnesses.

Clinical decision making and outcome in routine care for people with severe mental illness (CEDAR): study protocol

BACKGROUND

A considerable amount of research has been conducted on clinical decision making (CDM) in short-term physical conditions. However, there is a lack of knowledge on CDM and its outcome in long-term illnesses, especially in care for people with severe mental illness.

METHODS/DESIGN

The study entitled "Clinical decision making and outcome in routine care for people with severe mental illness" (CEDAR) is carried out in six European countries (Denmark, Germany, Hungary, Italy, Switzerland and UK). First, CEDAR establishes a methodology to assess CDM in people with severe mental illness. Specific instruments are developed (and psychometric properties established) to measure CDM style, key elements of CDM in routine care, as well as CDM involvement and satisfaction from patient and therapist perspectives. Second, these instruments are being put to use in a multi-national prospective observational study (bimonthly assessments during a one-year observation period; N = 560). This study investigates the immediate, short- and long-term effect of CDM on crucial dimensions of clinical outcome (symptom level, quality of life, needs) by taking into account significant variables moderating the relationship between CDM and outcome.

DISCUSSION

The results of this study will make possible to delineate quality indicators of CDM, as well as to specify prime areas for further improvement. Ingredients of best practice in CDM in the routine care for people with severe mental illness will be extracted and recommendations formulated. With its explicit focus on the patient role in CDM, CEDAR will also contribute to strengthening the service user perspective. This project will substantially add to improving the practice of CDM in mental health care across Europe.

TRIAL REGISTER

ISRCTN75841675.

Outcome measurement in chronic mental illness

This review begins with an outline of outcome measurement in the country where it has been most thoroughly implemented, namely Australia. There follows a consideration of what constitutes an outcome in mental illness generally, and chronic mental illness in particular. Some instruments, such as the Health of the Nation Outcome Scales (HoNOS), focus primarily on illness severity, and examples of their use in the area of chronic mental illness are presented. Other instruments, such as the Life Skills Profile (LSP), assess personal functioning or disability, and that literature is reviewed. One major area of attention in the chronically mentally ill is quality of life. Another fruitful approach to assessing outcome is to look at needs, especially unmet needs, for which the leading instrument is the Camberwell Assessment of Need; relevant findings are reviewed. The most recent area of interest is recovery. While several scales have been developed, there are as yet relatively few reports of their application with patients with chronic mental illness. The concluding section considers the benefits and weaknesses of using the same standard instruments with all consumers within a service, and shows the utility of outcome results in groups and individuals with generally small overall changes.

Providing support to psychiatric patients living in the community in Japan: patient needs and care providers perceptions

Background

Social support programs are a critical component of care for psychiatric patients living in community or residential settings. There is little information, however, on how to optimally deliver these services in the Japanese context.

Methods

We selected ten community life support centers for patients with major mental illness and administered questionnaires to 199 pairs of patients and staff members. These questionnaires consisted of twenty-six items from six categories: difficulties with interpersonal relationships; risks to physical well-being; risks to mental health; difficulties with life skills; challenges regarding living conditions; risks towards community safety. For each of these items, patients were asked whether they had experienced difficulties during the previous month, and staff members were asked the extent to which their patients needed support.

Results

The results demonstrated that staff members tended to understate patients' needs regarding chronic medical conditions (p < 0.01), dietary habits (< 0.01), and excessive smoking or alcohol drinking (< 0.05). On the other hand, staff members recognized patients' needs regarding mental health problems to a greater extent than patients themselves (< 0.05).

Conclusion

Results of this study suggest that social services geared towards specific tasks of daily living form an important component of comprehensive care for psychiatric patients living in community settings in Japan.