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Oberleitner LMS, Madden LM, Muthulingam D, Marcus R, Oberleitner DE, Beitel M, Gaeta M, Tamberelli JF, Barry DT. A qualitative investigation of addiction counselors' perceptions and experiences implementing an open-access model for treating opioid use disorder. J Subst Abuse Treat 2020; 121:108191. [PMID: 33357602 DOI: 10.1016/j.jsat.2020.108191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/18/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine addiction counselors' perceptions and experiences of implementing an open-access model for methadone maintenance treatment (MMT), in which the program rapidly enrolled prospective patients, irrespective of ability to pay, and provided real-time access to multiple voluntary treatment options. Between 2006, when the treatment program initially implemented this model, and 2020, the census of clients receiving methadone maintenance at the study site grew from 1431 to 4500. METHODS Participants were 31 addiction counselors employed at a treatment organization that implemented an open-access model to scale up MMT. We examined counselors' perceptions and experiences of working in programs that employed this model, using individual semi-structured interviews, which an interdisciplinary team audiotaped, transcribed, and systematically coded using grounded theory. The team reviewed themes and reconciled disagreements (rater agreement was 98%). We describe themes that more than 10% of participants reported. RESULTS Counselors described perceived advantages of the open-access model for clients (e.g., "individualized to client needs"), clinicians (e.g., "fewer demands"), and the community (e.g., "crime reduced"). Counselors also described perceived disadvantages of the open-access model for clinicians (e.g., "uneven workload") and clients (e.g., "need for more intensive services for some clients"), as well as program-level concerns (e.g., "perceived lack of structure"). CONCLUSIONS Counselors who work in opioid treatment programs that use an open-access framework described multiple benefits to themselves, their clients, and the public; they also outlined disadvantages for themselves and clients, which research should further explore and address to facilitate MMT scale up.
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Affiliation(s)
- Lindsay M S Oberleitner
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Lynn M Madden
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA
| | - Dharushana Muthulingam
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA; Washington University, Division of Infectious Disease, St. Louis, MO 63112, USA
| | - Ruthanne Marcus
- The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Department of Internal Medicine, New Haven, CT 06510, USA
| | - David E Oberleitner
- The APT Foundation, Inc., New Haven, CT 06519, USA; University of Bridgeport, Department of Psychology, Bridgeport, CT 06604, USA
| | - Mark Beitel
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Child Study Center, New Haven, CT 06510, USA
| | - Marina Gaeta
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Joseph F Tamberelli
- Western Connecticut State University, Department of Psychology, Danbury, CT 06810, USA; The APT Foundation, Inc., New Haven, CT 06519, USA
| | - Declan T Barry
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06510, USA; The APT Foundation, Inc., New Haven, CT 06519, USA; Yale School of Medicine, Child Study Center, New Haven, CT 06510, USA.
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Abstract
As primary care models increasingly include nonphysician team members, more attention should be paid to patient- and family-centered care (PFCC) among medical assistants (MAs). The aims of this article are to describe parent perceptions of PFCC by MAs and assess associations between MA PFCC and other perceptions of their care experience. To assess PFCC, we administered the CARE (Consultation and Relational Empathy) measure to the parent/guardian of 360 children following a primary care visit. Perceptions of PFCC by MAs were significantly associated with 6 of 7 other measures of patient experience, including PFCC by the physician, treatment by the receptionist, and satisfaction with wait time. Each team member can potentially shape perceptions of care in ways that could "spill over" into other parts of the visit.
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3
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Sandage SJ, Moon SH, Rupert D, Paine DR, Ruffing EG, Kehoe LE, Bronstein M, Hassen SC. Relational dynamics between psychotherapy clients and clinic administrative staff: A pilot study. PSYCHODYNAMIC PRACTICE 2017. [DOI: 10.1080/14753634.2017.1335226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Steven J. Sandage
- Albert and Jessie Danielsen Institute, Boston University, Boston, MA, USA
- MF Norwegian School of Theology, Oslo, Norway
| | - Sarah H. Moon
- Albert and Jessie Danielsen Institute, Boston University, Boston, MA, USA
| | - David Rupert
- Albert and Jessie Danielsen Institute, Boston University, Boston, MA, USA
| | - David R. Paine
- Albert and Jessie Danielsen Institute, Boston University, Boston, MA, USA
| | | | - Lauren E. Kehoe
- Albert and Jessie Danielsen Institute, Boston University, Boston, MA, USA
| | - Miriam Bronstein
- Albert and Jessie Danielsen Institute, Boston University, Boston, MA, USA
| | - Sarah C. Hassen
- Albert and Jessie Danielsen Institute, Boston University, Boston, MA, USA
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Abstract
Children's mental health problems are among global health advocates' highest priorities. Nearly three-quarters of adult disorders have their onset or origins during childhood, becoming progressively harder to treat over time. Integrating mental health with primary care and other more widely available health services has the potential to increase treatment access during childhood, but requires re-design of currently-available evidence-based practices to fit the context of primary care and place a greater emphasis on promoting positive mental health. While some of this re-design has yet to be accomplished, several components are currently well-defined and show promise of effectiveness and practicality.
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Affiliation(s)
- Lawrence S Wissow
- Center for Mental Health in Pediatric Primary Care, Department of Health, Behavior, and Society, Johns Hopkins School of Public Health, 703 Hampton House, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Nadja van Ginneken
- Departments of Psychological Sciences and Health Services, Institute of Psychology, Health & Society, University of Liverpool, Waterhouse Building, 2nd Floor Block B, 1-5 Brownlow Street, Liverpool L69 3GL, UK
| | - Jaya Chandna
- Departments of Psychological Sciences and Health Services, Institute of Psychology, Health & Society, University of Liverpool, Waterhouse Building, 2nd Floor Block B, 1-5 Brownlow Street, Liverpool L69 3GL, UK
| | - Atif Rahman
- Departments of Psychological Sciences and Health Services, Institute of Psychology, Health & Society, University of Liverpool, Waterhouse Building, 2nd Floor Block B, 1-5 Brownlow Street, Liverpool L69 3GL, UK
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Zugai JS, Stein-Parbury J, Roche M. Therapeutic alliance in mental health nursing: an evolutionary concept analysis. Issues Ment Health Nurs 2015; 36:249-57. [PMID: 25988275 DOI: 10.3109/01612840.2014.969795] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The concept of therapeutic alliance is relevant in contemporary mental health care, as the consumer-led recovery movement promotes the development of collaborative relationships, and is focussed on the consumer's individual concept of wellbeing. An evolutionary concept analysis was undertaken to establish a contemporary interpretation of therapeutic alliance for mental health nursing. The CINAHL, Scopus and PsycINFO databases were searched for articles (n = 322), with 52 deemed appropriate for analysis. Therapeutic alliance is characterised by mutual partnerships between nurses and consumers, and is dependent on a humanistic healthcare culture. Therapeutic alliance is associated with enhanced consumer outcomes and experiences with care.
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Affiliation(s)
- Joel Sebastian Zugai
- University of Technology Sydney, Faculty of Health, Sydney, New South Wales, Australia
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Lê Cook B, Brown JD, Loder S, Wissow L. Acculturation differences in communicating information about child mental health between Latino parents and primary care providers. J Immigr Minor Health 2014; 16:1093-102. [PMID: 24705736 PMCID: PMC4185306 DOI: 10.1007/s10903-014-0010-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Significant Latino-white disparities in youth mental health care access and quality exist yet little is known about Latino parents' communication with providers about youth mental health and the role of acculturation in influencing this communication. We estimated regression models to assess the association between time in the US and the number of psychosocial issues discussed with the medical assistant (MA) and doctor, adjusting for child and parent mental health and sociodemographics. Other proxies of acculturation were also investigated including measures of Spanish and English language proficiency and nativity. Parent's length of time in the US was positively associated with their communication of: their child's psychosocial problems with their child's MA, stress in their own life with their child's MA, and their child's school problems with their child's doctor. These differences were especially apparent for parents living in the US for >10 years. Parent-child language discordance, parent and child nativity were also significantly associated with communication of psychosocial problems. Greater provider and MA awareness of variation in resistance to communicating psychosocial issues could improve communication, and improve the prevention, diagnosis and treatment of youth mental illness.
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Affiliation(s)
- Benjamin Lê Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Assistant Professor, Department of Psychiatry, Harvard Medical School, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8449, 617-503-8430 (fax),
| | - Jonathan D. Brown
- Mathematica Policy Research, 1100 1st St NE #1200, Washington, DC 20002, (202) 484-9220,
| | - Stephen Loder
- Center for Multicultural Mental Health Research, Cambridge Health, Alliance, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8440, 617-503-8430 (fax),
| | - Larry Wissow
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, #703 Baltimore, MD 21287, 410-614-1243,
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Brown JD, Wissow LS, Cook BL, Longway S, Caffery E, Pefaure C. Mental health communications skills training for medical assistants in pediatric primary care. J Behav Health Serv Res 2013; 40:20-35. [PMID: 23070564 DOI: 10.1007/s11414-012-9292-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Paraprofessional medical assistants (MAs) could help to promote pediatric primary care as a source of mental health services, particularly among patient populations who receive disparate mental health care. This project piloted a brief training to enhance the ability of MAs to have therapeutic encounters with Latino families who have mental health concerns in pediatric primary care. The evaluation of the pilot found that MAs were able to master most of the skills taught during the training, which improved their ability to have patient-centered encounters with families during standardized patient visits coded with the Roter Interaction Analysis System. Parents interviewed 1 and 6 months following the training were more than twice as willing as parents interviewed 1 month before the training to discuss mental health concerns with MAs, and they had better perceptions of their interactions with MAs (all p < 0.01) even after controlling for a range of patient and visit characteristics. Before training, 10.2% of parents discussed a mental health concern with the MA but not the physician; this never happened 6 months after training. This pilot provides preliminary evidence that training MAs holds potential to supplement other educational and organizational interventions aimed at improving mental health services in pediatric primary care, but further research is necessary to test this type of training in other settings and among different patient populations.
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Rethinking the mental health treatment skills of primary care staff: a framework for training and research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 39:489-502. [PMID: 21915748 DOI: 10.1007/s10488-011-0373-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Health care reforms may offer several opportunities to build the mental health treatment capacity of primary care. Capitalizing on these opportunities requires identifying the types of clinical skills that the primary care team requires to deliver mental health care. This paper proposes a framework that describes mental health skills for primary care receptionists, medical assistants, nurses, nurse practitioners, and physicians. These skills are organized on three levels: cross-cutting skills to build therapeutic alliance; broad-based, brief interventions for major clusters of mental health symptoms; and evidence-based interventions for diagnosis specific disorders. This framework is intended to help inform future mental health training in primary care and catalyze research that examines the impact of such training.
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Cookson A, Daffern M, Foley F. Relationship between aggression, interpersonal style, and therapeutic alliance during short-term psychiatric hospitalization. Int J Ment Health Nurs 2012; 21:20-9. [PMID: 21819511 DOI: 10.1111/j.1447-0349.2011.00764.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Aggression during psychiatric hospitalization is frequent, problematic, and a major challenge for nurses and mental health services more generally. The strength of the therapeutic alliance between nursing staff and patients has been posited as an important protective factor that can limit the likelihood of aggression. This study examined the relationship between interpersonal style, perceived coercion, and psychiatric symptoms on the therapeutic alliance between patients and staff, and how each, in turn, is related to aggression. Participants in this study were 79 patients admitted to an acute psychiatric hospital. Each participant was interviewed to determine perceived coercion, symptoms of psychiatric illness, interpersonal style, and therapeutic alliance. Incidents of aggression were recorded at discharge through a review of incident forms, file review, and interviews with unit nursing staff. The results showed that a hostile-dominant interpersonal style and symptoms of paranoia predicted poor therapeutic alliance, contributing 14% of the variance in therapeutic alliance scores. A dominant interpersonal style predicted aggression towards staff. Therapeutic alliance, perceived coercion, and symptoms of psychiatric illness did not predict aggression. Implications for engagement in treatment and the prevention of aggression are discussed.
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Affiliation(s)
- Amy Cookson
- School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
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10
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Loos S, Kilian R, Becker T, Janssen B, Freyberger H, Spiessl H, Grempler J, Priebe S, Puschner B. Psychometric Properties of the German Version of the Scale to Assess the Therapeutic Relationship in Community Mental Health Care (D-STAR). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2012. [DOI: 10.1027/1015-5759/a000105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: There are presently no instruments available in German language to assess the therapeutic relationship in psychiatric care. This study validates the German version of the Scale to Assess the Therapeutic Relationship in Community Mental Health Care (D-STAR). Method: 460 persons with severe mental illness and 154 clinicians who had participated in a multicenter RCT testing a discharge planning intervention completed the D-STAR. Psychometric properties were established via item analysis, analyses of missing values, internal consistency, and confirmatory factor analysis. Furthermore, convergent validity was scrutinized via calculating correlations of the D-STAR scales with two measures of treatment satisfaction. Results: As in the original English version, fit indices of a 3-factor model of the therapeutic relationship were only moderate. However, the feasibility and internal consistency of the D-STAR was good, and correlations with other measures suggested reasonable convergent validity. Conclusions: The psychometric properties of the D-STAR are acceptable. Its use can be recommended in German-speaking countries to assess the therapeutic relationship in both routine care and research.
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Affiliation(s)
- Sabine Loos
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University, Günzburg, Germany
| | - Birgit Janssen
- Department of Psychiatry and Psychotherapy, Düsseldorf University, Germany
| | - Harald Freyberger
- Department of Psychiatry and Psychotherapy, Greifswald University, Stralsund, Germany
| | - Hermann Spiessl
- Department of Psychiatry and Psychotherapy, Regensburg University, Germany
| | - Julia Grempler
- Department of Psychiatry and Psychotherapy I, Ulm University, Ravensburg, Germany
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, UK
| | - Bernd Puschner
- Department of Psychiatry II, Ulm University, Günzburg, Germany
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Pinho LBD, Hernández AMB, Kantorski LP. Reforma psiquiátrica, trabalhadores de saúde mental e a "parceria" da família: o discurso do distanciamento. INTERFACE - COMUNICAÇÃO, SAÚDE, EDUCAÇÃO 2010. [DOI: 10.1590/s1414-32832010000100009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Este estudo analisou o discurso de trabalhadores de saúde mental sobre a participação da família no tratamento. O corpus foi composto por entrevistas aplicadas a 17 dos 25 profissionais que trabalham em um serviço substitutivo de uma cidade da região Sul do Brasil. O referencial teórico-filosófico foi a Análise Crítica do Discurso. O dispositivo metodológico que subsidiou a sistematização dos dados foi o "diagrama axiológico-discursivo". Verificou-se que os trabalhadores manifestam a importância da família no tratamento do usuário, entretanto, representação ainda pautada na responsabilização e culpabilização, quando a família se afasta do tratamento. Aos poucos, a "parceria" vai dando espaço ao "distanciamento", como dimensão cuidadora nos serviços de saúde mental. Espera-se que este estudo subsidie a constante reflexão sobre o papel das famílias em saúde mental, temática importante para repensar saberes e práticas sobre o louco, a loucura e suas relações no contexto da reforma psiquiátrica.
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