An engagement and access model for healthcare delivery to adolescents with mood and anxiety concerns

Factors associated with initiation of community-based therapy for emerging adults with mood and anxiety disorders

AIM

The First Episode Mood and Anxiety Program (FEMAP) is a community-based early intervention program that has been shown to improve health outcomes for emerging adults (EAs) with mood and anxiety disorders. However, not all EAs who are admitted to the program initiate treatment. Our aim was to identify factors that distinguish those who initiated treatment from those who did not.

METHODS

FEMAP administered questionnaires to EAs upon first contact with the program, collecting information on a range of socioeconomic, patient and condition-related factors. We compared EAs who initiated treatment in the program (n = 318, 87.4%) to those who did not (n = 46, 12.6%). To examine factors associated with treatment initiation, we specified a parsimonious logistic regression model, using the method of purposeful selection to choose from a range of candidate variables.

RESULTS

Anxiety Sensitivity Index - Revised (ASI-R), binge drinking and cannabis use were included in the final logistic regression model. Each one-point increment in the ASI-R score was associated with a 1% increase in the odds of treatment initiation (OR = 1.014; 95% CI [1.003, 1.026]). No other variable was significantly associated with treatment initiation.

CONCLUSIONS

Our study provides insight on the differences between EAs with mood and anxiety disorders who initiated targeted treatment services and those who did not. Anxiety sensitivity was significantly associated with treatment initiation at FEMAP. Our findings suggest that it may be anxiety sensitivity, rather than depression or functional impairment per se that drive treatment initiation among EAs.

Partners in Recovery: an early phase evaluation of an Australian mental health initiative using program logic and thematic analysis

Background

Mental illness is a leading cause of illness and disability and around 75% of people suffering mental illness do not have access to adequate care. In Australia, nearly half the population experiences mental illness at some point in their life. The Australian Government developed a National program called Partners in Recovery (PIR) to support those with severe and persistent mental illness. The program was implemented through 48 consortia across Australia. One of these was led by the Nepean Blue Mountains Medicare Local who adapted the program according to its specific local needs.

Methods

We conducted an early evaluation of the PIR program in Nepean Blue Mountains (NBMPIR) using a program logic model (PLM) to frame the evaluation and complemented this with an additional thematic analysis. Participants (n = 73) included clients and carers, program management and staff of the Consortium and other partners and agencies, and clinical, allied health, and other service providers. Our PLM utilised multiple data sources that included document review, open and closed survey questions, and semi-structured interviews. Quantitative data received a descriptive analysis and qualitative data was analysed both in alignment with the PLM framework and inductively.

Results

We aligned our results to PLM domains of inputs, activities, outputs, outcomes and impacts. The NBMPIR consortium implemented a recovery approach and provided greater access to services by enhancing healthcare provider partnerships. Our thematic analysis further described five key themes of collaboration; communication; functioning of PIR; structural/organisational challenges; and understanding of PIR approaches. Facilitators and barriers to the NBMPIR program centred on the alignment of vision and purpose; building an efficient system; getting the message out and sharing information; understanding roles and support and training of staff; building capacity and systems change; addressing service gaps; and engaging peers.

Conclusions

Our study provided helpful insights into the coordinated management of complex mental illness. The NBMPIR’s focus on partnerships and governance, service coordination, and systems change has relevance for others engaged in this work. This PLM effectively mapped the program, including its processes and resources, and is a useful framework providing a baseline for future evaluations.

Full report available at https://researchdirect.westernsydney.edu.au/islandora/object/uws:33977/

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4360-2) contains supplementary material, which is available to authorized users.

Access and Health System Impact of an Early Intervention Treatment Program for Emerging Adults with Mood and Anxiety Disorders

OBJECTIVES

Early intervention programs are effective for improving outcomes in first-episode psychosis; however, less is known about their effectiveness for mood and anxiety disorders. We sought to evaluate the impact of an early intervention program for emerging adults with mood and anxiety disorders in the larger health system context, relative to standard care.

METHODS

Using health administrative data, we constructed a retrospective cohort of cases of mood and anxiety disorders among emerging adults aged 16 to 25 years in the catchment of the First Episode Mood and Anxiety Program (FEMAP) in London, Ontario, between 2009 and 2014. This cohort was linked to primary data from FEMAP to identify service users. We used proportional hazards models to compare indicators of service use between FEMAP users and a propensity score-matched group of nonusers receiving care elsewhere in the health system.

RESULTS

FEMAP users (n = 490) had more rapid access to a psychiatrist relative to nonusers (hazard ratio [HR], 2.82; 95% confidence interval, 2.45 to 3.26; median time, 16 vs. 71 days). In the year following admission, FEMAP users also had lower rates of emergency department use for mental health reasons (HR, 0.73; 95% CI, 0.53 to 0.99). We did not observe differences in psychiatric hospitalization rates.

CONCLUSIONS

An early intervention model of care for mood and anxiety disorders is associated with better access to psychiatric care and lower use of the emergency department. Our findings suggest that early intervention services for mood and anxiety disorders may be beneficial from a health systems perspective, and further research on the effectiveness of this model of care is warranted.

Psychological interventions in psychosis in children and adolescents: a systematic review

BACKGROUND

Early onset psychosis (EOP), referring to psychosis with onset before the age of 18 years, is a more severe form of psychosis associated with worse prognosis. While medication is the treatment of choice, psychological interventions are also considered to have an important role in the management of symptoms and disability associated with this condition. The present review aimed to explore the effectiveness of such interventions.

METHOD

An electronic search was conducted on the Embase, Medline, and PsychInfo databases for papers of randomized controlled trials (RCTs) referring to psychological interventions in EOP. References of identified papers were hand searched for additional studies. Identified studies were quality assessed.

RESULTS

Eight studies were included in the present review evaluating cognitive remediation therapy (CRT), cognitive behavioural therapy (CBT), a family intervention and psychoeducation. CRT was associated with improvement in cognitive function and CBT and CRT seem to also have a positive effect in psychosocial functioning. Symptom reduction appears to not be significantly affected by the proposed treatments.

CONCLUSIONS

There is some evidence supporting the effectiveness of psychological interventions in EOP. However, most research on adolescents is focused on CRT and its effects on cognitive deficits. More studies on the effects of psychological interventions in EOP are needed.

Youth Perspectives on the Mental Health Treatment Process: What Helps, What Hinders?

In this study we explored adolescent perceptions of what was most helpful and most challenging about mental health treatment for mood and/or anxiety disorders. Youth seeking treatment at the First Episode Mood and Anxiety Program were recruited to participate in a follow-up survey about their experiences of mental health care services. Responses to two open-ended questions were analyzed for emerging themes and differences between age groups and gender. Males were more likely to report therapy as being helpful than females, 16-18 year olds were more likely to report medication as a challenge to treatment and 19-26 year olds were more likely to report accessing services as a challenge to treatment. Understanding what helps and what hinders treatment-seeking youth can guide both clinical treatment and service delivery models for this population.