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Gotham HJ, Benson F, Canelo R, Walker ER, Navarro M, Clayton CN, Orobitg-Brenes D, Carrión-González I, Tomlin K, Olson JR. A National Snapshot of Training and Technical Assistance Needs Within the Mental Health Workforce. Psychiatr Serv 2024:appips20230602. [PMID: 39257311 DOI: 10.1176/appi.ps.20230602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
OBJECTIVE This report summarizes results from a national survey that aimed to assess the training and technical assistance needs of individuals who work in mental health. METHODS A survey was distributed to mental health workers by 10 regional centers of a large, nationwide, federally funded training and technical assistance network during January-October 2021. RESULTS A total of 2,321 individuals from 58 states and territories responded to the survey. The three training and technical assistance needs they indicated most frequently were equitable and culturally responsive services, co-occurring mental and substance use disorders, and mental health awareness and literacy. CONCLUSIONS The survey findings reflect the continued need to address inequities in mental health services, particularly for communities of color. In addition, a cluster of topics (i.e., mental health awareness and literacy, trauma-informed care, crisis services, grief, and provider well-being) stemmed from the COVID-19 pandemic and its effects on the nation's mental health.
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Affiliation(s)
- Heather J Gotham
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Felicia Benson
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Ricardo Canelo
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Elizabeth Reisinger Walker
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Mia Navarro
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Christina N Clayton
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Darice Orobitg-Brenes
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Ibis Carrión-González
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Kathyleen Tomlin
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
| | - Jonathan R Olson
- Mental Health Technology Transfer Center (MHTTC) Network Coordinating Office, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California (Gotham, Benson, Canelo, Navarro); Southeast MHTTC, Rollins School of Public Health, Emory University, Atlanta (Walker); Northwest MHTTC, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Clayton, Olson); National Hispanic and Latino MHTTC, School of Medicine, Universidad Central del Caribe, Bayamon, Puerto Rico (Orobitg-Brenes, Carrión-González); National American Indian and Alaska Native MHTTC, University of Iowa, Iowa City (Tomlin)
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McClanahan A, Adams CN, Hackman AL, Cotes RO, Minkoff K. Postcrisis Follow-Up and Linkage to Community Services. Psychiatr Clin North Am 2024; 47:531-546. [PMID: 39122344 DOI: 10.1016/j.psc.2024.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
During the postcrisis period, many individuals struggle to transition to available care, often falling through the cracks. This article discusses effective postcrisis approaches that provide rapid access to transitional team-based care using critical time intervention strategies. It also highlights the development of state, county, and funder models for "care-traffic control" to ensure swift linkage to follow-up services, along with new funding models that support intensive community crisis stabilization during the postcrisis period. Emerging crisis systems can leverage these emerging services and approaches to facilitate successful transitions for individuals in need.
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Affiliation(s)
- Alexander McClanahan
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President Street, MSC 865, Charleston, SC 29425, USA
| | - Curtis N Adams
- Department of Psychiatry, University of Maryland School of Medicine, 701 W Pratt Street, 5th Floor, Baltimore, MD 21201, USA
| | - Ann L Hackman
- Department of Psychiatry, University of Maryland School of Medicine, 701 W Pratt Street, 5th Floor, Baltimore, MD 21201, USA
| | - Robert O Cotes
- Department of Psychiatry and Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA 30303, USA
| | - Kenneth Minkoff
- ZiaPartners, Inc, 15270 North Oracle Road, Suite 124-308, Catalina, AZ 85739, USA.
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Roosenschoon BJ, van Weeghel J, Deen ML, van Esveld EW, Kamperman AM, Mulder CL. Fidelity and Clinical Competence in Providing Illness Management and Recovery: An Explorative Study. Community Ment Health J 2023; 59:1508-1520. [PMID: 37253901 PMCID: PMC10598171 DOI: 10.1007/s10597-023-01137-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 05/07/2023] [Indexed: 06/01/2023]
Abstract
Illness Management and Recovery (IMR) is a psychosocial intervention supporting people with serious mental illnesses. In this study, 15 IMR groups were assessed for fidelity and clinician competency to establish the implementation level of all IMR elements and explore complementarity of the IMR Treatment Integrity Scale (IT-IS) to the standard IMR Fidelity Scale. Use of the IT-IS was adapted, similar to the IMR Fidelity Scale. Descriptive statistics were applied. Implementation success of IMR elements varied widely on the IMR Fidelity Scale and IT-IS (M = 3.94, SD = 1.13, and M = 3.29, SD = 1.05, respectively). Twelve IMR elements (60%) were well-implemented, whereas eight (40%) were implemented insufficiently, including some critical cognitive-behavioral techniques (e.g., role-playing). The scales appeared largely complementary, though strongly correlated (r (13) = 0.74, p = 0.002). Providing all IMR elements adequately requires a variety of clinical skills. Specific additional training and supervision may be necessary.
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Affiliation(s)
- Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
- Parnassia Academy, Parnassia Psychiatric Institute, Kiwistraat 32, Den Haag, 2552 DH, The Netherlands.
| | - Jaap van Weeghel
- Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, 5000 LE, The Netherlands
| | - Mathijs L Deen
- Parnassia Academy, Parnassia Psychiatric Institute, Kiwistraat 32, Den Haag, 2552 DH, The Netherlands
- Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
| | | | - Astrid M Kamperman
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
- ANTES Mental Health Care, Parnassia Psychiatric Institute, Albrandswaardsedijk 74, Poortugaal, 3172 AA, The Netherlands
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4
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Meneghelli A, Ciancaglini P, Di Domenico M, Mazzola A, Ghio L, Preti A. Implementation of early intervention clinical services within the National Health System in Italy: Third wave survey with focus on structures, resources, and fidelity to the evidence-based model. Early Interv Psychiatry 2023; 17:884-892. [PMID: 36682817 DOI: 10.1111/eip.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/23/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Early intervention in psychosis (EIP) is a well-established approach aimed at detecting and treating early signs and symptoms of psychosis to prevent its long-term consequences. The present study aimed at detailing the current status of EIP services in Italy, covering all the Departments of Mental Health (DMHs) operating in 2018. METHODS All directors of public DMHs operating in Italy in 2018 (n = 127) were invited to fill in a Census form about EIP structure and activities. The first episode psychosis services fidelity scale (FEPS-FS) was used to investigate fidelity to the EIP model of the centre. RESULTS An active EIP service was reported by 41 DMHs (32% of the total DMHs; 56% of those who took part in the survey). Most EIP services had an autonomous team. The large majority of the Italian EIP centres provided psychosocial interventions to their patients, principally psychotherapy, family support, and psychoeducation. Among those with an active EIP, 29 DMHs filled in the FEPS-FS. Internal consistency was good when based on the replies of the respondents, but reliability was weak when measured on the basis of an independent evaluation (Cohen's kappa = 0.571). The fidelity to the guidelines for early intervention was uneven, with some criteria met by most centres, especially those peculiar to the Italian community psychiatry. CONCLUSION A further spreading of the early intervention model across the Italian DMHs was found. A lack of resources might limit the use of specific psychosocial treatments, such as cognitive-behavioural therapy or manualized family support.
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Affiliation(s)
- Anna Meneghelli
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Panfilo Ciancaglini
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Marina Di Domenico
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Andrea Mazzola
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
| | - Lucio Ghio
- Department of Mental Health and Addiction, Azienda Sanitaria Locale 3 (ASL3) Genova, Genoa, Italy
| | - Antonio Preti
- Associazione Italiana per la Prevenzione e l'Intervento Precoce nella Salute Mentale, Milan, Italy
- Department of Neuroscience, University of Turin, Turin, Italy
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5
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Heflin K, Rosen BJ, Costanzo R, Ballard J, Fetter JC. Psychiatric Boarding in Emergency Departments and the COVID-19 First Wave: The New Hampshire Response. Health Secur 2023. [PMID: 37184664 DOI: 10.1089/hs.2022.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
The COVID-19 pandemic forced unprecedented challenges for emergency department operations during the spring of 2020. Before the COVID-19 pandemic, psychiatric boarding in emergency departments required a substantial amount of staffing and administrative resources. This case study describes one state's efforts to rapidly decrease psychiatric boarding by 93% in 2 weeks with a multipronged approach, and simultaneously minimal effects observed on outcome measures of psychiatric hospital readmissions and suicide rates. Lessons learned are discussed regarding workflow adaptations and leadership implications.
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Affiliation(s)
- Katherine Heflin
- Katherine Heflin, MSPH, is a Medical Student; at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Brian J Rosen
- Brian J. Rosen, MD, is a Resident Physician, at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Rosemary Costanzo
- Rosemary Costanzo, RN, MSN, PMH-BC, is Chief Nursing Officer, New Hampshire Hospital, Concord, NH
| | - Jonathan Ballard
- Jonathan Ballard, MD, is [title], at the Geisel School of Medicine at Dartmouth, Hanover, NH
- Jonathan Ballard is also Chief Medical Officer, New Hampshire Department of Health and Human Services, Concord, NH
| | - Jeffrey C Fetter
- Jeffrey C. Fetter, MD, is Assistant Professor, Department of Psychiatry; at the Geisel School of Medicine at Dartmouth, Hanover, NH
- Jeffrey C. Fetter, MD, is Chief Medical Officer, New Hampshire Hospital, Concord, NH
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6
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Powers KE, das Nair R, Phillips J, Farrin A, Radford KA. Exploring the Association between Individual-Level Attributes and Fidelity to a Vocational Rehabilitation Intervention within a Randomised Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4694. [PMID: 36981601 PMCID: PMC10048688 DOI: 10.3390/ijerph20064694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Understanding what attributes or characteristics of those delivering interventions affect intervention fidelity and patient outcomes is important for contextualising intervention effectiveness. It may also inform implementation of interventions in future research and clinical practice. This study aimed to explore the relationships between attributes of Occupational Therapists (OTs), their faithful delivery of an early stroke specialist vocational rehabilitation intervention (ESSVR), and stroke survivor return-to-work (RTW) outcomes. Thirty-nine OTs were surveyed about their experience and knowledge of stroke and vocational rehabilitation and were trained to deliver ESSVR. ESSVR was delivered across 16 sites in England and Wales between February 2018 and November 2021. OTs received monthly mentoring to support ESSVR delivery. The amount of mentoring each OT received was recorded in OT mentoring records. Fidelity was assessed using an intervention component checklist completed using retrospective case review of one randomly selected participant per OT. Linear and logistic regression analyses explored relationships between OT attributes, fidelity, and stroke survivor RTW outcome. Fidelity scores ranged from 30.8 to 100% (Mean: 78.8%, SD: 19.2%). Only OT engagement in mentoring was significantly associated with fidelity (b = 0.29, 95% CI = 0.05-0.53, p < 0.05). Increased fidelity (OR = 1.06, 95% CI = 1.01-1.1, p = 0.01) and increasing years of stroke rehabilitation experience (OR = 1.17, 95% CI = 1.02-1.35) was significantly associated with positive stroke survivor RTW outcomes. Findings of this study suggest that mentoring OTs may increase fidelity of delivery of ESSVR, which may also be associated with positive stroke survivor return-to-work outcomes. The results also suggest that OTs with more experience of stroke rehabilitation may be able to support stroke survivors to RTW more effectively. Upskilling OTs to deliver complex interventions, such as ESSVR, in clinical trials may require mentoring support in addition to training to ensure fidelity.
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Affiliation(s)
- Katie E. Powers
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Roshan das Nair
- Health Division, SINTEF, 7465 Trondheim, Norway
- Mental Health & Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - Julie Phillips
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds LS2 9JT, UK
| | - Kathryn A. Radford
- Injury, Inflammation & Recovery Sciences, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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Abufarsakh B, Kappi A, Pemberton KM, Williams LB, Okoli CTC. Substance use outcomes among individuals with severe mental illnesses receiving assertive community treatment: A systematic review. Int J Ment Health Nurs 2022; 32:704-726. [PMID: 36534491 DOI: 10.1111/inm.13103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Assertive Community Treatment (ACT) is a multidisciplinary treatment approach to support people with severe mental illnesses (SMI) in their recovery. While the majority of ACT recipients report co-morbid substance use issues, limited reviews have evaluated the impact of receiving ACT services on substance use outcomes. The purpose of this systematic review was to evaluate the impact of ACT involvement on substance use outcomes among people with SMI. A systematic literature search was conducted including articles published prior to April 2021. Twenty-nine studies were included in this review. Of them, 15 studies implemented a controlled design (six studies demonstrated high quality) and 14 studies implemented a cohort design. From a synthesis of the reviewed studies, five areas of changes associated with substance use emerged including reduced alcohol and drug use severity, lower prevalence of alcohol and drug use, increased stage of change in substance use treatment, and fewer days of hospitalization and intoxication. Thus, future studies should examine the integration of substance use treatment services as part of ACT interventions for opportunities to enhance recovery outcomes among individuals with SMI.
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Affiliation(s)
| | - Amani Kappi
- University of Kentucky College of Nursing, Lexington, Kentucky, USA
| | - Kylie M Pemberton
- University of Kentucky College of Education, Lexington, Kentucky, USA
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Implementation of Integrated Dual Disorder Treatment in Routine Veterans Health Administration Settings. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Westen K, Boyle P, Kroon H. An observational comparison of FACT and ACT in the Netherlands and the US. BMC Psychiatry 2022; 22:311. [PMID: 35505332 PMCID: PMC9063161 DOI: 10.1186/s12888-022-03927-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/23/2022] [Indexed: 12/05/2022] Open
Abstract
Assertive Community Treatment (ACT) is a well-defined service delivery model for the care and treatment of the most severely mentally ill in the community with American origins. The Dutch have adapted the model in order to accommodate a broader range of needs and allow more flexible implementation. Functional Assertive Community Treatment (FACT) provides the intensity of care needed to help participants sustain life in the community as well as continuity of care over time for many vulnerable client populations.
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Affiliation(s)
- Koen Westen
- grid.440506.30000 0000 9631 4629Avans University of Applied Sciences, Breda, The Netherlands ,CCAF, Utrecht, The Netherlands ,grid.491422.80000 0004 0546 0823Reinier van Arkel, ’s, Hertogenbosch, The Netherlands
| | - Patrick Boyle
- Center for Evidence Based Practices, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA.
| | - Hans Kroon
- CCAF, Utrecht, The Netherlands ,grid.416017.50000 0001 0835 8259Department of Mental Health Care and Participation, Trimbos Institute, Utrecht, The Netherlands ,grid.12295.3d0000 0001 0943 3265Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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10
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Abstract
LEARNING OBJECTIVE After participating in this activity, learners should be better able to:• Assess characteristics of forensic assertive community treatment programs. ABSTRACT Forensic assertive community treatment (FACT) has emerged internationally as an intervention strategy for people with serious mental disorders who are involved with the criminal justice system. Studies to date have shown marked variability, however, in FACT program design and operation. Based upon a literature review and relevant experience, the authors present their perspective on the essential elements of FACT. Given that FACT is an adaptation of the evidence-based assertive community treatment (ACT) model, it is recommended that FACT programs maintain a high-fidelity ACT component. FACT programs should also have both mental health and criminal justice admission criteria because service recipients are involved in both service systems. For optimal effectiveness, FACT team clinicians must partner with criminal justice agencies that provide community-based supervision to their patients. Prospective FACT enrollees should receive a clear explanation of the program, including how their respective mental health and criminal justice service providers will work collaboratively with them to prevent incarceration. FACT programs should also use risk/need assessment to inform treatment planning, evidence-based mental health and community correctional practices to promote both wellness and public safety, and shared training to promote effective collaboration. Additional elements to consider include housing, medical care, and transitional services. These elements are presented and discussed, including a rationale and evidence to support each component. The article concludes with introduction of a FACT fidelity scale, the Rochester Forensic Assertive Community Treatment Scale (R-FACTS). By operationalizing essential FACT elements, the R-FACTS is designed to support FACT program development, implementation, and dissemination in a more consistent and measurable manner.
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11
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Sijercic I, Lane JEM, Gutner CA, Monson CM, Stirman SW. The Association Between Clinician and Perceived Organizational Factors with Early Fidelity to Cognitive Processing Therapy for Posttraumatic Stress Disorder in a Randomized Controlled Implementation Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:8-18. [PMID: 31463667 DOI: 10.1007/s10488-019-00966-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A common metric for determining implementation success is the measurement of clinician adherence to, and competence in, delivering a psychotherapy. The present study examined clinician and organizational factors as predictors of early adherence and competence among 78 clinicians delivering cognitive processing therapy (CPT), an evidence-based psychotherapy (EBP) for posttraumatic stress disorder, in a randomized controlled implementation trial. Results indicated that clinicians' willingness to adopt an EBP if required to do so was significantly associated with early adherence and competence in CPT delivery. Level of clinician education was significantly associated with early competence in delivering CPT. Organizational factors did not predict early adherence or competence. Implications of the findings are discussed.
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Affiliation(s)
| | | | | | | | - Shannon Wiltsey Stirman
- National Center for PTSD, VA Palo Alto Healthcare System & Stanford University, 795 Willow Road, NC-PTSD 334, Menlo Park, CA, 94025, USA.
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12
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Roosenschoon BJ, van Weeghel J, Deen ML, van Esveld EW, Kamperman AM, Mulder CL. Effects of Illness Management and Recovery: A Multicenter Randomized Controlled Trial. Front Psychiatry 2021; 12:723435. [PMID: 34970161 PMCID: PMC8712643 DOI: 10.3389/fpsyt.2021.723435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
There have been inconsistent findings in the literature with respect to the efficacy of Illness Management and Recovery (IMR) in the psychosocial treatment of people with schizophrenia or other severe mental illnesses. This study aimed to comprehensively investigate the effectiveness of IMR, including the impact of completion and fidelity. In this randomized controlled trial (RCT), 187 outpatients received either IMR plus care as usual (CAU) or only CAU. Multilevel modeling was implemented to investigate group differences over an 18-month period, comprising 12 months of treatment and six months of follow-up. The primary outcome was overall illness management, which was assessed using the client version of the IMR scale. Secondary outcomes included measures regarding illness management, clinical, personal, and functional recovery, and hospitalizations. The interviewers were blinded to group allocation. This clinical trial was registered with the Netherlands Trial Register (NL4931, NTR5033). Patients who received IMR showed statistically significant improvement in self-reported overall illness management (the primary outcome). Moreover, they showed an improvement in self-esteem, which is a component of personal recovery. There were no effects within the other questionnaires. There were also no statistically significant between-group differences in terms of hospitalizations. Patients in both groups showed statistically significant improvement in clinician-rated overall illness management, social support, clinical and functional recovery, and self-stigma over time. IMR completion was associated with stronger effects. High IMR fidelity was associated with self-esteem. This study confirms the efficacy of IMR in overall illness self-management. To our knowledge, this is the first RCT on IMR to explore the impact of fidelity on treatment efficacy. Future studies should further establish efficacy in personal recovery. To improve efficacy, it appears important to promote IMR completion and fidelity.
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Affiliation(s)
- Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Rotterdam, Netherlands.,Parnassia Academy, Parnassia Psychiatric Institute, Den Haag, Netherlands
| | - Jaap van Weeghel
- Parnassia Academy, Parnassia Psychiatric Institute, Den Haag, Netherlands.,Department of TRANZO, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Mathijs L Deen
- Parnassia Academy, Parnassia Psychiatric Institute, Den Haag, Netherlands.,Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Leiden, Netherlands
| | | | - Astrid M Kamperman
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus MC University Medical Centre, Rotterdam, Netherlands.,Antes Mental Health Care, Parnassia Psychiatric Institute, Rotterdam, Netherlands
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13
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The Family Psychoeducation Fidelity Scale: Psychometric Properties. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:894-900. [PMID: 32323217 PMCID: PMC7547979 DOI: 10.1007/s10488-020-01040-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined psychometric properties and feasibility of the Family Psychoeducation (FPE) Fidelity Scale. Fidelity assessors conducted reviews using the FPE fidelity scale four times over 18 months at five sites in Norway. After completing fidelity reviews, assessors rated feasibility of the fidelity review process. The FPE fidelity scale showed excellent interrater reliability (.99), interrater item agreement (88%), and internal consistency (mean = .84 across four time points). By the 18-month follow-up, all five sites increased fidelity and three reached adequate fidelity. Fidelity assessors rated feasibility as excellent. The FPE fidelity scale has good psychometric properties and is feasible for evaluating the implementation of FPE programs. Trial registration ClinicalTrials.gov Identifier: NCT03271242.
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Broersen M, Creemers DHM, Frieswijk N, Vermulst AA, Kroon H. Investigating the critical elements and psychosocial outcomes of Youth Flexible Assertive Community Treatment: a study protocol for an observational prospective cohort study. BMJ Open 2020; 10:e035146. [PMID: 32265243 PMCID: PMC7245379 DOI: 10.1136/bmjopen-2019-035146] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION When adolescents experience complex psychiatric and social problems, numerous healthcare services usually become involved. In these cases, fragmentation of care services is a risk that often results in both ineffective care and in patients disengaging from care services. To address these issues, Youth Flexible Assertive Community Treatment (Youth Flexible ACT) was developed in the Netherlands. This client-centred service delivery model aims to tackle the fragmented care system by providing psychiatric treatment and support in a flexible and integrated manner. While Youth Flexible ACT is gaining in popularity, the effectiveness of the care model remains largely unexamined. METHODS AND ANALYSIS Here, we present an observational prospective cohort (2017-2021) in which a broad range of treatment outcomes will be monitored. The primary aim of the study is to examine change in treatment outcomes over the course of the Flexible ACT care. The secondary aim is to examine the association between (elements of) Youth Flexible ACT model fidelity and treatment outcomes. An estimated total number of 200 adolescents who receive care from one of the 16 participating Youth Flexible ACT teams will be included in the study. Participants will be asked to complete assessments at four time points in 6-month intervals, resulting in a study duration of 18 months. Latent growth curve analysis will be conducted to examine change in psychosocial functioning over time and its relation to model fidelity. ETHICS AND DISSEMINATION This study received ethical approval from Trimbos Ethics Committee (201607_75-FACT2). This approval applies for all participating institutions. The results of the study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results will be disseminated via peer-reviewed academic journals and presentations at conferences. In addition, results will be made available for participating sites, funders and researchers.
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Affiliation(s)
- Marieke Broersen
- GGZ Oost Brabant, Oss, The Netherlands
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | | | | | | | - Hans Kroon
- Tranzo - Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Trimbos Institute, Utrecht, The Netherlands
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15
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Archibald L, Brunette MF, Wallin DJ, Green AI. Alcohol Use Disorder and Schizophrenia or Schizoaffective Disorder. Alcohol Res 2019; 40:arcr.v40.1.06. [PMID: 31886105 PMCID: PMC6927747 DOI: 10.35946/arcr.v40.1.06] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Schizophrenia and schizoaffective disorder are schizophrenia spectrum disorders that cause significant disability. Among individuals who have schizophrenia or schizoaffective disorder, alcohol use disorder (AUD) is common, and it contributes to worse outcomes than for those who do not have co-occurring substance use disorder. Common neurobiological mechanisms, including dysfunction in brain reward circuitry, may explain the high rates of co-occurrence of schizophrenia and AUD or other substance use disorders. Optimal treatment combines pharmacologic intervention and other therapeutic modalities to address both the psychotic disorder and AUD. Further research on the etiology of these co-occurring disorders and on treatment of affected individuals is needed.
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Affiliation(s)
- Luke Archibald
- Luke Archibald, M.D., is an assistant professor in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Mary F Brunette
- Mary F. Brunette, M.D., is an associate professor in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Diana J Wallin
- Diana J. Wallin, Ph.D., is a postdoctoral fellow in the Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Alan I Green
- Alan I. Green, M.D., is the Raymond Sobel Professor of Psychiatry, a professor in the Department of Molecular and Systems Biology, and the chair of the Department of Psychiatry, Geisel School of Medicine at Dartmouth, as well as the director, Dartmouth Clinical and Translational Science Institute, Dartmouth College, Hanover, New Hampshire
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16
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Hunt GE, Siegfried N, Morley K, Brooke‐Sumner C, Cleary M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2019; 12:CD001088. [PMID: 31829430 PMCID: PMC6906736 DOI: 10.1002/14651858.cd001088.pub4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. OBJECTIVES To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. SEARCH METHODS The Information Specialist of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (2 May 2018), which is based on regular searches of major medical and scientific databases. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. DATA COLLECTION AND ANALYSIS Review authors independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. Where meta-analyses were possible, we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. MAIN RESULTS Our review now includes 41 trials with a total of 4024 participants. We have identified nine comparisons within the included trials and present a summary of our main findings for seven of these below. We were unable to summarise many findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low- or very-low quality due to high or unclear risks of bias because of poor trial methods, or inadequately reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. 1. Integrated models of care versus standard care (36 months) No clear differences were found between treatment groups for loss to treatment (RR 1.09, 95% CI 0.82 to 1.45; participants = 603; studies = 3; low-quality evidence), death (RR 1.18, 95% CI 0.39 to 3.57; participants = 421; studies = 2; low-quality evidence), alcohol use (RR 1.15, 95% CI 0.84 to 1.56; participants = 143; studies = 1; low-quality evidence), substance use (drug) (RR 0.89, 95% CI 0.63 to 1.25; participants = 85; studies = 1; low-quality evidence), global assessment of functioning (GAF) scores (MD 0.40, 95% CI -2.47 to 3.27; participants = 170; studies = 1; low-quality evidence), or general life satisfaction (QOLI) scores (MD 0.10, 95% CI -0.18 to 0.38; participants = 373; studies = 2; moderate-quality evidence). 2. Non-integrated models of care versus standard care There was no clear difference between treatment groups for numbers lost to treatment at 12 months (RR 1.21, 95% CI 0.73 to 1.99; participants = 134; studies = 3; very low-quality evidence). 3. Cognitive behavioural therapy (CBT) versus standard care There was no clear difference between treatment groups for numbers lost to treatment at three months (RR 1.12, 95% CI 0.44 to 2.86; participants = 152; studies = 2; low-quality evidence), cannabis use at six months (RR 1.30, 95% CI 0.79 to 2.15; participants = 47; studies = 1; very low-quality evidence) or mental state insight (IS) scores by three months (MD 0.52, 95% CI -0.78 to 1.82; participants = 105; studies = 1; low-quality evidence). 4. Contingency management versus standard care We found no clear differences between treatment groups for numbers lost to treatment at three months (RR 1.55, 95% CI 1.13 to 2.11; participants = 255; studies = 2; moderate-quality evidence), number of stimulant positive urine tests at six months (RR 0.83, 95% CI 0.65 to 1.06; participants = 176; studies = 1) or hospitalisations (RR 0.21, 95% CI 0.05 to 0.93; participants = 176; studies = 1); both low-quality evidence. 5. Motivational interviewing (MI) versus standard care We found no clear differences between treatment groups for numbers lost to treatment at six months (RR 1.71, 95% CI 0.63 to 4.64; participants = 62; studies = 1). A clear difference, favouring MI, was observed for abstaining from alcohol (RR 0.36, 95% CI 0.17 to 0.75; participants = 28; studies = 1) but not other substances (MD -0.07, 95% CI -0.56 to 0.42; participants = 89; studies = 1), and no differences were observed in mental state general severity (SCL-90-R) scores (MD -0.19, 95% CI -0.59 to 0.21; participants = 30; studies = 1). All very low-quality evidence. 6. Skills training versus standard care At 12 months, there were no clear differences between treatment groups for numbers lost to treatment (RR 1.42, 95% CI 0.20 to 10.10; participants = 122; studies = 3) or death (RR 0.15, 95% CI 0.02 to 1.42; participants = 121; studies = 1). Very low-quality, and low-quality evidence, respectively. 7. CBT + MI versus standard care At 12 months, there was no clear difference between treatment groups for numbers lost to treatment (RR 0.99, 95% CI 0.62 to 1.59; participants = 327; studies = 1; low-quality evidence), number of deaths (RR 0.60, 95% CI 0.20 to 1.76; participants = 603; studies = 4; low-quality evidence), relapse (RR 0.50, 95% CI 0.24 to 1.04; participants = 36; studies = 1; very low-quality evidence), or GAF scores (MD 1.24, 95% CI -1.86 to 4.34; participants = 445; studies = 4; very low-quality evidence). There was also no clear difference in reduction of drug use by six months (MD 0.19, 95% CI -0.22 to 0.60; participants = 119; studies = 1; low-quality evidence). AUTHORS' CONCLUSIONS We included 41 RCTs but were unable to use much data for analyses. There is currently no high-quality evidence to support any one psychosocial treatment over standard care for important outcomes such as remaining in treatment, reduction in substance use or improving mental or global state in people with serious mental illnesses and substance misuse. Furthermore, methodological difficulties exist which hinder pooling and interpreting results. Further high-quality trials are required which address these concerns and improve the evidence in this important area.
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Affiliation(s)
- Glenn E Hunt
- The University of SydneyDiscipline of PsychiatryConcord Centre for Mental HealthHospital RoadSydneyNSWAustralia2139
| | - Nandi Siegfried
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Kirsten Morley
- The University of SydneyAddiction MedicineSydneyAustralia
| | - Carrie Brooke‐Sumner
- South African Medical Research CouncilAlcohol, Tobacco and Other Drug Research UnitTybergCape TownSouth Africa
| | - Michelle Cleary
- University of TasmaniaSchool of Nursing, College of Health and MedicineSydney, NSWAustralia
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Bond GR, Drake RE. Assessing the Fidelity of Evidence-Based Practices: History and Current Status of a Standardized Measurement Methodology. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:874-884. [PMID: 31691055 DOI: 10.1007/s10488-019-00991-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence-based practices are effective only when implemented faithfully. This paper explicates the history, standardization, and methods for developing and validating measures of fidelity. We overviewed the past 20 years of developing fidelity measures, summarized standardization of the development procedures, and described needed psychometric assessments. Fidelity assessment has become the sine qua non of implementation, technical assistance, and research on evidence-based practices. Researchers have established standardized procedures for scale development and psychometric testing. Widescale use of fidelity measurement remains challenging. The implementation of evidence-based practice and the development and validation of fidelity measures are interdependent. International improvements of mental health care will require attention to both.
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Affiliation(s)
- Gary R Bond
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C3-1, Lebanon, NH, 03766, USA
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18
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Wewiorski NJ, Gorman JA, Ellison ML, Hunt MG, Evans L, Charns MP. A site visit protocol for assessing recovery promotion at the program level: An example from the Veterans Health Administration. Psychiatr Rehabil J 2019; 42:323-328. [PMID: 31233322 PMCID: PMC6741775 DOI: 10.1037/prj0000369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE A site visit protocol was developed to assess recovery promotion in the organizational climate and culture of programs for veterans with serious mental illnesses. METHOD The protocol was pilot-tested in 4 programs: 2 that had scored high on the pilot version of a staff survey measure of program-level recovery promotion and 2 that had scored low. Two-person teams conducted onsite visits and assigned global and organizational domain ratings. Interrater agreement was assessed by examining adjacent agreement and computing weighted kappa. RESULTS The on-site protocol had good interrater agreement and discriminated between sites that scored high and low on the staff survey. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This site visit protocol and procedure shows promise for evaluating recovery promotion in milieu-based programs. After further refinement of this tool, adaptations could be developed for accreditation protocols or for program self-assessment and quality improvement efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Nancy J Wewiorski
- Center for Healthcare Organization and Implementation Research (CHOIR)
| | - Jay A Gorman
- Social and Community Reintegration Research Program (SoCRR), Bedford VA Medical Center
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Livet M, Blanchard C, Frail C, Sorensen T, McClurg MR. Ensuring effective implementation: A fidelity assessment system for comprehensive medication management. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1155] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Melanie Livet
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Carrie Blanchard
- Center for Medication Optimization (CMO), Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Caity Frail
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy; University of Minnesota; Minneapolis Minnesota
| | - Todd Sorensen
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy; University of Minnesota; Minneapolis Minnesota
| | - Mary R. McClurg
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
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Wolitzky-Taylor K, Schiffman J. Predictive Associations Among the Repeated Measurements of Anxiety, Depression, and Craving in a Dual Diagnosis Program. J Dual Diagn 2019; 15:140-146. [PMID: 30982462 DOI: 10.1080/15504263.2019.1589660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Anxiety and depression commonly co-occur with substance use disorders. Conceptual models would presume that changes in anxiety and depression should lead to changes in drug and alcohol craving during treatment for co-occurring disorders, but no longitudinal investigation has explored this assumption. This study examined the associations among craving, anxiety, and depression in a dual diagnosis program. Methods: In all, 93 adult patients at a community-based dual diagnosis program for substance use disorders and comorbid anxiety and mood disorders provided daily ratings of anxiety and depression. We examined whether these ratings predicted changes in craving and vice versa. Results: Using hierarchical linear modeling to examine day-to-day change over time, we observed that anxiety and depression ratings uniquely and independently predicted subsequent craving ratings, and craving ratings also predicted subsequent anxiety and depression ratings. Conclusions: These preliminary findings support mutual maintenance models of substance use and psychiatric comorbidity, thus providing preliminary support for integrated programs that simultaneously address both problems. Implications and future directions are discussed.
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Affiliation(s)
- Kate Wolitzky-Taylor
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles , Los Angeles , California , USA
| | - Jason Schiffman
- Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, The Camden Center , Los Angeles , California , USA
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21
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Spivak S, Mojtabai R, Green C, Firth T, Sater H, Cullen BA. Distribution and Correlates of Assertive Community Treatment (ACT) and ACT-Like Programs: Results From the 2015 N-MHSS. Psychiatr Serv 2019; 70:271-278. [PMID: 30602345 DOI: 10.1176/appi.ps.201700561] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study examined the availability and characteristics of assertive community treatment (ACT) programs across mental health treatment facilities in the United States. METHODS Prevalence and correlates of facilities that reported offering ACT, broadly defined as intensive community services for serious mental illness provided by multidisciplinary teams in the clients' natural settings and including both ACT and "ACT-like" programs, were examined by using data from the National Mental Health Services Survey. Availability of services essential to the ACT model in these facilities was also examined. RESULTS Of the 12,826 surveyed facilities, 13.4% reported offering ACT, with significant variability among states. Of the facilities with ACT, 19.2% reported offering all core ACT services. Few facilities offered peer support, employment, and housing services. Compared with programs at facilities that did not offer all core ACT services, facilities with ACT programs that offered these services had higher odds of being publicly owned (odds ratio [OR]=2.12, 95% confidence interval [CI]=1.64-2.74) and of receiving federal (OR=3.60, CI=2.17-5.98) or grant funding (OR=1.87, CI=1.45-2.41). Facilities with ACT that offered all core services also had higher odds of offering other services important to individuals with serious mental disorders. CONCLUSIONS Substantial differences existed in availability of ACT and ACT-like programs among states, with evidence of a large unmet need overall, even when a very broad and inclusive definition of ACT was used. Few ACT programs offered all core services. Legislative, administrative, and funding differences may explain some of the variability.
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Affiliation(s)
- Stanislav Spivak
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Ramin Mojtabai
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Charee Green
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Tyler Firth
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Holly Sater
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
| | - Bernadette A Cullen
- Johns Hopkins University School of Medicine and Johns Hopkins University Bloomberg School of Public Health (Spivak, Mojtabai, Cullen); Johns Hopkins Medical Systems (Green, Firth, Sater)
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Mueser KT, Meyer-Kalos PS, Glynn SM, Lynde DW, Robinson DG, Gingerich S, Penn DL, Cather C, Gottlieb JD, Marcy P, Wiseman JL, Potretzke S, Brunette MF, Schooler NR, Addington J, Rosenheck RA, Estroff SE, Kane JM. Implementation and fidelity assessment of the NAVIGATE treatment program for first episode psychosis in a multi-site study. Schizophr Res 2019; 204:271-281. [PMID: 30139553 PMCID: PMC6382606 DOI: 10.1016/j.schres.2018.08.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/18/2018] [Accepted: 08/12/2018] [Indexed: 11/19/2022]
Abstract
The NAVIGATE program was developed for the Recovery After Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, which compared NAVIGATE to usual Community Care in a cluster randomized design involving 34 sites and 404 patients. This article describes the approach to training and implementing the NAVIGATE program at the 17 sites (including 134 practitioners) randomized to provide it, and to evaluating the fidelity of service delivery to the NAVIGATE model. Fidelity was evaluated to five different components of the program, all of which were standardized in manuals in advance of implementation. The components included four interventions (Individualized Resiliency Training, Family Education Program, Supported Employment and Education, Personalized Medication Management) and the overall organization (staffing and structure) of the NAVIGATE team. Most of the sites demonstrated acceptable or higher levels of fidelity in their implementation of the four interventions and the organization of the program, with all 17 sites demonstrating at least acceptable overall fidelity to the NAVIGATE program. The results indicate that the NAVIGATE program can be implemented with good fidelity to the treatment model in a diverse array of community mental health care settings serving persons with a first episode psychosis.
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Affiliation(s)
- Kim T Mueser
- Boston University, Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston, MA, USA.
| | - Piper S Meyer-Kalos
- University of Minnesota, School of Social Work, Minnesota Center for Chemical and Mental Health, St. Paul, MN, USA.
| | - Shirley M Glynn
- Semel Institute of Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - David W Lynde
- Geisel School of Medicine at Dartmouth, Department of Psychiatry, Lebanon, NH, USA
| | - Delbert G Robinson
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
| | | | - David L Penn
- University of North Carolina-Chapel Hill, Department of Psychology, Chapel Hill, NC, USA; Australian Catholic University, School of Psychology, Melbourne, VIC, Australia
| | | | - Jennifer D Gottlieb
- Boston University, Center for Psychiatric Rehabilitation, Departments of Occupational Therapy, Psychiatry, and Psychology, Boston, MA, USA
| | | | - Jennifer L Wiseman
- University of Minnesota, Minnesota Center for Chemical and Mental Health, St. Paul, MN, USA
| | - Sheena Potretzke
- Oregon Health and Science University, Department of Behavioral Neuroscience, Portland, OR, USA
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Bureau of Mental Health Services, Department of Health and Human Services, Concord, NH, USA
| | - Nina R Schooler
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; SUNY Downstate Medical Center, Department of Psychiatry, Brooklyn, NY, USA
| | - Jean Addington
- Hotchkiss Brain Institute, Department of Psychiatry, University of Calgary, Calgary, Canada
| | | | - Sue E Estroff
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - John M Kane
- Zucker Hillside Hospital, Psychiatry Research, North Shore - Long Island Jewish Medical Center, Glen Oaks, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY, USA
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Effectiveness of Health and Social Service Networks for Severely Mentally Ill Patients’ Outcomes: A Case–Control Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 46:288-297. [DOI: 10.1007/s10488-018-0910-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Margolies PJ, Humensky JL, Chiang IC, Covell NH, Jewell TC, Broadway-Wilson K, Gregory R, Scannevin G, Dixon LB. Relationship Between Self-Assessed Fidelity and Self-Reported Employment in the Individual Placement and Support Model of Supported Employment. Psychiatr Serv 2018; 69:609-612. [PMID: 29656706 PMCID: PMC6561725 DOI: 10.1176/appi.ps.201700472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE A growing body of literature demonstrates that high-fidelity implementation of the individual placement and support (IPS) model of supported employment increases the chances of achieving desired outcomes. This study examined the relationship between IPS fidelity, as self-reported by program sites, and employment outcomes and determined whether this relationship was maintained over time. METHODS A total of 78 outpatient programs in New York State provided data on self-reported IPS fidelity and employment outcomes. Pearson correlations were used to determine the relationship between fidelity scores and competitive employment rates. A mixed-effects model examined the relationship between repeated fidelity and employment measures over time. RESULTS A significant positive relationship was found between better self-reported IPS fidelity and greater employment. The relationship between IPS fidelity and employment was sustained over time (up to one year). CONCLUSIONS Higher-fidelity implementation of the IPS model, as self-assessed by program sites, was associated with higher employment rates, which were sustained over time.
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Affiliation(s)
- Paul J Margolies
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
| | - Jennifer L Humensky
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
| | - I-Chin Chiang
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
| | - Nancy H Covell
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
| | - Thomas C Jewell
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
| | - Karen Broadway-Wilson
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
| | - Raymond Gregory
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
| | - Gary Scannevin
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
| | - Lisa B Dixon
- Dr. Margolies, Dr. Humensky, Dr. Covell, and Dr. Dixon are with the Department of Psychiatry, Columbia University Medical Center, New York. They are also with the New York State Psychiatric Institute, New York, where all of the other authors are affiliated
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Usera JJ. The Efficacy of an American Indian Culturally-Based Risk Prevention Program for Upper Elementary School Youth Residing on the Northern Plains Reservations. J Prim Prev 2018; 38:175-194. [PMID: 28032306 DOI: 10.1007/s10935-016-0462-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Culturally-based risk behavior prevention programs for American Indian elementary school children are sparse. Thus a group of American Indian educators collaborated in the creation of a program that helps children make healthy decisions based on their cultural and traditional value system. In this paper the effectiveness of Lakota Circles of Hope (LCH), an elementary school culturally-based prevention program was studied and evaluated. Three cohorts of fourth and fifth graders participated in a mixed methods quasi-experimental evaluative research design that included focus groups and surveys prior to and following the intervention. Five research questions regarding the program's impact on students' self-esteem and self-efficacy, Lakota identity, communication, conflict resolution and risk behaviors were addressed in this study. Participants were compared to non-participants in three American Indian reservation school sites. Educators completed a survey to record their observations and feedback regarding the implementation of the program within their respective school sites. The study provides preliminary evidence that, when delivered with fidelity, LCH contributes to statistically significant changes in risk behaviors, Lakota identity, respect for others, and adult and parent communication. A two-way multivariate analysis of variance with post hoc analysis of data collected from the LCH participants (N = 1392) were used to substantiate a significant increase in respect for others and a decrease in risk behaviors which included alcohol, tobacco, and substance use at the 0.10 alpha level. Significant positive improvements in parent and adult communication and an increased Lakota identity at the 0.01 alpha level were obtained. There were no significant differences in self-esteem and conflict resolution from pre to post intervention and in comparison with non LCH participating students.
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Affiliation(s)
- John J Usera
- Research and Evaluation, Catholic Social Services, 529 Kansas City Street, Rapid City, SD, 57701, USA. .,Delta Evaluation Consulting, LLC, 1010 Ball Park Road, Suite 9, Sturgis, SD, 57785, USA.
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de Vet R, Lako DAM, Beijersbergen MD, van den Dries L, Conover S, van Hemert AM, Herman DB, Wolf JRLM. Critical Time Intervention for People Leaving Shelters in the Netherlands: Assessing Fidelity and Exploring Facilitators and Barriers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:67-80. [PMID: 26573154 PMCID: PMC5225207 DOI: 10.1007/s10488-015-0699-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
International dissemination of evidence-based interventions calls for rigorous evaluation. As part of an evaluation of critical time intervention (CTI) for homeless people and abused women leaving Dutch shelters, this study assessed fidelity in two service delivery systems and explored factors influencing model adherence. Data collection entailed chart review (n = 70) and two focus groups with CTI workers (n = 11). The intervention obtained an overall score of three out of five (fairly implemented) for compliance fidelity and chart quality combined. Fidelity did not differ significantly between service systems, supporting its suitability for a range of populations. The eight themes that emerged from the focus groups as affecting model adherence provide guidance for future implementation efforts.
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Affiliation(s)
- Renée de Vet
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Danielle A M Lako
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Mariëlle D Beijersbergen
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Linda van den Dries
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Sarah Conover
- Silberman School of Social Work at Hunter College, City University of New York, New York, NY, USA
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands
| | - Daniel B Herman
- Silberman School of Social Work at Hunter College, City University of New York, New York, NY, USA
| | - Judith R L M Wolf
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands.
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Lako DAM, Beijersbergen MD, Jonker IE, de Vet R, Herman DB, van Hemert AM, Wolf JRLM. The effectiveness of critical time intervention for abused women leaving women's shelters: a randomized controlled trial. Int J Public Health 2018; 63:513-523. [PMID: 29299613 PMCID: PMC5938300 DOI: 10.1007/s00038-017-1067-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 10/23/2017] [Accepted: 12/14/2017] [Indexed: 12/01/2022] Open
Abstract
Objectives To examine the effectiveness of critical time intervention (CTI)—an evidence-based intervention—for abused women transitioning from women’s shelters to community living. Methods A randomized controlled trial was conducted in nine women’s shelters across the Netherlands. 136 women were assigned to CTI (n = 70) or care-as-usual (n = 66). Data were analyzed using intention-to-treat three-level mixed-effects models. Results Women in the CTI group had significant fewer symptoms of post-traumatic stress (secondary outcome) (adjusted mean difference − 7.27, 95% CI − 14.31 to − 0.22) and a significant fourfold reduction in unmet care needs (intermediate outcome) (95% CI 0.06–0.94) compared to women in the care-as-usual group. No differences were found for quality of life (primary outcome), re-abuse, symptoms of depression, psychological distress, self-esteem (secondary outcomes), family support, and social support (intermediate outcomes). Conclusions This study shows that CTI is effective in a population of abused women in terms of a reduction of post-traumatic stress symptoms and unmet care needs. Because follow-up ended after the prescribed intervention period, further research is needed to determine the full long-term effects of CTI in this population. Electronic supplementary material The online version of this article (10.1007/s00038-017-1067-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danielle A M Lako
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
- Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Mariëlle D Beijersbergen
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Irene E Jonker
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Renée de Vet
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Daniel B Herman
- Silberman School of Social Work at Hunter College, City University of New York, New York, NY, USA
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R L M Wolf
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands.
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Abstract
Recent developments in UK government policy have highlighted the unmet needs of people with dual diagnosis (comorbidity of substance misuse and psychiatric disorder, particularly severe mental illness). Advances in assessment techniques and diagnostic practice have informed the treatment of comorbidity and improved its outcome. There is growing evidence for the effectiveness of psychosocial interventions such as motivational interviewing and cognitive–behavioural therapy, mostly from US studies. However, within the secondary care provided by addiction and general psychiatric services there are serious implementation barriers related to service organisation, staffing levels, training and – most importantly – the difficulties of engaging people with severe mental illness and comorbid substance misuse in treatment. The evidence for the effectiveness of psychosocial treatments and models of service is reviewed and challenges for optimal practice in the UK are highlighted.
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A National Survey of Assertive Outreach Treatment Services for People Who Frequently Attend Hospital due to Alcohol-Related Reasons in England. Alcohol Alcohol 2017; 53:277-281. [DOI: 10.1093/alcalc/agx095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 10/25/2017] [Indexed: 11/12/2022] Open
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Vijverberg R, Ferdinand R, Beekman A, van Meijel B. The effect of youth assertive community treatment: a systematic PRISMA review. BMC Psychiatry 2017; 17:284. [PMID: 28768492 PMCID: PMC5541424 DOI: 10.1186/s12888-017-1446-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND During the past decades deinstitutionalisation policies have led to a transition from inpatient towards community mental health care. Many European countries implement Assertive Community Treatment (ACT) as an alternative for inpatient care for "difficult to reach" children and adolescents with severe mental illness. ACT is a well-organized low-threshold treatment modality; patients are actively approached in their own environment, and efforts are undertaken to strengthen the patient's motivation for treatment. The assumption is that ACT may help to avoid psychiatric hospital admissions, enhance cost-effectiveness, stimulate social participation and support, and reduce stigma. ACT has been extensively investigated in adults with severe mental illness and various reviews support its effectiveness in this patient group. However, to date there is no review available regarding the effectiveness of youth-ACT. It is unknown whether youth-ACT is as effective as it is in adults. This review aims to assess the effects of youth-ACT on severity of psychiatric symptoms, general functioning, and psychiatric hospital admissions. METHOD A systematic literature search was conducted in PubMed, Cochrane Library, PsychINFO and CINAHL published up to March 2017. To assess methodological quality of the included studies, the Oxford Centre of Evidence-Based Medicine grading system was used. RESULTS Thirteen studies were included in this review. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. CONCLUSIONS The current literature on youth-ACT is limited but promising. There are indications that youth-ACT is effective in reducing severity of psychiatric symptoms, improving general functioning, and reducing duration and frequency of psychiatric hospital admissions. The effect of youth-ACT may be comparable with the effect of ACT in adults. Similar as in adult ACT, the studies on youth-ACT found effects that vary from small to large. Randomized experimental research designs are needed to further corroborate effectiveness.
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Affiliation(s)
- Richard Vijverberg
- Department of Child and Adolescent Psychiatry, GGZ-Delfland, PO-box 5016, 2600 GA Delft, The Netherlands
- VU Medical Centre/GGZ-InGeest, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Robert Ferdinand
- Department of Child and Adolescent Psychiatry, GGZ-Delfland, PO-box 5016, 2600 GA Delft, The Netherlands
| | - Aartjan Beekman
- VU Medical Centre/GGZ-InGeest, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Berno van Meijel
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
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Harrison J, Cousins L, Spybrook J, Curtis A. Peers and Co-Occurring Research-Supported Interventions. ACTA ACUST UNITED AC 2017; 14:201-215. [PMID: 28459377 DOI: 10.1080/23761407.2017.1316220] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Harrison J, Curtis A, Cousins L, Spybrook J. Integrated Dual Disorder Treatment Implementation in a Large State Sample. Community Ment Health J 2017; 53:358-366. [PMID: 27234036 DOI: 10.1007/s10597-016-0019-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 05/23/2016] [Indexed: 11/25/2022]
Abstract
Individuals with co-occurring illnesses are at risk for poor outcomes related to criminal justice, hospitalization, housing, and employment. High fidelity evidence-based models, including integrated dual disorder treatment (IDDT), are associated with significant outcome improvements. A descriptive analysis of secondary datasets including the full sample of IDDT fidelity reviews completed from 2006 to 2012 in one state was completed. Total IDDT fidelity significantly improved from baseline fidelity review (68) to second review (40) [t(38) = 35.00, p < .001], and from second review to third review (13) [t(12) = 22.60, p < .001], with adequate inner-rater reliability by the second review. Individual items that were lower across reviews included practice penetration and family interventions, and higher individual items included multi-disciplinary team, integrated treatment specialist, and time-unlimited services, and treatment measures are higher than organizational measures in baseline and subsequent reviews. In this large state-wide sample, IDDT took time to implement, and improved fidelity occurred from baseline to third review, and variance between components of the practice was significant.
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Affiliation(s)
- Jennifer Harrison
- School of Social Work, Western Michigan University, 1903 W. Michigan, Kalamazoo, MI, 49008, USA.
| | - Amy Curtis
- Interdisciplinary Health Sciences PhD Program, Western Michigan University, Kalamazoo, USA
| | - Linwood Cousins
- Department of Anthropology, Western Michigan University, Kalamazoo, USA
| | - Jessaca Spybrook
- Department of Educational Leadership, Research, and Technology, Western Michigan University, Kalamazoo, USA
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Dieterich M, Irving CB, Bergman H, Khokhar MA, Park B, Marshall M. Intensive case management for severe mental illness. Cochrane Database Syst Rev 2017; 1:CD007906. [PMID: 28067944 PMCID: PMC6472672 DOI: 10.1002/14651858.cd007906.pub3] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input. OBJECTIVES To assess the effects of ICM as a means of caring for severely mentally ill people in the community in comparison with non-ICM (caseload greater than 20) and with standard community care. We did not distinguish between models of ICM. In addition, to assess whether the effect of ICM on hospitalisation (mean number of days per month in hospital) is influenced by the intervention's fidelity to the ACT model and by the rate of hospital use in the setting where the trial was conducted (baseline level of hospital use). SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (last update search 10 April 2015). SELECTION CRITERIA All relevant randomised clinical trials focusing on people with severe mental illness, aged 18 to 65 years and treated in the community care setting, where ICM is compared to non-ICM or standard care. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, assessed quality, and extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% CI. We employed a random-effects model for analyses.We performed a random-effects meta-regression analysis to examine the association of the intervention's fidelity to the ACT model and the rate of hospital use in the setting where the trial was conducted with the treatment effect. We assessed overall quality for clinically important outcomes using the GRADE approach and investigated possible risk of bias within included trials. MAIN RESULTS The 2016 update included two more studies (n = 196) and more publications with additional data for four already included studies. The updated review therefore includes 7524 participants from 40 randomised controlled trials (RCTs). We found data relevant to two comparisons: ICM versus standard care, and ICM versus non-ICM. The majority of studies had a high risk of selective reporting. No studies provided data for relapse or important improvement in mental state.1. ICM versus standard careWhen ICM was compared with standard care for the outcome service use, ICM slightly reduced the number of days in hospital per month (n = 3595, 24 RCTs, MD -0.86, 95% CI -1.37 to -0.34,low-quality evidence). Similarly, for the outcome global state, ICM reduced the number of people leaving the trial early (n = 1798, 13 RCTs, RR 0.68, 95% CI 0.58 to 0.79, low-quality evidence). For the outcome adverse events, the evidence showed that ICM may make little or no difference in reducing death by suicide (n = 1456, 9 RCTs, RR 0.68, 95% CI 0.31 to 1.51, low-quality evidence). In addition, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment due to very low-quality evidence (n = 1129, 4 RCTs, RR 0.70, 95% CI 0.49 to 1.0, very low-quality evidence).2. ICM versus non-ICMWhen ICM was compared with non-ICM for the outcome service use, there was moderate-quality evidence that ICM probably makes little or no difference in the average number of days in hospital per month (n = 2220, 21 RCTs, MD -0.08, 95% CI -0.37 to 0.21, moderate-quality evidence) or in the average number of admissions (n = 678, 1 RCT, MD -0.18, 95% CI -0.41 to 0.05, moderate-quality evidence) compared to non-ICM. Similarly, the results showed that ICM may reduce the number of participants leaving the intervention early (n = 1970, 7 RCTs, RR 0.70, 95% CI 0.52 to 0.95,low-quality evidence) and that ICM may make little or no difference in reducing death by suicide (n = 1152, 3 RCTs, RR 0.88, 95% CI 0.27 to 2.84, low-quality evidence). Finally, for the outcome social functioning, there was uncertainty about the effect of ICM on unemployment as compared to non-ICM (n = 73, 1 RCT, RR 1.46, 95% CI 0.45 to 4.74, very low-quality evidence).3. Fidelity to ACTWithin the meta-regression we found that i.) the more ICM is adherent to the ACT model, the better it is at decreasing time in hospital ('organisation fidelity' variable coefficient -0.36, 95% CI -0.66 to -0.07); and ii.) the higher the baseline hospital use in the population, the better ICM is at decreasing time in hospital ('baseline hospital use' variable coefficient -0.20, 95% CI -0.32 to -0.10). Combining both these variables within the model, 'organisation fidelity' is no longer significant, but the 'baseline hospital use' result still significantly influences time in hospital (regression coefficient -0.18, 95% CI -0.29 to -0.07, P = 0.0027). AUTHORS' CONCLUSIONS Based on very low- to moderate-quality evidence, ICM is effective in ameliorating many outcomes relevant to people with severe mental illness. Compared to standard care, ICM may reduce hospitalisation and increase retention in care. It also globally improved social functioning, although ICM's effect on mental state and quality of life remains unclear. Intensive Case Management is at least valuable to people with severe mental illnesses in the subgroup of those with a high level of hospitalisation (about four days per month in past two years). Intensive Case Management models with high fidelity to the original team organisation of ACT model were more effective at reducing time in hospital.However, it is unclear what overall gain ICM provides on top of a less formal non-ICM approach.We do not think that more trials comparing current ICM with standard care or non-ICM are justified, however we currently know of no review comparing non-ICM with standard care, and this should be undertaken.
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Affiliation(s)
- Marina Dieterich
- Azienda USL Toscana Nord OvestDepartment of PsychiatryLivornoItaly
| | - Claire B Irving
- The University of NottinghamCochrane Schizophrenia GroupInstitute of Mental HealthUniversity of Nottingham Innovation Park, Triumph RoadNottinghamUKNG7 2TU
| | - Hanna Bergman
- Enhance Reviews LtdCentral Office, Cobweb buildingsThe Lane, LyfordWantageUKOX12 0EE
| | - Mariam A Khokhar
- University of SheffieldOral Health and Development15 Askham CourtGamston Radcliffe RoadNottinghamUKNG2 6NR
| | - Bert Park
- Nottinghamshire Healthcare NHS TrustAMH Management SuiteHighbury HospitalNottinghamUKNG6 9DR
| | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPrestonLancashireUK
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Rollins AL, Kukla M, Salyers MP, McGrew JH, Flanagan ME, Leslie DL, Hunt MG, McGuire AB. Comparing the Costs and Acceptability of Three Fidelity Assessment Methods for Assertive Community Treatment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:810-816. [DOI: 10.1007/s10488-016-0785-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Effectiveness of wraparound versus case management for children and adolescents: results of a randomized study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:309-22. [PMID: 24973891 DOI: 10.1007/s10488-014-0571-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In this study, we compared service experiences and outcomes for youths with serious emotional disorder (SED) randomly assigned to care coordination via a defined wraparound process (n = 47) versus more traditional intensive case management (ICM; n = 46) The wraparound group received more mean hours of care management and services; however, there ultimately were no group differences in restrictiveness of residential placement, emotional and behavioral symptoms, or functioning. Wraparound implementation fidelity was found to be poor. Organizational culture and climate, and worker morale, were poorer for the wraparound providers than the ICM group. Results suggest that, for less-impaired youths with SED, less intensive options such as ICM may be equally effective to poor-quality wraparound delivered in the absence of wraparound implementation supports and favorable system conditions.
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Roosenschoon BJ, van Weeghel J, Bogaards M, Deen ML, Mulder CL. Illness Management & Recovery (IMR) in the Netherlands; a naturalistic pilot study to explore the feasibility of a randomized controlled trial. BMC Psychiatry 2016; 16:391. [PMID: 27829392 PMCID: PMC5103352 DOI: 10.1186/s12888-016-1096-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illness Management & Recovery (IMR) is a curriculum-based program for people with severe and persistent mental illness. To date, four randomized controlled trials (RCTs) have been published on it. As these produced mixed results, we conducted a pilot study to test the feasibility of conducting a new RCT in a Dutch psychiatric institute. Because our primary objective was to evaluate support for implementing IMR on a broader scale, we examined participant recruitment, client outcomes, and clients' and clinicians' satisfaction. Secondary objectives were to evaluate fidelity, trainers' training and supervision, and to explore program duration, dropout, and client characteristics related to dropout. For reporting, we used the checklist for pilot studies adopted from the CONSORT Statement. METHODS This program evaluation included a process-evaluation and an outcome evaluation with a One Group Pre-Posttest Design (N = 81). Interviews and internal reports were used to monitor participant numbers, program duration, dropout, and completers' characteristics. Clients' and clinicians' satisfaction and provision of trainers' training and supervision were assessed through interviews. Fidelity was assessed on the IMR Fidelity Scale; client outcomes were assessed on the IMR scale (client and clinician versions) and the Recovery Markers Questionnaire (RMQ). RESULTS Eighty-one participants were recruited of 167 people who were assessed for eligibility. Completers and clinicians were satisfied, and scores for completers improved significantly on the IMR scale (clinician version) (d = 0.84) and RMQ (d = 0.52), and not significantly on the IMR scale client version (d = 0.41). Mean fidelity was good, but three groups had only moderate fidelity. Our feasibility criterion for trainers' education and supervision was partly attained. Dropout from treatment was 51 %; female participants and people who scored higher on both IMR-scales at baseline had a significantly lower chance of dropping out. The duration of IMR varied (M = 12.7 months, SD = 2.87). CONCLUSIONS Results suggested that feasibility of conducting an RCT on IMR was good. Special attention is required to fidelity, IMR duration, trainers' education and supervision, and dropout, especially of men. One study limitation was our inability to conduct follow-up measurements of non-completers.
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Affiliation(s)
- Bert-Jan Roosenschoon
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. .,Parnassia Psychiatric Institute, Parnassia Academy, Kiwistraat 32, 2552, DH, Den Haag, The Netherlands.
| | - Jaap van Weeghel
- Tilburg School of Social and Behavioral Sciences, Department of TRANZO, Tilburg University, Warandelaan 2, 5037 AB Tilburg, The Netherlands ,Parnassia Psychiatric Institute, Dijk en Duin, Oude Parklaan 125, 1901 ZZ Castricum, The Netherlands
| | - Moniek Bogaards
- Parnassia Psychiatric Institute, Bavo-Europoort, Prins Constantijnweg 48-54, 3066 TA Rotterdam, The Netherlands
| | - Mathijs L. Deen
- Parnassia Psychiatric Institute, Parnassia Academy, Kiwistraat 32, 2552 DH Den Haag, The Netherlands ,Faculty of Social and Behavioral Sciences, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute, Erasmus University Medical Centre, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands ,Parnassia Psychiatric Institute, Bavo-Europoort, Prins Constantijnweg 48-54, 3066 TA Rotterdam, The Netherlands
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Abstract
Evidence-based practice (EBP) represents a paradigm shift in health care. This review has two aims. The first is to consider the merits of EBP, especially in respect of its use in mental health settings. The second is both to identify psychosocial interventions that have an established evidence base for effectiveness and to provide an analysis of the quality of this evidence and its implications for occupational therapy. Supported employment, family psychoeducation, assertive case management and integrated substance use treatment are examined in detail. It is proposed that occupational therapists working in mental health give priority to psychosocial interventions that are based on evidence and incorporate these into their practice. It is further proposed that, in implementing EBP, practitioners take an active evaluating position in relation to published evidence, paying particular attention to the evidence of effectiveness in equivalent clinical environments.
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van Vugt MD, Kroon H, Delespaul PAEG, Mulder CL. Assertive community treatment and associations with delinquency. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:93-97. [PMID: 27599432 DOI: 10.1016/j.ijlp.2016.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Indexed: 06/06/2023]
Abstract
This article draws on a prospective longitudinal study in which Assertive Community Treatment (ACT) model fidelity and patient outcomes were assessed in twenty outpatient treatment teams. 530 severely mentally ill patients participated in the study. Delinquency outcomes were assessed three times during a two-year follow-up period. At baseline, 49% of the patients had a recent criminal history, meaning that they had at least one reported contact with the police and/or the justice system in the past year. Patients with a recent criminal history had more serious psychosocial problems at baseline compared to those without a recent criminal history. Delinquency outcomes showed improvement over time, but this was not associated with ACT model fidelity. The study shows an association for homelessness and criminal activity. The persistent criminal activities of some of the patients showed that for this group extra interventions are needed that specifically target reduction of criminal behavior.
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Affiliation(s)
- Maaike D van Vugt
- Department of Reintegration, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands.
| | - Hans Kroon
- Department of Reintegration, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS Utrecht, The Netherlands
| | - Philippe A E G Delespaul
- Mental Health Services Research & Development, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - Cornelis L Mulder
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Gates PJ, Sabioni P, Copeland J, Le Foll B, Gowing L. Psychosocial interventions for cannabis use disorder. Cochrane Database Syst Rev 2016; 2016:CD005336. [PMID: 27149547 PMCID: PMC4914383 DOI: 10.1002/14651858.cd005336.pub4] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cannabis use disorder is the most commonly reported illegal substance use disorder in the general population; although demand for assistance from health services is increasing internationally, only a minority of those with the disorder seek professional assistance. Treatment studies have been published, but pressure to establish public policy requires an updated systematic review of cannabis-specific treatments for adults. OBJECTIVES To evaluate the efficacy of psychosocial interventions for cannabis use disorder (compared with inactive control and/or alternative treatment) delivered to adults in an out-patient or community setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 6), MEDLINE, EMBASE, PsycINFO, the Cumulaive Index to Nursing and Allied Health Literature (CINAHL) and reference lists of articles. Searched literature included all articles published before July 2015. SELECTION CRITERIA All randomised controlled studies examining a psychosocial intervention for cannabis use disorder (without pharmacological intervention) in comparison with a minimal or inactive treatment control or alternative combinations of psychosocial interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by The Cochrane Collaboration. MAIN RESULTS We included 23 randomised controlled trials involving 4045 participants. A total of 15 studies took place in the United States, two in Australia, two in Germany and one each in Switzerland, Canada, Brazil and Ireland. Investigators delivered treatments over approximately seven sessions (range, one to 14) for approximately 12 weeks (range, one to 56).Overall, risk of bias across studies was moderate, that is, no trial was at high risk of selection bias, attrition bias or reporting bias. Further, trials included a large total number of participants, and each trial ensured the fidelity of treatments provided. In contrast, because of the nature of the interventions provided, participant blinding was not possible, and reports of researcher blinding often were unclear or were not provided. Half of the reviewed studies included collateral verification or urinalysis to confirm self report data, leading to concern about performance and detection bias. Finally, concerns of other bias were based on relatively consistent lack of assessment of non-cannabis substance use or use of additional treatments before or during the trial period.A subset of studies provided sufficient detail for comparison of effects of any intervention versus inactive control on primary outcomes of interest at early follow-up (median, four months). Results showed moderate-quality evidence that approximately seven out of 10 intervention participants completed treatment as intended (effect size (ES) 0.71, 95% confidence interval (CI) 0.63 to 0.78, 11 studies, 1424 participants), and that those receiving psychosocial intervention used cannabis on fewer days compared with those given inactive control (mean difference (MD) 5.67, 95% CI 3.08 to 8.26, six studies, 1144 participants). In addition, low-quality evidence revealed that those receiving intervention were more likely to report point-prevalence abstinence (risk ratio (RR) 2.55, 95% CI 1.34 to 4.83, six studies, 1166 participants) and reported fewer symptoms of dependence (standardised mean difference (SMD) 4.15, 95% CI 1.67 to 6.63, four studies, 889 participants) and cannabis-related problems compared with those given inactive control (SMD 3.34, 95% CI 1.26 to 5.42, six studies, 2202 participants). Finally, very low-quality evidence indicated that those receiving intervention reported using fewer joints per day compared with those given inactive control (SMD 3.55, 95% CI 2.51 to 4.59, eight studies, 1600 participants). Notably, subgroup analyses found that interventions of more than four sessions delivered over longer than one month (high intensity) produced consistently improved outcomes (particularly in terms of cannabis use frequency and severity of dependence) in the short term as compared with low-intensity interventions.The most consistent evidence supports the use of cognitive-behavioural therapy (CBT), motivational enhancement therapy (MET) and particularly their combination for assisting with reduction of cannabis use frequency at early follow-up (MET: MD 4.45, 95% CI 1.90 to 7.00, four studies, 612 participants; CBT: MD 10.94, 95% CI 7.44 to 14.44, one study, 134 participants; MET + CBT: MD 7.38, 95% CI 3.18 to 11.57, three studies, 398 participants) and severity of dependence (MET: SMD 4.07, 95% CI 1.97 to 6.17, two studies, 316 participants; MET + CBT: SMD 7.89, 95% CI 0.93 to 14.85, three studies, 573 participants), although no particular intervention was consistently effective at nine-month follow-up or later. In addition, data from five out of six studies supported the utility of adding voucher-based incentives for cannabis-negative urines to enhance treatment effect on cannabis use frequency. A single study found contrasting results throughout a 12-month follow-up period, as post-treatment outcomes related to overall reduction in cannabis use frequency favoured CBT alone without the addition of abstinence-based or treatment adherence-based contingency management. In contrast, evidence of drug counselling, social support, relapse prevention and mindfulness meditation was weak because identified studies were few, information on treatment outcomes insufficient and rates of treatment adherence low. In line with treatments for other substance use, abstinence rates were relatively low overall, with approximately one-quarter of participants abstinent at final follow-up. Finally, three studies found that intervention was comparable with treatment as usual among participants in psychiatric clinics and reported no between-group differences in any of the included outcomes. AUTHORS' CONCLUSIONS Included studies were heterogeneous in many aspects, and important questions regarding the most effective duration, intensity and type of intervention were raised and partially resolved. Generalisability of findings was unclear, most notably because of the limited number of localities and homogeneous samples of treatment seekers. The rate of abstinence was low and unstable although comparable with treatments for other substance use. Psychosocial intervention was shown, in comparison with minimal treatment controls, to reduce frequency of use and severity of dependence in a fairly durable manner, at least in the short term. Among the included intervention types, an intensive intervention provided over more than four sessions based on the combination of MET and CBT with abstinence-based incentives was most consistently supported for treatment of cannabis use disorder.
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Affiliation(s)
- Peter J Gates
- National Cannabis Prevention and Information Centre22‐32 King StUNSW Medicine, SydneyAustralia2031
| | - Pamela Sabioni
- Centre for Addiction and Mental Health; University of TorontoTranslational Addiction Research Laboratory33 Russell StreetTorontoONCanada
| | - Jan Copeland
- UNSW MedicineNational Cannabis Prevention and Information Centre22‐‐32 King StreetSydneyAustralia2052
| | - Bernard Le Foll
- Centre for Addiction and Mental Health; University of TorontoTranslational Addiction Research Laboratory33 Russell StreetTorontoONCanada
| | - Linda Gowing
- University of AdelaideDiscipline of PharmacologyFrome RoadAdelaideSouth AustraliaAustralia5005
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Lloyd-Evans B, Fullarton K, Lamb D, Johnston E, Onyett S, Osborn D, Ambler G, Marston L, Hunter R, Mason O, Henderson C, Goater N, Sullivan SA, Kelly K, Gray R, Nolan F, Pilling S, Bond G, Johnson S. The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial. Trials 2016; 17:158. [PMID: 27004517 PMCID: PMC4804533 DOI: 10.1186/s13063-016-1283-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity. METHODS/DESIGN Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services' electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study's primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme. DISCUSSION Our trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams. TRIAL REGISTRATION Current Controlled Trials ISRCTN47185233.
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Affiliation(s)
| | - Kate Fullarton
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Danielle Lamb
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Elaine Johnston
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Steve Onyett
- />Onyett Entero Ltd, Care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY UK
| | - David Osborn
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Gareth Ambler
- />Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT UK
| | - Louise Marston
- />Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Rachael Hunter
- />Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Oliver Mason
- />Department of Clinical Education and Health Psychology, UCL, Gower Street, London, WC1E 6BT UK
| | - Claire Henderson
- />Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF UK
| | - Nicky Goater
- />West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU UK
| | - Sarah A. Sullivan
- />Epidemiology and Health Services Research, CLAHRC West, Lewins Mead, Bristol, BS1 2NT UK
| | - Kathleen Kelly
- />Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Richard Gray
- />Mental Health Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY UK
| | - Fiona Nolan
- />Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Stephen Pilling
- />Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Gary Bond
- />Department of Psychiatry, Dartmouth Psychiatric Research Centre, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756 USA
| | - Sonia Johnson
- />Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
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Ruggiero KJ, Bunnell BE, Andrews Iii AR, Davidson TM, Hanson RF, Danielson CK, Saunders BE, Soltis K, Yarian C, Chu B, Adams ZW. Development and Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment. JMIR Res Protoc 2015; 4:e143. [PMID: 26717906 PMCID: PMC4712346 DOI: 10.2196/resprot.4416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 12/03/2022] Open
Abstract
Background Children need access to high quality mental health care. Effective treatments now exist for a wide range of mental health conditions. However, these interventions are delivered with variable effectiveness in traditional mental health service settings. Innovative solutions are needed to improve treatment delivery quality and effectiveness. Objective The aim of this study was to develop a scalable, sustainable technology-based approach to improve the quality of care in child mental health treatment. Methods A tablet-based resource was developed with input from mental health training experts, mental health providers, and patients. A series of qualitative data collection phases (ie, expert interviews, patient and provider focus groups, usability testing) guided the initial concept and design of the resource, and then its refinement. The result was an iPad-based “e-workbook” designed to improve child engagement and provider fidelity in implementation of a best-practice treatment. We are currently conducting a small scale randomized controlled trial to evaluate the feasibility of e-workbook facilitated child mental health treatment with 10 providers and 20 families recruited from 4 local community-based mental health clinics. Results Usability and focus group testing yielded a number of strong, favorable reactions from providers and families. Recommendations for refining the e-workbook also were provided, and these guided several improvements to the resource prior to initiating the feasibility trial, which is currently underway. Conclusions This study aimed to develop and preliminarily evaluate a tablet-based application to improve provider fidelity and child engagement in child mental health treatment. If successful, this approach may serve as a key step toward making best-practice treatment more accessible to children and families. As various technologies continue to increase in popularity worldwide and within the health care field more specifically, it is essential to rigorously test the usability, feasibility, acceptability, and effectiveness of novel health technology solutions. It is also essential to ensure that patients and providers drive decision making that supports the development of these resources to ensure that they can be seamlessly integrated into practice. Trial Registration Clinicaltrials.gov NCT01915160; https://clinicaltrials.gov/ct2/show/NCT01915160 (Archived by WebCite at http://www.webcitation.org/6cPIiQDpu)
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Affiliation(s)
- Kenneth J Ruggiero
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
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Farren L, Snowden M, Steinman L, Monroe-DeVita M. Development and Evaluation of a Fidelity Instrument for PEARLS. Front Public Health 2015; 2:200. [PMID: 25964917 PMCID: PMC4410416 DOI: 10.3389/fpubh.2014.00200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/03/2014] [Indexed: 11/24/2022] Open
Abstract
Purpose This manuscript describes the development and the preliminary evaluation of a fidelity instrument for the Program for Encouraging Active and Rewarding Lives (PEARLS), an evidence-based depression care management (DCM) program. The objective of the study was to find an effective, practical, multidimensional approach to measure fidelity of PEARLS programs to the original, research-driven PEARLS protocol in order to inform program implementation at various settings nationwide. Methods We conducted key informant interviews with PEARLS stakeholders, and held focus groups with former PEARLS clients, to identify core program components. These components were then ranked using a Q-sort process, and incorporated into a brief instrument. We tested the instrument at two time points with PEARLS counselors, other DCM program counselors, and non-DCM program counselors (n = 56) in six states. Known-groups method was used to compare findings from PEARLS programs, other DCM programs, and non-DCM programs. We asked supervisors of the counselors to complete the fidelity instrument on behalf of their counselors to affirm the validity of the results. We examined the association of PEARLS program fidelity with individual client outcomes. Results Program for Encouraging Active and Rewarding Lives providers reported the highest fidelity scores compared to DCM program providers and non-DCM program providers. The sample size was too small to yield significant results on the comparison between counselor experience and fidelity. Scores varied between PEARLS counselors and their supervisors. PEARLS program fidelity was not significantly correlated with client outcomes, suggesting that other implementation factors may have influenced the outcomes and/or that the instrument needs refinement. Conclusion Our findings suggest that providers may be able to use the instrument to assess PEARLS program fidelity in various settings across the country. However, more rigorous research is needed to evaluate instrument effectiveness.
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Affiliation(s)
- Laura Farren
- Health Promotion Research Center, University of Washington , Seattle, WA , USA
| | - Mark Snowden
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington , Seattle, WA , USA
| | - Lesley Steinman
- Health Promotion Research Center, University of Washington , Seattle, WA , USA
| | - Maria Monroe-DeVita
- Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle, WA , USA
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Rollins AL, McGrew JH, Kukla M, McGuire AB, Flanagan ME, Hunt MG, Leslie DL, Collins LA, Wright-Berryman JL, Hicks LJ, Salyers MP. Comparison of Assertive Community Treatment Fidelity Assessment Methods: Reliability and Validity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 43:157-67. [DOI: 10.1007/s10488-015-0641-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Engagement in assertive community treatment as experienced by recovering clients with severe mental illness and concurrent substance use. Int J Ment Health Syst 2014; 8:40. [PMID: 25389446 PMCID: PMC4226907 DOI: 10.1186/1752-4458-8-40] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 10/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clients with severe mental illness (SMI) who use substances are less engaged in treatment than those who do not use substances, and assertive community treatment (ACT) engages and retains clients with SMI and concurrent substance use at a higher rate compared with traditional treatment. This qualitative study aimed to explore the experiences of being recruited to, and remaining in, ACT among recovering clients diagnosed with SMI and concurrent substance use. METHODS Twenty semi-structured interviews were undertaken among 11 clients with SMI and concurrent substance use who were included in ACT teams. The inclusion criteria were SMI and concurrent substance use and improvement after a minimum of 12 months in treatment regarding one or several of the following parameters: quality of life, general functioning and substance use. Systematic text condensation was applied in the analyses. RESULTS The experiences of building trust through enduring involvement and receiving benefits were most important for the acceptance of ACT by clients. A feeling of exclusiveness, perceiving ACT as a safety net and the clients' own personal responsibility for taking part in the treatment were stated as the most important factors for remaining in treatment. CONCLUSIONS The implications of the results of the present study are that service providers have to prove that they can be trusted in the initial phase of the clients' contact with the team. The feeling by clients with SMI and concurrent substance use that service providers in ACT believe they can improve their client's quality of life, is of importance for feeling exclusive, having hope for the future and remaining in treatment.
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Silva TFCD. Avaliando a fidelidade de intervenções psicossociais: uma revisão sistemática da literatura. JORNAL BRASILEIRO DE PSIQUIATRIA 2014. [DOI: 10.1590/0047-2085000000034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Intervenções psicossociais têm tido impacto positivo na vida das pessoas com transtorno mental grave, porém tais intervenções devem ser implementadas fielmente ao protocolo. A fidelidade refere-se à medida que uma intervenção adere ao modelo original e sua avaliação é essencial para que os desfechos possam ser creditados à intervenção. O objetivo deste estudo foi realizar uma revisão sistemática da literatura mundial das intervenções psicossociais destinadas a pacientes com transtornos mentais que possuem um instrumento ou método de avaliação de fidelidade ao modelo original. Métodos Pesquisas bibliográficas sistemáticas foram realizadas para encontrar estudos relevantes ao tema nas seguintes bases de dados: Embase, Medline, Scopus e SciELO. Foram incluídos estudos de intervenções psicossociais, realizados na comunidade, dirigidos a pacientes diagnosticados com transtornos mentais. Intervenções de comparação poderiam incluir tanto o tratamento-padrão como uma intervenção de comparação ativa. A qualidade dos estudos foi avaliada de forma independente por dois revisores, utilizando critérios adaptados de instrumentos validados. Resultados Trinta estudos preencheram os critérios de inclusão. Os estudos mostraram a eficácia da avaliação da fidelidade em diferenciar diferentes modelos de tratamento, sua validade preditiva para os desfechos e a confiabilidade dos instrumentos utilizados, bem como os fatores facilitadores e os obstáculos para a obtenção de alta fidelidade nas intervenções avaliadas. Conclusão Além de documentar a adesão ao modelo original, a fidelidade fornece informações relativas à população-alvo e aos desfechos esperados, o que contribui para que seja alcançada excelência no processo de implementação das intervenções psicossociais.
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Abstract
Une réforme ne peut voir le jour et atteindre ses objectifs sans être soutenue de diverses façons. Au Québec, le Plan d’action en santé mentale 2005-2010 – La force des liens a introduit de nombreuses réformes de fond et de forme dans le réseau de services en santé mentale. Cet article voudra explorer quelles formes d’encadrement peuvent soutenir cette réforme et à quel point ces formes ont été exploitées ou devraient l’être. Il pourra ainsi soutenir la réflexion sur les moyens d’encadrement qu’il faudra utiliser pour soutenir le prochain plan d’action actuellement en rédaction au ministère de la Santé et des Services sociaux.
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Affiliation(s)
- André Delorme
- M.D., FRCPC (Psych.), directeur de la santé mentale, ministère de la Santé et des Services sociaux, 1075, chemin Ste-Foy, 2e étage, Québec (Qc), Canada, G1S 2M1
| | - Michel Gilbert
- PS. Éd., coordonnateur, Centre national d’excellence en santé mentale, ministère de la Santé et des Services sociaux
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Hanson RF, Gros KS, Davidson TM, Barr S, Cohen J, Deblinger E, Mannarino AP, Ruggiero KJ. National trainers' perspectives on challenges to implementation of an empirically-supported mental health treatment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:522-34. [PMID: 23605292 PMCID: PMC3758397 DOI: 10.1007/s10488-013-0492-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined perceived challenges to implementation of an empirically supported mental health treatment for youth (Trauma-Focused Cognitive Behavioral Therapy; TF-CBT) and explored the potential use of technology-based resources in treatment delivery. Thematic interviews were conducted with 19 approved national TF-CBT trainers to assess their perspectives about challenges to implementation of TF-CBT and to explore their perceptions about the potential value of innovative, technology-based solutions to enhance provider fidelity and improve quality of care. These data offer some important insights and implications for training in evidence-based treatments, provider fidelity and competence, and patient engagement, particularly for those interventions targeting trauma-related symptoms among youth.
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Affiliation(s)
- Rochelle F Hanson
- National Crime Victims Research and Treatment Center, Medical University of South Carolina, MSC 861, Charleston, SC, 29425, USA,
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The Gloucester assertive community treatment team: A description and comparison with other services. Ir J Psychol Med 2014; 23:134-139. [DOI: 10.1017/s0790966700009927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractAssertive Community Treatment (ACT) has developed globally as a model of community care for the severely mentally ill. However, in the United Kingdom there is mixed evidence regarding improvements in outcome and concerns about ACT teams having poor fidelity to the original ACT model.Objective: This study presents the fidelity characteristics of an established ACT team serving Gloucester City. It describes service user demographic and illness data and compares these findings to other important studies in the United Kingdom.Method: The Dartmouth Assertive Community Treatment Scale was applied to rate the Gloucester ACT team's fidelity characteristics. The Gloucester Caseload Project Demographic Pro-Forma was collected from all of the team's 79 service users.Results: The population of severely mentally ill ACT service users in Gloucester City were an older and more “disabled” group compared to the classic ACT studies. Furthermore, although findings indicate a high level of fidelity to the original ACT model, the team it is still associated with high levels of inpatient treatment.Conclusion: High fidelity ACT services appear to be associated with high admission rates. Therefore teams should not be viewed as alternatives to hospital admission but have goals of improving engagement and social functioning. Furthermore, findings have allowed the team to benchmark its service and target areas for further service development. More consistent reporting of fidelity data on ACT research would facilitate comparison across different services.
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van Vugt MD, Kroon H, Delespaul PAEG, Mulder CL. Assertive community treatment and associations with substance abuse problems. Community Ment Health J 2014; 50:460-5. [PMID: 23771775 DOI: 10.1007/s10597-013-9626-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 06/03/2013] [Indexed: 11/30/2022]
Abstract
This study examined the associations between substance abuse problems in severely mentally ill patients, outcome and Assertive Community Treatment (ACT) model fidelity. In a prospective longitudinal study, ACT model fidelity and patient outcomes were assessed in 20 outpatient treatment teams using the Health of the Nation Outcome Scales, Camberwell Assessment of Needs short appraisal schedule and measures of service use. Five hundred and thirty severely mentally ill patients participated in the study. Substance abuse problems were assessed three times during a 2-year follow-up period. This study found that among patients with severe mental illness, patients with an addiction problem had more serious psychosocial problems at baseline. Substance abuse problems showed improvement over time, but this was not associated with ACT model fidelity. The study indicates that investment by teams to improve a patient's psychosocial situation can lead to improvements on substance problems.
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Affiliation(s)
- Maaike D van Vugt
- Department of Reintegration, Trimbos-institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands,
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Establishing Treatment Fidelity in Evidence-Based Parent Training Programs for Externalizing Disorders in Children and Adolescents. Clin Child Fam Psychol Rev 2014; 17:230-47. [DOI: 10.1007/s10567-014-0166-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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