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Briand C, Roebuck M, Vallée C, Bergeron-Leclerc C, Krupa T, Durbin J, Aubry T, Goscha R, Latimer E. Implementation of strengths model case management in seven mental health agencies in Canada: Direct-service practitioners' implementation experience. J Eval Clin Pract 2022; 28:1127-1137. [PMID: 35560475 DOI: 10.1111/jep.13696] [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] [Received: 11/01/2021] [Revised: 04/07/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
RATIONALE Implementation of strengths model case management is increasing internationally. However, few studies have focused on its implementation process, and none have specifically addressed the implementation experience of direct-service practitioners. OBJECTIVE This paper presents factors that facilitate and impede the successful implementation of the strengths model, with a specific focus on practitioners who deliver the intervention directly to service recipients. METHOD To address this objective, a qualitative study of seven mental health agencies that implemented the model was conducted, involving a combination of participant observations and qualitative semistructured interviews with case managers, team supervisors, and senior managers. Qualitative data were analyzed using open coding followed by axial coding. Finally, the findings were aligned with an adapted Consolidated Framework for Implementation Research. RESULTS Implementation of the strengths model involved a significant change in practice for case management practitioners. The results confirm that at the beginning of implementation, the strengths model was perceived as complex and not always adaptable to on-the-ground realities. With time, and with support from management, ongoing training and supervision sessions, and reflection and discussion, practitioners regained feelings of competence and resistance to the model diminished. The use of the model's structured team-based supervision tools was fundamental to supporting the implementation process by enabling an interactive and concrete training approach. CONCLUSIONS The more an approach leads to changes in daily practice and is perceived as complex, the more concrete support is needed during implementation. This article highlights the importance of attending to a practitioner's sense of personal effectiveness and competence in the adoption of new practices.
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Affiliation(s)
- Catherine Briand
- Research Center of Montreal Mental Health University Institut, Montreal, Québec, Canada.,Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Maryann Roebuck
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Catherine Vallée
- Department of Rehabilitation, Université Laval, Quebec City, Québec, Canada
| | | | - Terry Krupa
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Janet Durbin
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Tim Aubry
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Rick Goscha
- California Institut for Behavioural Health Solutions (CIBHS), Sacramento, California, USA
| | - Eric Latimer
- Research Center of Douglas Mental Health University Institut, Montreal, Québec, Canada.,Department of Psychiatry, McGill University, Montreal, Québec, Canada
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2
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Implementing the Strengths Model of Case Management: Assessing Practice Three Years After Initial Implementation. Community Ment Health J 2022; 58:1535-1543. [PMID: 35397721 DOI: 10.1007/s10597-022-00968-0] [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] [Received: 10/24/2021] [Accepted: 03/17/2022] [Indexed: 01/27/2023]
Abstract
While strengths approaches are important to recovery-oriented practice, implementation can be challenging. This study implemented the strengths model of case management (SMCM) in 11 CM teams and assessed the fidelity of delivery and staff perceptions of the model after 36 months using the SMCM fidelity scale and the Readiness Monitoring Tool. Paired sample t-tests assessed change in fidelity from baseline to 36 months. Adjusted regression analyses compared survey responses of direct and management staff. While fidelity ratings significantly improved across all domains, at 36 months they remained suboptimal in supervision practices and use of model tools. Staff perceptions were generally positive but consistently lower for front-line than management staff. Implementing SMCM into existing case management practice with good fidelity is feasible. However, clear support from management may strengthen staff motivation and delivery. A review of practice later in implementation can flag challenges for sustainability and guide implementation support.
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3
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Tan BL, Shi J, Yang S, Loh H, Ng D, Choo C, Medalia A. The use of virtual reality and augmented reality in psychosocial rehabilitation for adults with neurodevelopmental disorders: A systematic review. Front Psychiatry 2022; 13:1055204. [PMID: 36590624 PMCID: PMC9794993 DOI: 10.3389/fpsyt.2022.1055204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Virtual reality and augmented reality have been used in psychosocial rehabilitation for adults with neurodevelopmental disorders in recent years, to provide functional training in a scaffolded and appealing manner. This systematic review attempted to evaluate (1) how virtual reality or augmented reality technology was deployed, when used as an intervention for adults with neurodevelopmental disorders; and (2) how virtual or augmented reality-assisted psychosocial rehabilitation programs impacted on the functional domains of community living, employment and social participation. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was adopted and a search of publications between June 2012 and June 2022 was carried out. The target groups were adults with schizophrenia/schizoaffective disorders, autism spectrum disorder, intellectual disabilities and attention deficit hyperactivity disorder. Interventions that targeted at least one functional domain were included. RESULTS The database search generated 1,267 records and 38 studies met the inclusion criteria. Three studies utilized augmented reality while the rest utilized virtual reality. The virtual scenarios were displayed in various ways, such as head-mounted displays, computer screens, mobile devices and cave rooms. A few studies also used features such as speech recognition, eye tracking and motion-capture device to provide real-time feedback to participants during rehabilitation. Eleven studies reported interventions that addressed community living, 15 studies addressed vocational skills and nine studies trained participants in social skills or social cognition. Three studies sought to improve quality of life using virtual scenarios to expose participants to various situations. Majority of these studies reported preliminary promising results, with improvement in the functional domains addressed. However, several studies had small sample sizes and many single-arm pretest-posttest studies were assessed to be of serious or critical risk of bias. CONCLUSION Virtual reality and augmented reality are deployed in various ways to augment psychosocial rehabilitation for adults with neurodevelopmental disorders. Most interventions target skills training or strategy learning in the areas of community living, work and social participation. Preliminary positive findings of their effects on functional performance were reported. Larger and robust studies using ecologically valid outcome measures will be needed to establish their effects on real-world functional outcomes. SYSTEMATIC REVIEW REGISTRATION identifier: CRD42022335443.
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Affiliation(s)
- Bhing-Leet Tan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore.,Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Jing Shi
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Suyi Yang
- Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Hannah Loh
- Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Desiree Ng
- Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Cherie Choo
- Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Alice Medalia
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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4
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Nguyen A, Frobert L, Kollbrunner A, Favrod J. An Evaluation of an Online Training Platform for Teaching Positive Emotions for People With Schizophrenia. Front Psychiatry 2022; 13:798019. [PMID: 35197875 PMCID: PMC8859160 DOI: 10.3389/fpsyt.2022.798019] [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: 10/20/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The dissemination of new interventions in clinical practice remains challenging. E-learning may provide wide access in various settings and allow tailored learning trajectories and an adapted training pace. This study evaluates an online platform to train professionals to lead the Positive Emotion Program for Schizophrenia (PEPS) for patients with anhedonia. This study aims to test the reception provided by clinicians to the platform and its perceived usefulness and investigate whether e-PEPS training improves knowledge about the facilitation of PEPS. MATERIALS AND METHODS Participants were recruited through advertisements. All participants provided their informed consent on a registration form and completed two pre-test questionnaires, a knowledge test on negative symptoms in schizophrenia, learning strategies and the partnership relationship, and a test on the ability to savor pleasant moments. After the training, they completed the same questionnaire and an evaluation form of the training and its application in personal and professional life. RESULTS Two-hundred and ten participants were registered to participate into the study, 185 received the access to the platform, and 101 participants completed the training and the post-test assessments. Satisfaction with training was high. The results showed that the participants significantly improved their knowledge about PEPS and increased the skills taught in their personal repertoire after the training. The training allows most clinicians to plan to lead a PEPS group in the year following training. DISCUSSION As a result of this study, training has been improved and is now freely available to all interested clinicians.
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Affiliation(s)
- Alexandra Nguyen
- School of Nursing, La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne (HES-SO), Lausanne, Switzerland
| | - Laurent Frobert
- School of Nursing, La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne (HES-SO), Lausanne, Switzerland
| | - Aurélien Kollbrunner
- School of Nursing, La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne (HES-SO), Lausanne, Switzerland
| | - Jérôme Favrod
- School of Nursing, La Source, University of Applied Sciences and Arts of Western Switzerland, Lausanne (HES-SO), Lausanne, Switzerland
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Fletcher J, Brophy L, Pirkis J, Hamilton B. Contextual Barriers and Enablers to Safewards Implementation in Victoria, Australia: Application of the Consolidated Framework for Implementation Research. Front Psychiatry 2021; 12:733272. [PMID: 34803758 PMCID: PMC8599364 DOI: 10.3389/fpsyt.2021.733272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Safewards is a complex psychosocial intervention designed to reduce conflict and containment on inpatient mental health units. There is mounting international evidence of the effectiveness and acceptability of Safewards. However, a significant challenge exists in promising interventions, such as Safewards, being translated into routine practice. The Consolidated Framework for Implementation Research (CFIR) provides a framework through which to understand implementation in complex health service environments. The aim was to inform more effective implementation of Safewards using the CFIR domains and constructs, capitalizing on developing an understanding of variations across wards. Method: Seven Safewards Leads completed the Training and Implementation Diary for 18 wards that opted in to a trial of Safewards. Fidelity Checklist scores were used to categorize low, medium and high implementers of Safewards at the end of the 12-week implementation period. Results: Qualitative data from the diaries were analyzed thematically and coded according to the five CFIR domains which included 39 constructs. Twenty-six constructs across the five domains were highlighted within the data to have acted as a barrier or enabler. Further analysis revealed that six constructs distinguished between low, medium, and high implementing wards. Discussion: Our findings suggest that for implementation of Safewards to succeed, particular attention needs to be paid to engagement of key staff including managers, making training a priority for all ward staff, adequate planning of the process of implementation and creating an environment on each inpatient unit that prioritize and enables Safewards interventions to be undertaken by staff regularly.
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Affiliation(s)
- Justine Fletcher
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Bridget Hamilton
- Centre for Psychiatric Nursing, School of Health Sciences, The University of Melbourne, Parkville, VIC, Australia
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6
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Briand C, Routhier D, Chassé B. Contributions et défis de l’utilisation des technopédagogies à des fins de soutien à l’appropriation des meilleures pratiques en santé mentale. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081511ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Contexte Malgré les ressources considérables consacrées et les efforts des nombreux acteurs concernés, l’écart entre la production de connaissances scientifiques et leur utilisation dans la pratique demeure un défi. L’utilisation des technologies de l’information et des communications (TICs) constitue un outil précieux pour réduire cet écart. Afin de relever ce défi, un projet de démonstration misant sur l’utilisation des technologies à des fins d’application des connaissances a été déployé auprès de 23 équipes de soutien dans la communauté de 5 régions du Québec (2016-2018). Plus de 324 professionnels de la santé mentale, chefs d’équipe et gestionnaires ont bénéficié de l’initiative À portée de main, les meilleures pratiques axées vers le rétablissement.
Objectif Cet article présente les résultats de l’étude de satisfaction effectuée auprès des chefs d’équipe responsables du soutien clinique dans les équipes de soutien dans la communauté à l’étude. L’objectif de cette étude consiste à enrichir la compréhension d’enjeux colligés en cours d’implantation et d’émettre des recommandations en vue d’une mise à l’échelle pérenne du programme d’application des connaissances mis en oeuvre.
Méthode Un devis qualitatif en recherche évaluative a été privilégié. Au terme du processus d’implantation du programme, 2 entrevues de groupe ont été effectuées avec les chefs d’équipe. Une analyse de contenu suivant une approche inductive à 3 niveaux de codification a été réalisée.
Résultats Les résultats montrent un décalage numérique important au sein du réseau de la santé et des services sociaux québécois comparativement à d’autres secteurs d’activités. Les participants soulignent l’importance de se doter de mécanismes d’échange et de transfert des connaissances intégrés aux pratiques organisationnelles (temps dédié, supervision clinique formelle, etc.) mettant à contribution les TICs.
Conclusion Malgré une importante mise à niveau technologique requise, les résultats confirment la pertinence d’utiliser les technopédagogies comme principal moyen pour soutenir l’application des connaissances et la transformation des pratiques. Les outils conçus et les modalités de soutien explorés semblent faciliter l’accès aux meilleures pratiques en santé mentale et favoriser leur adoption.
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Affiliation(s)
- Catherine Briand
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal (CRIUSMM), Université du Québec à Trois-Rivières (UQTR)
| | - Danielle Routhier
- Centre national d’excellence en santé mentale, ministère de la Santé et des Services sociaux (CNESM-MSSS)
| | - Brigitte Chassé
- Centre national d’excellence en santé mentale, ministère de la Santé et des Services sociaux (CNESM-MSSS)
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Castro-Ramirez F, Al-Suwaidi M, Garcia P, Rankin O, Ricard JR, Nock MK. Racism and Poverty are Barriers to the Treatment of Youth Mental Health Concerns. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:534-546. [PMID: 34339320 DOI: 10.1080/15374416.2021.1941058] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Traditional studies of treatment moderators have focused largely on psychological factors such as clinical severity. Racial and economic inequity exert large effects on youth mental health, on treatment efficacy, and on the likelihood of receiving treatment altogether. Yet, these factors are studied less often by clinical psychological scientists. METHOD We conducted a narrative review of literature on racial and economic inequities and their impact on youth mental health. RESULTS First, systemic problems such as racism and poverty increase the risk of developing complex health issues and decrease the likelihood of benefiting from treatment. Second, attitudinal barriers, such as mistrust associated with treatments provided by researchers and government agencies, decrease the likelihood that minoritized groups will engage with or benefit from evidence-based treatments. Third, minoritized and underserved communities are especially unlikely to receive evidence-based treatment. CONCLUSION Clinical psychological science has unique insights that can help address systemic inequities that can decrease treatment efficacy for youth mental health treatment. Psychological scientists can help eliminate disparities in accessing evidence-based treatment and help end violent policies in underserved minoritized communities by at the very least (1) building and supporting scalable community-based treatments as well as (2) publicly advocating for an end to violent policies that impose negative social costs.
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Affiliation(s)
| | | | | | | | | | - Matthew K Nock
- Department of Psychology, Harvard University.,Department of Psychiatry, Massachusetts General Hospital.,Mental Health Research Program, Franciscan Children's
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8
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Lantta T, Anttila M, Varpula J, Välimäki M. Facilitators for improvement of psychiatric services and barriers in implementing changes: From the perspective of Finnish patients and family members. Int J Ment Health Nurs 2021; 30:506-523. [PMID: 33216435 DOI: 10.1111/inm.12815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/18/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
The need for psychiatric patients and their family members to have access to quality user-friendly services has been studied for decades, yet few improvements have been made in treatment services. This study aims to explain how patients and family members have experienced facilitators of improvements, and their thoughts about barriers in the implementation of changes. An explanatory qualitative design was adopted. Data were collected using semi-structured interviews with eight focus groups made up of a total of 35 participants from mental health associations in Finland. The Theoretical Domains Framework guided the deductive data analysis. The Consolidated Criteria for Reporting Qualitative Studies (COREQ) was followed in the study. Participants in patient and family member associations had similar experiences and thoughts about facilitators of improvements in psychiatric services and barriers in the implementation of changes. For example, both participant groups experienced that promoting more positive roles of professionals could facilitate improvements in psychiatric care. On the other hand, a lack of theoretical competence and interpersonal skills of professionals could hinder change. We conclude that many of the facilitators that patients and families suggested could be addressed by enhancing collaboration and communication, having a more person-centred approach, focusing on recovery throughout the course of care, and acknowledging staff's well-being at work. Second, the barriers to implementing changes centre around the limited knowledge and skills of staff, and a paternalistic system that focuses on managing risk and administering treatment.
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Minna Anttila
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya School of Nursing, Central South University, Changsha, China
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9
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Gühne U, Weinmann S, Becker T, Riedel-Heller SG. [Psychosocial therapy in psychiatry : Update of the DGPPN-S3 guidelines "Psychosocial therapies for severe mental illnesses"]. DER NERVENARZT 2020; 91:993-1002. [PMID: 32725490 DOI: 10.1007/s00115-020-00955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Severe mental illnesses are often associated with substantial impairments of psychosocial functioning and a high risk of social exclusion. Along with somatic and psychotherapeutic treatment approaches, psychosocial interventions are an integral component of treatment. Psychosocial therapies aim to improve participation and enable patients to live self-determined lives as far as possible. OBJECTIVE This paper provides an overview of the structure and recommendations of the German S3 guidelines "Psychosocial therapies for severe mental illnesses" of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). MATERIAL AND METHODS In the DGPPN S3 guidelines psychosocial therapies are systematically described for the first time and recommendations are formulated on the basis of a systematic processing of scientific evidence and a formalized consensus process. RESULTS The evidence-based and consensus-based guidelines formulate a total of 33 recommendations and 12 statements. For many psychosocial interventions there is a broad evidence base. In the field of individual interventions psychoeducation, social skills training and health-promoting interventions have been given the highest recommendation strength (A). In the field of system level interventions, team-based, multiprofessional community psychiatric approaches, supported employment and self-determined housing with mobile support (supported housing) are given A level recommendations. For other interventions, the current evidence base is less robust. CONCLUSION The successful implementation of guidelines depends not only on the quality but also on the dissemination. Therefore, in addition to the treatment guidelines a short version, a patient version and a waiting room version were developed.
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Affiliation(s)
- U Gühne
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät der Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland.
| | - S Weinmann
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum Am Urban, Berlin, Deutschland
| | - Th Becker
- Klinik für Psychiatrie und Psychotherapie II der Universität Ulm, Bezirkskrankenhaus Günzburg, Günzburg, Deutschland
| | - S G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät der Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland
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10
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Gabet M, Grenier G, Cao Z, Fleury MJ. Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study. BMC Health Serv Res 2020; 20:854. [PMID: 32917199 PMCID: PMC7488576 DOI: 10.1186/s12913-020-05708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Emergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs. Method Using mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced. Results Key implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED. Conclusions Before implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.
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Affiliation(s)
- Morgane Gabet
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada.,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Marie-Josée Fleury
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada. .,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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11
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Luigi M, Rapisarda F, Corbière M, De Benedictis L, Bouchard AM, Felx A, Miglioretti M, Abdel-Baki A, Lesage A. Determinants of mental health professionals' attitudes towards recovery: A review. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e62-e73. [PMID: 33062092 PMCID: PMC7522886 DOI: 10.36834/cmej.61273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The attitudes of mental health professionals towards consumers' recovery are far more pessimistic than what is needed for the recovery-orientation to truly permeate systems of care. It has become pressing to depict determinants for these attitudes and how they evolve during professionalization. This, in the hopes to adjust not only medical education, but also ongoing training of professionals. METHODS A systematic search of PubMed and PsycINFO databases was conducted, yielding a net 15 303 records. Twenty-two publications from specific educational journals and reference lists were added. Finally, thirty-four full texts were read, from which twenty-two articles were included. RESULTS From the reviewed studies emerged five main determinants: profession, education, age, clinical experience, and nature of the contact with consumers. Traditional clinical placements during residency, negative experiences with acute patients, younger age and the professional attitudes of psychiatrists seem to all be determining factors for professionals' pessimistic attitudes towards recovery. CONCLUSIONS This review found specific determinants for attitudes in recovery and four out of five can be acted upon. For a recovery-orientation to be implemented across our mental health system, we formulate recommendations within the Canadian context for revision of curriculum, recovery-specific training, and operationalisation through state/provincial technical assistance centers.
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Affiliation(s)
- Mimosa Luigi
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Filippo Rapisarda
- Department of Psychology, Università degli Studi di Milano-Bicocca, Italy
| | - Marc Corbière
- Department of Education and Pedagogy – Faculty of the Sciences of Education, University of Quebec, Quebec, Canada
| | - Luigi De Benedictis
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
- Program for psychotic disorders, Institut Universitaire en Santé Mentale de Montréal, CIUSSS East-of-Montreal, Quebec, Canada
| | - Anne-Marie Bouchard
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Amélie Felx
- Mental health and substance abuse program, Institut Universitaire en Santé Mentale Douglas, CIUSSS West-of-Montreal, Quebec, Canada
| | | | - Amal Abdel-Baki
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
| | - Alain Lesage
- Department of Psychiatry and Addictology, University of Montreal, Quebec, Canada
- Research Centre, Institut Universitaire en Santé Mentale de Montréal, CIUSSS East-of-Montreal, Quebec, Canada
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12
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Karow A, Brettschneider C, Helmut König H, Correll CU, Schöttle D, Lüdecke D, Rohenkohl A, Ruppelt F, Kraft V, Gallinat J, Lambert M. Better care for less money: cost-effectiveness of integrated care in multi-episode patients with severe psychosis. Acta Psychiatr Scand 2020; 141:221-230. [PMID: 31814102 DOI: 10.1111/acps.13139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare cost-effectiveness of integrated care with therapeutic assertive community treatment (IC-TACT) versus standard care (SC) in multiple-episode psychosis. METHOD Twelve-month IC-TACT in patients with schizophrenia-spectrum and bipolar I disorders were compared with a historical control group. Primary outcomes were entropy-balanced cost-effectiveness based on mental healthcare costs from a payers' perspective and quality-adjusted life years (QALYs) as a measure of health effects during 12-month follow-up. RESULTS At baseline, patients in IC-TACT (n = 214) had significantly higher illness severity and lower functioning than SC (n = 56). Over 12 months, IC-TACT had significantly lower days in inpatient (10.3 ± 20.5 vs. 28.2 ± 44.9; P = 0.005) and day-clinic care (2.6 ± 16.7 vs. 16.4 ± 33.7; P = 0.004) and correspondingly lower costs (€-55 084). Within outpatient care, IC-TACT displayed a higher number of treatment contacts (116.3 ± 45.3 vs. 15.6 ± 6.3) and higher related costs (€+1417). Both resulted in lower total costs in IC-TACT (mean difference = €-13 248 ± 2975, P < 0.001). Adjusted incremental QALYs were significantly higher for IC-TACT versus SC (+0.10 ± 0.37, P = 0.05). The probability of cost-effectiveness of IC-TACT was constantly higher than 99%. CONCLUSION IC-TACT was cost-effective compared with SC. The use of prima facies 'costly' TACT teams is highly recommended to improve outcomes and save total cost for patients with severe psychotic disorders.
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Affiliation(s)
- A Karow
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C U Correll
- Recognition and Prevention Program, Zucker Hillside Hospital, New York, NY, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, New York, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - D Schöttle
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Lüdecke
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rohenkohl
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Ruppelt
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Kraft
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Gallinat
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Lambert
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hill JN, Locatelli SM, Bokhour BG, Fix GM, Solomon J, Mueller N, LaVela SL. Evaluating broad-scale system change using the Consolidated Framework for Implementation Research: challenges and strategies to overcome them. BMC Res Notes 2018; 11:560. [PMID: 30075807 PMCID: PMC6076417 DOI: 10.1186/s13104-018-3650-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 07/25/2018] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this paper is to demonstrate the utility of the CFIR framework for evaluating broad-scale change by discussing the challenges to be addressed when planning the assessment of broad-scale change and the solutions developed by the evaluation team to address those challenges. The evaluation of implementation of Patient-centered Care and Cultural Transformation (PCC&CT) within the Department of Veterans Affairs (VA) will be used as a demonstrative example. Patient-Centered Care (PCC) is personalized health care that considers a patient's circumstances and goals. The Department of Veterans Affairs (VA) is working towards implementing PCC throughout its healthcare system, comprised of multiple interventions with a singular long-term goal of cultural transformation, however little is known about the factors influencing its implementation. This paper discusses the issues that arose using CFIR to qualitatively assess the factors influencing implementation of cultural transformation. RESULTS Application of CFIR to this broad-scale evaluation revealed three strategies recommended for use in evaluating implementation of broad-scale change: (1) the need for adapted definitions for CFIR constructs (especially due to new application to broad-scale change), (2) the use of a mixed deductive-inductive approach with thematic coding to capture emergent themes not encompassed by CFIR, and (3) its use for expedited analysis and synthesis for rapid delivery of findings to operational partners. This paper is among the first to describe use of CFIR to guide the evaluation of a broad-scale transformation, as opposed to discrete interventions. The processes and strategies described in this paper provide a detailed example and structured approach that can be utilized and expanded upon by others evaluating implementation of broad-scale evaluations. Although CFIR was the framework selected for this evaluation, the strategies described in this paper including: use of adapted definitions, use of mixed deductive-inductive approach, and the approach for expedited analysis and synthesis can be transferred and tested with other frameworks.
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Affiliation(s)
- Jennifer N Hill
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Center of Innovation for, Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, 5000 S. 5th Ave (151H), Hines, IL, 60141, USA.
| | - Sara M Locatelli
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Center of Innovation for, Complex Chronic Health Care (CINCCH), Edward Hines Jr. VA Hospital, 5000 S. 5th Ave (151H), Hines, IL, 60141, USA
| | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center, Center for Evaluating Patient-Centered Care (EPCC), Boston University School of Public Health, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Rd, Bedford, MA, 01730, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Evaluating Patient-Centered Care (EPCC), Boston University School of Public Health, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Rd, Bedford, MA, 01730, USA
| | - Jeffrey Solomon
- Evaluating Patient-Centered Care (EPCC), Edith Nourse Rogers Memorial VA Hospital, 200 Springs Rd, Bedford, MA, 01730, USA
| | - Nora Mueller
- Center for Healthcare Organization and Implementation Research (CHOIR), ENRM Veterans Affairs Medical Center, Center for Evaluating Patient-Centered Care (EPCC), Boston University School of Public Health, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Rd, Bedford, MA, 01730, USA
| | - Sherri L LaVela
- Center for Evaluation of Practices and Experiences of Patient-Centered Care (CEPEP), Center of Innovation for Complex Chronic Health Care (CINCCH), Center for Healthcare Studies, Institute for Public Health and Medicine General Internal Medicine and Geriatrics, Edward Hines Jr. VA Hospital, Northwestern University, Feinberg School of Medicine, 5000 S. 5th Ave (151H), Hines, IL, 60141, USA
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Lockett H, Waghorn G, Kydd R. A framework for improving the effectiveness of evidence-based practices in vocational rehabilitation. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Helen Lockett
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
- The Wise Group, Hamilton, New Zealand
| | - Geoffrey Waghorn
- The ORS Group, Brisbane, Queensland, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Rob Kydd
- Department of Psychological Medicine, School of Medicine, The University of Auckland, Auckland, New Zealand
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15
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Lambert M, Schöttle D, Sengutta M, Ruppelt F, Rohenkohl A, Luedecke D, Nawara LA, Galling B, Falk AL, Wittmann L, Niehaus V, Sarikaya G, Handwerk U, Rothländer W, Rietschel L, Gagern C, Lange B, Meigel-Schleiff C, Naber D, Schulte-Markwort M, Krüger H, Unger HP, Sippel S, Ott S, Romer G, Daubmann A, Wegscheider K, Correll CU, Schimmelmann BG, Bock T, Gallinat J, Karow A. Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III). Early Interv Psychiatry 2018; 12:96-106. [PMID: 27618789 DOI: 10.1111/eip.12361] [Citation(s) in RCA: 6] [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] [Received: 03/02/2016] [Revised: 05/25/2016] [Accepted: 06/28/2016] [Indexed: 12/18/2022]
Abstract
AIM The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. METHODS This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment). RESULTS Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group. CONCLUSION To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.
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Affiliation(s)
- Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Mary Sengutta
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anja Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Luise Antonia Nawara
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Britta Galling
- Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Anne-Lena Falk
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Linus Wittmann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Vivien Niehaus
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gizem Sarikaya
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ute Handwerk
- Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany
| | | | - Liz Rietschel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Charlotte Gagern
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - Benjamin Lange
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christina Meigel-Schleiff
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Dieter Naber
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Helmut Krüger
- Community Psychiatric Center Eimsbüttel (GPZE), Hamburg, Germany
| | - Hans-Peter Unger
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Sven Sippel
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Sabine Ott
- Center for Mental Health, Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - Georg Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Münster, Germany
| | - Anne Daubmann
- Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karl Wegscheider
- Institute for Biostatistics and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Benno G Schimmelmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jürgen Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Fullerton CA, Henke RM, Crable EL, Hohlbauch A, Cummings N. The Impact Of Medicare ACOs On Improving Integration And Coordination Of Physical And Behavioral Health Care. Health Aff (Millwood) 2018; 35:1257-65. [PMID: 27385242 DOI: 10.1377/hlthaff.2016.0019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The accountable care organization (ACO) model holds the promise of reducing costs and improving the quality of care by realigning payment incentives to focus on health outcomes instead of service volume. One key to managing the total cost of care is improving care coordination for and treatment of people with behavioral health disorders. We examined qualitative data from ninety organizations participating in Medicare ACO demonstration programs from 2012 through 2015 to determine whether and how they focused on behavioral health care. These ACOs had mixed degrees of engagement in improving behavioral health care for their populations. The biggest challenges included a lack of behavioral health care providers, data availability, and sustainable financing models. Nonetheless, we found substantial interest in integrating behavioral health care into primary care across a majority of the ACOs.
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Affiliation(s)
- Catherine A Fullerton
- Catherine A. Fullerton is a senior research leader in the Center for Behavioral Health Services Research at Truven Health Analytics, an IBM company, in Cambridge, Massachusetts
| | - Rachel M Henke
- Rachel M. Henke is director of research in the Center for Behavioral Health Services Research at Truven Health Analytics in Cambridge
| | - Erika L Crable
- Erica Crable is a research analyst II in the Center for Behavioral Health Services Research at Truven Health Analytics in Cambridge
| | - Andriana Hohlbauch
- Andriana Hohlbauch is a research leader in the Center for Behavioral Health Services Research at Truven Health Analytics in Santa Barbara, California
| | - Nicholas Cummings
- Nicholas Cummings is a research analyst II in the Center for Behavioral Health Services Research at Truven Health Analytics in Bethesda, Maryland
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Lambert M, Schöttle D, Ruppelt F, Rohenkohl A, Sengutta M, Luedecke D, Nawara LA, Galling B, Falk AL, Wittmann L, Niehaus V, Sarikaya G, Rietschel L, Gagern C, Schulte-Markwort M, Unger HP, Ott S, Romer G, Daubmann A, Wegscheider K, Correll CU, Schimmelmann BG, Wiedemann K, Bock T, Gallinat J, Karow A. Early detection and integrated care for adolescents and young adults with psychotic disorders: the ACCESS III study. Acta Psychiatr Scand 2017; 136:188-200. [PMID: 28589683 DOI: 10.1111/acps.12762] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of the study was to investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early psychosis compared to standard care (SC). METHODS ACCESS III is a prospective non-randomized historical control design 1-year study examining the efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12-29 years. Primary outcome was the rate of ≥6 months combined symptomatic and functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and satisfaction with care. RESULTS In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted by EDIC (OR = 6.8, CI: 3.15-14.53, P < 0.001); younger age predicted non-remission (OR = 1.1, CI: 1.01-1.19, P = 0.038). Linear regressions indicated a reduction of DUP in EDIC (P < 0.001), but not in SC (P = 0.41). MMRMs showed significantly larger improvements in PANSS positive (P < 0.001) and GAF (P < 0.01) scores in EDIC vs. SC, and in EDIC over time in CGI-Severity (P < 0.001) and numerically in Q-LES-Q-18 (P = 0.052). CONCLUSIONS EDIC lead to significantly higher proportions of patients achieving combined remission. Moderating variables included a reduction of DUP and EDIC, offering psychotherapeutic interventions.
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Affiliation(s)
- M Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - D Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - F Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Sengutta
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - D Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
| | - L A Nawara
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - B Galling
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA
| | - A-L Falk
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Wittmann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - V Niehaus
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - G Sarikaya
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Rietschel
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - C Gagern
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - M Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
| | - H-P Unger
- Center for Mental Health, Department of Psychiatry, Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - S Ott
- Center for Mental Health, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Asklepios Hospital Harburg, Hamburg, Germany
| | - G Romer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Muenster, Münster, Germany
| | - A Daubmann
- Department of Medical Biometry and Epidemiology, UKE, Hamburg, Germany
| | - K Wegscheider
- Department of Medical Biometry and Epidemiology, UKE, Hamburg, Germany
| | - C U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Glen Oaks, NY, USA
| | - B G Schimmelmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany.,University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - K Wiedemann
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - T Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - J Gallinat
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - A Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, UKE, Hamburg, Germany
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Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles. Int J Integr Care 2017; 17:3. [PMID: 29042845 PMCID: PMC5630082 DOI: 10.5334/ijic.2482] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION This study evaluates implementation of the Quebec Mental Health Reform (2005-2015), which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered. METHODS Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1) reform characteristics; 2) implementation context; 3) organizational characteristics; and 4) integration strategies. RESULTS While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions. CONCLUSION Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.
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Lesage A, Bland R, Musgrave I, Jonsson E, Kirby M, Vasiliadis HM. The Case for a Federal Mental Health Transition Fund. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:4-7. [PMID: 28055255 PMCID: PMC5302113 DOI: 10.1177/0706743716673324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alain Lesage
- Centre de recherche Fernand-Seguin, Institut universitaire en santé mentale de Montréal, Montréal, Québec
- Alain Lesage, MD, Centre de recherche Fernand-Seguin, Institut universitaire en santé mentale de Montréal, 7401 Hochelaga, Montréal, Québec H1N 3M5, Canada.
| | - Roger Bland
- Department of Psychiatry, University of Alberta, Edmonton, Alberta
| | | | - Egon Jonsson
- Institute of Health Economics, Edmonton, Alberta
| | - Mike Kirby
- Partners for Mental Health, Ottawa, Ontario
| | - Helen-Maria Vasiliadis
- Université de Sherbrooke, Département des sciences de la santé communautaire, Longueuil, Québec
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Fleury MJ, Grenier G, Vallée C, Aubé D, Farand L, Bamvita JM, Cyr G. Implementation of the Quebec mental health reform (2005-2015). BMC Health Serv Res 2016; 16:586. [PMID: 27756297 PMCID: PMC5069811 DOI: 10.1186/s12913-016-1832-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 10/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background This study evaluates implementation of the Quebec Mental Health (MH) Reform (2005–2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined. Methods Eleven Quebec MH service networks provided the study setting. Networks were identified in consultation with 20 key MH decision makers and selected based on variation in services offered, integration strategies, best practices, and geographic criteria. Data collection included: primary documents, structured questionnaires completed by 25 managers from MH primary care teams and 16 respondent-psychiatrists working in shared-care, and semi-structured interviews with 102 network stakeholders involved in the reform. The study employed a mixed method approach, triangulating the three data sources across networks. Results While implementation was not fully achieved in most networks, the Quebec reform succeeded in improving primary care services with the creation of adult primary care teams, and one-stop services which increased access to care, mainly for clients with common MH disorders. In terms of clinical strategies implemented, the functions provided by respondent-psychiatrists had a greater impact on the MH primary care teams than on general practitioners (GPs) in medical clinics; whereas the implementation of best practices were indirect outcomes of another reform developed simultaneously by the Quebec substance use disorders program. The main integration strategies used for increasing continuity of care and collaboration between primary care and specialized services were those involving fewer formal procedures such as referrals between teams and organizations. The lack of operational mechanisms and protocols governing new services and structures were important barriers to primary care consolidation and service integration, as was the lack of interest and involvement of most GPs in MH. Conclusions Successful and sustained healthcare reform requires attention to process and outcomes as well as structural change or service reorganization. Six recommendations for more successful implementation of the Quebec MH Reform are provided, with implications for healthcare reform internationally. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1832-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 845 Sherbrooke Street, Montreal, H3A 0G4, Quebec, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada
| | - Catherine Vallée
- Rehabilitation Department, Laval University, Quebec, Quebec, GIV 0A6, Canada
| | - Denise Aubé
- Department of Social and Preventive Medicine, Laval University, National Public Health Institute of Québec, Quebec, Quebec, GIV 0A6, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation, School of Public Health, University of Montreal, Montreal, Quebec, H3T 3J7, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada
| | - Geneviève Cyr
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada
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Lord S, Moore SK, Ramsey A, Dinauer S, Johnson K. Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers. JMIR Ment Health 2016; 3:e24. [PMID: 27352884 PMCID: PMC4942682 DOI: 10.2196/mental.4927] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 01/19/2016] [Accepted: 04/06/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Research supports the effectiveness of technology-based treatment approaches for substance use disorders. These approaches have the potential to broaden the reach of evidence-based care. Yet, there is limited understanding of factors associated with implementation of technology-based care approaches in different service settings. OBJECTIVES In this study, we explored provider and staff perceptions of facilitators and barriers to implementation of a mobile phone substance use recovery support app with clients in 4 service settings. METHODS Interviews were conducted with leadership and provider stakeholders (N=12) from 4 agencies in the first year of an implementation trial of the mobile phone app. We used the Consolidated Framework for Implementation Research as the conceptual foundation for identifying facilitators and barriers to implementation. RESULTS Implementation process facilitators included careful planning of all aspects of implementation before launch, engaging a dedicated team to implement and foster motivation, working collaboratively with the app development team to address technical barriers and adapt the app to meet client and agency needs, and consistently reviewing app usage data to inform progress. Implementation support strategies included training all staff to promote organization awareness about the recovery support app and emphasize its priority as a clinical care tool, encouraging clients to try the technology before committing to use, scaling rollout to clients, setting clear expectations with clients about use of the app, and using peer coaches and consistent client-centered messaging to promote engagement. Perceived compatibility of the mobile phone app with agency and client needs and readiness to implement emerged as salient agency-level implementation facilitators. Facilitating characteristics of the recovery support app itself included evidence of its impact for recovery support, perceived relative advantage of the app over usual care, the ability to adapt the app to improve client use, and its ease of use. The mobile phone itself was a strong motivation for clients to opt in to use the app in settings that provided phones. App access was limited in settings that did not provide phones owing to lack of mobile phone ownership or incompatibility of the app with clients' mobile phones. Individual differences in technology literacy and provider beliefs about substance use care either facilitated or challenged implementation. Awareness of patient needs and resources facilitated implementation, whereas external policies and regulations regarding technology use introduced barriers to implementation. CONCLUSIONS The conceptually grounded facilitators and barriers identified in this study can guide systematic targeting of strategies to improve implementation of mobile phone interventions in community treatment settings. Results also inform the design of technology-based therapeutic tools. This study highlights directions for research with regard to implementation of technology-based behavioral health care approaches.
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Affiliation(s)
- Sarah Lord
- Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.
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Barbato A, Vallarino M, Rapisarda F, Lora A, Parabiaghi A, D'Avanzo B, Lesage A. Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy. Int J Soc Psychiatry 2016; 62:334-44. [PMID: 26896028 DOI: 10.1177/0020764016631368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known. AIMS This study aims to investigate access of people with bipolar disorders to psychosocial treatments in a community-based care system. METHOD Information on care delivery and service utilization were retrieved from the psychiatric database of Lombardy, Italy, covering a population of 9,743,000, for all adults who had at least one contact in 2009 with psychiatric services. Rates of patients with a diagnosis of bipolar disorder who had access to individual psychotherapy, couple/family therapy, group psychotherapy and family interventions were calculated and compared to patients with schizophrenia and depression. RESULTS A total of 8,899 subjects with bipolar disorder had been in contact with psychiatric services, corresponding to a treated annual prevalence rate of 1.1‰. More than 80% of patients were treated in community settings. Rates of patients receiving structured psychosocial treatments ranged from 0.7% for couple/family therapy to 6.1% for individual psychotherapy. No differences with patients with schizophrenia and depression were found. Patients with schizophrenia received more interventions labeled as rehabilitation. CONCLUSION Few people with bipolar disorders had access to psychosocial treatments. Even in a well-developed system of community care, offer of psychosocial interventions for bipolar disorders is inadequate. This issue should be a target for future research on dissemination and implementation strategies.
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Affiliation(s)
- Angelo Barbato
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy IRIS Postgraduate School of Psychotherapy, Milan, Italy
| | - Martine Vallarino
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Filippo Rapisarda
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Antonio Lora
- Mental Health Department, Lecco Hospital, Lecco, Italy
| | - Alberto Parabiaghi
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Barbara D'Avanzo
- Laboratory of Epidemiology and Social Psychiatry, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Alain Lesage
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
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Lambert M. [Flexibilization of sectoral borders? For]. DER NERVENARZT 2016; 87:315-316. [PMID: 26601985 DOI: 10.1007/s00115-015-4461-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Lambert
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland.
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Lambert M, Schöttle D, Ruppelt F, Lüdecke D, Sarikaya G, Schulte-Markwort M, Gallinat J, Karow A. [Integrated care for patients with first and multiple episodes of severe psychotic illnesses: 3-year results of the Hamburg model]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 58:408-19. [PMID: 25676450 DOI: 10.1007/s00103-015-2123-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The so-called "Hamburg model" is a designated integrated care model according to § 140 of the Social Code Book (SGB) V for psychosis patients fulfilling the definition of severe mental illness (SMI). OBJECTIVES Description of the model and evaluation of efficacy of all patients being treated for ≥ 3 years. MATERIALS AND METHODS Service entry illness status, course of illness, and interventions were assessed within a continuous quality assurance study. One hundred and fifty-eight patients who fulfilled the criterion of being treated for ≥ 3 years were analyzed. RESULTS At service entry, SMI were among others mirrored by a high level of psychopathology (Brief Psychiatric Rating Scale [BPRS]: 80.3) and severity of illness (Clinical Global Impression Severity [CGI-S]/Clinical Global Impression Bipolar scales [CGI-BP]: 5.8), low functioning level (Global Assessment of Functioning scale [GAF]: 35.9), and high rates of comorbid psychiatric (94.3 %) and somatic (81.6 %) disorders. Only 8 patients (5.1 %) disengaged from the service within the 3-year treatment period. The course of the illness over 3 years showed significant and stable improvements in psychopathology (BPRS: p < 0.001), the severity of illness (CGI-S/CGI-BP: p < 0.001), functioning (GAF: p < 0.001), quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire [Q-LES-Q-18]: p < 0.001), and satisfaction with care (Client Satisfaction Questionnaire [CSQ-8]: 2.0 to 3.3; p = 0.164; nonsignificant because of early improvements). Further, compulsory admissions were reduced and medication adherence in addition to working ability improved (all p < 0.001). Data on interventions showed a continuously high frequency of outpatient interventions over time (on average 112.0 per year), a high percentage of patients in psychotherapy (67 %), and a nearly 90 % reduction in inpatient treatment days from year 1 to year 3. CONCLUSION Integrated care in severely ill patients with psychotic disorders leads to multidimensional illness improvement and stabilization by offering intensive outpatient care.
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Affiliation(s)
- Martin Lambert
- Arbeitsbereich Psychosen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 52, 20246, Hamburg, Deutschland,
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Rodrigues ÂAP, Xavier ML, Figueiredo MAGD, Almeida Filho AJD, Peres MAA. INFLUENCES OF THE PSYCHIATRIC REFORM IN NURSING CARE AT THE CASA DE SAÚDE ESPERANÇA, IN JUIZ DE FORA, MINAS GERAIS, BRAZIL (1994-1998). TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016001450014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The aim of this socio-historical study was to describe the insertion process of nurses and to analyze the reformulation strategies of nursing care at the Casa de Saúde Esperança from 1994 to 1998. Historical sources, written and oral documents, were analyzed based on Michel Foucault's concept of power/knowledge. The results showed that, after nearly three decades of working in the absence of or with only one nurse, the Casa de Saúde Esperança hired four nurses, in order to meet the legal requirements of operation. To expand their power/knowledge in nursing, the nurses promoted meetings and trainings with the team. It was concluded that the strategies used produced effects such as: greater recognition of the power/knowledge in nursing; practical knowledge giving way to scientific knowledge; development of a more humanized care; and accreditation of the institution in psychiatry IV, which, by psychiatric hospitals' classification, allowed its operation in partnership with the Unified Health System.
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Almeida Filho AJD, Queirós PJP, Rodrigues MA. REABILITAÇÃO PSICOSSOCIAL EM MORADIAS ASSISTIDAS NO BRASIL E EM PORTUGAL. TEXTO & CONTEXTO ENFERMAGEM 2016. [DOI: 10.1590/0104-07072016000770015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O objetivo desta pesquisa é discutir como as Moradias Terapêuticas para usuários com transtorno mental, nos municípios de Miranda do Corvo-Portugal e de Volta Redonda-Brasil contribuem com o processo de reabilitação psicossocial das pessoas com sofrimento psíquico. Estudo de perspectiva histórica, cujas fontes foram leis, resoluções e relatórios oficiais e depoimentos de enfermeiros, psicólogos e assistentes sociais. Constatou-se que, embora em ambos os municípios a intenção seja a desinstitucionalização das pessoas com sofrimento psíquico, em Miranda do Corvo-Portugal a gestão financeira e administrativa é de responsabilidade de uma Fundação e, em Volta Redonda-Brasil, essa gestão fica sob os auspícios do poder executivo municipal, além de se observar em Miranda do Corvo a adoção de normas disciplinares em função no excesso de usuários. Conclui-se que a crise econômica em Portugal interferiu na política de expansão de Moradias Terapêuticas para uma quantidade de usuários que não permite intervenção mais individualizada.
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González-Valderrama A, Mena C, Undurraga J, Gallardo C, Mondaca P. Implementing psychosocial evidence-based practices in mental health: are we moving in the right direction? Front Psychiatry 2015; 6:51. [PMID: 25926800 PMCID: PMC4396081 DOI: 10.3389/fpsyt.2015.00051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 03/25/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alfonso González-Valderrama
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile ; Facultad de Medicina, Universidad Finis Terrae , Santiago , Chile
| | - Cristián Mena
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile
| | - Juan Undurraga
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile ; Department of Psychiatry, Facultad de Medicina Clínica Alemana Universidad del Desarrollo , Santiago , Chile
| | - Carlos Gallardo
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile
| | - Pilar Mondaca
- Early Intervention in Psychosis Program, Instituto Psiquiátrico "Dr. José Horwitz Barak" , Santiago , Chile
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Lesage A. Regional tertiary psychiatric care and rehabilitation authorities for people with severe mental illness in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:175-7. [PMID: 25007109 PMCID: PMC4079134 DOI: 10.1177/070674371405900401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/01/2013] [Indexed: 01/16/2023]
Affiliation(s)
- Alain Lesage
- Psychiatrist and Researcher, Institut universitaire en santé mentale de Montréal, Department of Psychiatry, University of Montreal, Montreal, Quebec
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Menear M, Briand C. Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 1-review of major initiatives and implementation strategies. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:178-86. [PMID: 25007110 PMCID: PMC4079135 DOI: 10.1177/070674371405900402] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Accepted: 10/01/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Providing comprehensive care to people with severe mental illness (SMI) involves moving beyond pharmacological treatment and ensuring access to a wide range of evidence-based psychosocial services. Numerous initiatives carried out in North America and internationally have promoted the widespread adoption of such services. Objectives of this rapid review were 3-fold: to identify these implementation initiatives, to describe the implementation strategies used to promote the uptake of psychosocial services, and to identify key issues related to the implementation of a broad range of services. Part 1 presents findings for objectives 1 and 2 of the review. METHOD Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, psychosocial practices, and implementation. Contacts with experts and reference list and reverse citation searches were also conducted. RESULTS Fifty-five articles were retained that identified more than a dozen major North American and international implementation initiatives. Initiative leaders employed diverse strategies at the planning, execution, and evaluation stages of the implementation process. Stakeholder meetings, training, ongoing consultation, and quality or fidelity monitoring were strategies consistently adopted across most initiatives, whereas theory-based approaches and organizational- and system-level strategies were less frequently described. CONCLUSION Insights from the initiatives identified in this review can help guide future efforts to implement a broad range of psychosocial services for people with SMI. However, such efforts will also need to be informed by more rigorous, theory-based studies of implementation processes and outcomes.
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Affiliation(s)
- Matthew Menear
- Student, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec
| | - Catherine Briand
- Associate Professor, School of Rehabilitation, University of Montreal, Montreal, Quebec; Researcher, Centre d'études sur la réadaptation, le rétablissement et l'insertion sociale (CÉRRIS), Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec
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