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Rodríguez-Nogueira Ó, Leirós-Rodríguez R, Pinto-Carral A, Álvarez-Álvarez MJ, Morera-Balaguer J, Moreno-Poyato AR. The association between empathy and the physiotherapy-patient therapeutic alliance: A cross-sectional study. Musculoskelet Sci Pract 2022; 59:102557. [PMID: 35338901 DOI: 10.1016/j.msksp.2022.102557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/15/2022] [Accepted: 03/18/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND The central component of person-centred care is in having a therapeutic realtionship. Furthermore, the empathy of the physiotherapist is one of the most important attributes in achieving a successful therapeutic alliance. OBJECTIVE The aim of the research was to determine the association between the constructs of empathy and therapeutic alliance in Spanish physical therapists and the possible influence of socio-professional variables on them. DESIGN Cross-sectional research. METHODS An electronic survey including the Working Alliance Inventory-Short Form, the Interpersonal Reactivity Index and sociodemographic data with 473 Spanish physiotherapists. A descriptive, bivariate and simple lineal regression analysis was carried out. RESULTS Work experience has a positive influence on bonding and the agreement on objectives and tasks (0.04 < B > 0.06; p < 0.01). The perspective taking dimensions and empathic concern positively influence the agreement on achievement (0.14 < B > 0.19; p < 0.001). Personal distress inversely influences bonding and the agreement on achievements and tasks (-0.13 < B > -0.09; p < 0.01). CONCLUSIONS The dimensions of perspective taking and empathic concern seem to facilitate successful shared decision making in terms of treating objectives. Furthermore, the physiotherapist's personal distress acts as an obstacle to the development of the three subcomponents of the therapeutic alliance analysed.
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Affiliation(s)
- Óscar Rodríguez-Nogueira
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Arrate Pinto-Carral
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - María José Álvarez-Álvarez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Universidad de León, Astorga Ave. 15, 24401, Ponferrada, León, Spain.
| | - Jaume Morera-Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Carrer Carmelitas 3, 03203, Elche, Alicante, Spain.
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.
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Tan HT, Lui YS, Peh LH, Winslow RM, Guo S. Examining the Attitudes of Non-Psychiatric Practicing Healthcare Workers Towards Patients With Alcohol Problems in General Hospital Setting. Subst Abuse 2022; 16:11782218211065755. [PMID: 35035219 PMCID: PMC8753239 DOI: 10.1177/11782218211065755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Problematic alcohol-use affect the physical and mental well-being of hospitalised individuals and may receive screening and brief-intervention during treatment. Non-psychiatric doctors and nurses might respond inadequately due to negative attitudes and beliefs. This study aimed to examine these attitudes of non-psychiatric workers in the medical and surgical wards. METHODS A total of 457 doctors and 1643 nurses were recruited from the medical, surgical and orthopaedic disciplines over a period of 4 months. Three questionnaires were administered: demographics, Alcohol & Alcohol-Problems Perceptions Questionnaire (AAPPQ) and Staff Perception of Alcohol Treatment Resources. RESULTS About 128 doctors and 785 nurses responded. Around 75.5% doctors and 51.9% nurses endorsed role-legitimacy in the AAPPQ. Both the doctor (86.7%) and nurse (77.6%) groups agreed on the importance to initiate intervention for patients with problematic alcohol-use in daily work. Both groups were sceptical and negative towards these patients endorsing low-level role-adequacy (41.2%), role-support (36.9%), motivation (36.5%), task-specific self-esteem (25.1) as well as work satisfaction (20.5%). CONCLUSION/DISCUSSION Doctors and nurses demonstrated low levels of therapeutic commitments towards patients with problematic alcohol-use thereby necessitating the introduction of in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention. SCIENTIFIC SIGNIFICANCE The prompt identification and treatment of patients with alcohol problems are contingent on the workers' attitudes towards them. This study's results should spark a nation-wide interest to improve the training and recognition of such patients and providing adequate educational resources.
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Affiliation(s)
- Ho Teck Tan
- Department of Psychological Medicine,
National University Hospital, Singapore
| | - Yit Shiang Lui
- Department of Psychological Medicine,
National University Health System, Singapore
| | - Lai Huat Peh
- Department of Psychological Medicine,
Changi General Hospital, Singapore
| | | | - Song Guo
- National Addictions Management Service,
Institute of Mental Health, Singapore
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3
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Louie E, Giannopoulos V, Baillie A, Uribe G, Wood K, Teesson M, Childs S, Rogers D, Haber PS, Morley KC. Barriers and Facilitators to the Implementation of the Pathways to Comorbidity Care (PCC) Training Package for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings. FRONTIERS IN HEALTH SERVICES 2021; 1:785391. [PMID: 36926478 PMCID: PMC10012778 DOI: 10.3389/frhs.2021.785391] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022]
Abstract
Background: We have previously reported that the Pathways to Comorbidity Care (PCC) training program for alcohol and other drug (AOD) clinicians improved identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity. We aimed to identify barriers and facilitators of implementation of the PCC training program in drug and alcohol settings. Methods: The PCC training program was implemented across 6 matched sites in Australia as per (1), and 20 clinicians received training. PCC training included seminar presentations, workshops conducted by local "clinical champions," individual clinical supervision, and access to an online information portal. We examined barriers and facilitators of implementation according to the Consolidated Framework for Implementation Research. Results: Barriers included inner setting (e.g., allocated time for learning) and characteristics of individuals (e.g., resistance). Facilitators included intervention characteristics (e.g., credible sources), inner setting (e.g., leadership), and outer setting domains (e.g., patient needs). Clinical champions were identified as an important component of the implementation process. Conclusions: Barriers included limited specific allocated time for learning. A credible clinical supervisor, strong leadership engagement and an active clinical champion were found to be facilitators of the PCC training program.
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Affiliation(s)
- Eva Louie
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gabriela Uribe
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Katie Wood
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Steven Childs
- Central Coast Local Health District, Drug and Alcohol Clinical Services, Gosford, NSW, Australia
| | - David Rogers
- Drug and Alcohol Services, Mid North Coast Local Health District, Port Macquarie, NSW, Australia
| | - Paul S. Haber
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kirsten C. Morley
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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4
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Louie E, Morley KC, Giannopoulos V, Uribe G, Wood K, Marel C, Mills KL, Teesson M, Edwards M, Childs S, Rogers D, Dunlop A, Baillie A, Haber PS. Implementation of a Multi-Modal Training Program for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings: Pathways to Comorbidity Care (PCC). J Dual Diagn 2021; 17:304-312. [PMID: 34699336 DOI: 10.1080/15504263.2021.1984152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We aimed to evaluate the impact of the Pathways to Comorbidity Care (PCC) training program for alcohol and other drugs (AOD) clinicians to improve the management of comorbidity. METHODS A controlled before-and-after study using PCC training was conducted across 6 matched sites in Australia including 35 clinicians. Controls received standard workplace training. PCC training included seminar presentations, workshops conducted by local "clinical champions," individual clinical supervision, and access to an online information portal. We examined (a) identification (screening, assessment) and treatment (treatment, referral) of comorbidity in practice (N = 10 clinical files per clinician), (b) self-efficacy, knowledge, and attitudes of clinicians. RESULTS Significant improvements were observed in the PCC group but not the control sites with regards to the rate of clinical files showing identification of comorbidity (+50% v -12% change from baseline, respectively; [X2 (1, N = 340) = 35.29, p = .01] with only a trend for improvements in the rate of files demonstrating treatment of comorbidity [X2 (1, N = 340) = 10.45, p = .06]. There were significant improvements in the PCC relative to the control group for clinician self-efficacy, F(1,33) = 6.40, p = .02 and knowledge and attitudes of comorbidity monitoring, F(1,33) = 8.745, p = .01. CONCLUSIONS The PCC training package may help improve identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity in drug and alcohol settings.
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Affiliation(s)
- Eva Louie
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Edith Collins Centre Translational Research (Alcohol, Drugs & Toxicology), Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kirsten C Morley
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Edith Collins Centre Translational Research (Alcohol, Drugs & Toxicology), Royal Prince Alfred Hospital, Camperdown, Australia
| | - Vicki Giannopoulos
- Edith Collins Centre Translational Research (Alcohol, Drugs & Toxicology), Royal Prince Alfred Hospital, Camperdown, Australia
| | - Gabriela Uribe
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katie Wood
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Christina Marel
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katherine L Mills
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Michael Edwards
- Drug Health Services, South West Sydney Local Health District, Liverpool, Australia
| | - Steven Childs
- Central Coast Local Health District Drug and Alcohol Clinical Services, Gosford, Australia
| | - David Rogers
- Drug and Alcohol Services, Mid North Coast Local Health District, Port Macquarie, Australia
| | - Adrian Dunlop
- Drug and Alcohol Clinical Services, Hunter New England Local Health District, Taree, Australia.,University of Newcastle, Clinical Research and Improvement Network, Newcastle, Australia
| | - Andrew Baillie
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Paul S Haber
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,Edith Collins Centre Translational Research (Alcohol, Drugs & Toxicology), Royal Prince Alfred Hospital, Camperdown, Australia
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5
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Hansen A, McGarry D, Johnson A, Roche MA. The impact of an undergraduate students' culture on their learning about mental health: A scoping review. Nurs Health Sci 2021; 23:352-361. [PMID: 33797193 DOI: 10.1111/nhs.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
Mental disorders are highly prevalent. This necessitates undergraduate students in health-related courses are provided with the knowledge, skills, and attitudes to deliver safe care. Research confirms undergraduate health students maintain discriminative, stigmatizing, and inaccurate beliefs and attitudes toward those experiencing mental disorders. However, there is a paucity of research exploring how culture influences these beliefs. This scoping review addressed the question: 'What is the impact of an undergraduate student's culture on their learning about mental health?' A systematic search was undertaken of the MEDLINE, CINAHL, Scopus, PsycINFO, and ERIC databases. Results indicate variance between students' cultural beliefs in their attitudes toward and knowledge of mental disorders and understanding of interventions and treatment. None of the identified studies reviewed the ramifications for pedagogy beyond anecdotal suggestions. Educators need to acknowledge the potential impact that students' cultural beliefs have on their learning about mental health and consider appropriate learning activities to acknowledge the role of culture. Research of the impact of undergraduate students' culture on their learning about mental health will provide an evidence base for the development of these learning activities.
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Affiliation(s)
- Alison Hansen
- School of Nursing & Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Denise McGarry
- School of Nursing, College of Health and Medicine, University of Tasmania, Rozelle Campus, New South Wales, Australia
| | - Amanda Johnson
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael A Roche
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Mental Health Drug and Alcohol, Northern Sydney Local Health District, North Ryde, New South Wales, Australia
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6
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Giannopoulos V, Morley KC, Uribe GM, Louie E, Wood K, Teesson M, Baillie A, Haber PS. The role of clinical supervision in implementing evidence-based practice for managing comorbidity. CLINICAL SUPERVISOR 2021. [DOI: 10.1080/07325223.2021.1909517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Vicki Giannopoulos
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Kirsten C. Morley
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gabriela M. Uribe
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Eva Louie
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katie Wood
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Andrew Baillie
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paul S. Haber
- Drug Health Services, Royal Prince Alfred Hospital, Camperdown, Australia
- Sydney School of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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7
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Anandan R, Cross W, Olasoji M. Mental Health Nurses' Attitudes towards Consumers with co-Existing Mental Health and Drug and Alcohol Problems: A Scoping Review. Issues Ment Health Nurs 2021; 42:346-357. [PMID: 32822234 DOI: 10.1080/01612840.2020.1806964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Consumers with co-existing mental health and drug/alcohol problems are exposed to more stigma than those with any other health problems. This scoping review aimed to systematically map the available literature regarding mental health nurses' attitudes, empathy, and caring efficacy towards consumers with a dual diagnosis. Twenty studies reported outcomes regarding nurse attitudes; however, none reported nurses' empathy or caring efficacy towards consumers with a dual diagnosis. Further research is required to advance the evidence on the impact of mental health nurses' attitudes, empathy and caring effectiveness, and the outcomes should lead to improved service delivery for consumers with a dual diagnosis.
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Affiliation(s)
- Roopalal Anandan
- School of Health, Federation University Australia, Berwick, Victoria, Australia
| | - Wendy Cross
- School of Health, Federation University Australia, Berwick, Victoria, Australia
| | - Michael Olasoji
- School of Health, Federation University Australia, Berwick, Victoria, Australia.,School of Health Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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8
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Mahmoud KF, Terhorst L, Lindsay D, Brager J, Rodney T, Sanchez M, Hansen BR, Savage CL, Seale JP, Mitchell AM, Johnson JA, Finnell DS. Psychometric Properties of the Person-Centered Version of the Alcohol and Alcohol Problems Perceptions Questionnaire (PC-AAPPQ). Alcohol Alcohol 2020; 55:652-659. [DOI: 10.1093/alcalc/agaa061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Given the importance of addressing provider attitudes toward individuals with unhealthy alcohol use and the current emphasis on person-centered language to help decrease stigma and mitigate negative attitudes, the aim of this study was to evaluate the psychometric properties of a contemporary version of the Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) that uses person-centered language and addresses the spectrum of alcohol use.
Methods
The authors created a person-centered version of the AAPPQ (PC-AAPPQ) and conducted a cross-sectional study of its psychometric properties in academic settings in the Northeastern United States. The PC-AAPPQ was administered to 651 nursing students. Reliability analysis of the new instrument was performed using the total sample. Only surveys with complete data (n = 637) were randomly split into two datasets, one used for the exploratory factor analysis (EFA) (n = 310) and the other for confirmatory factor analysis (CFA) (n = 327).
Results
Compared to all the models generated from the EFA, neither the original six-factor structure nor the five-factor structure was superior to any of the other models. The results indicate that a seven-factor structure with all 30 items is the best fit for the PC-AAPPQ.
Conclusions
The PC-AAPPQ represents a positive effort to modernize the four-decade-old AAPPQ. This 30-item instrument, which adds one additional subscale, offers a means to assess providers’ attitudes using respectful wording that avoids perpetuating negative biases and reinforces efforts to affirm the worth and dignity of the population being treated.
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Affiliation(s)
- Khadejah F Mahmoud
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA 15213, USA
| | - Lauren Terhorst
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA 15219, USA
| | - Dawn Lindsay
- Institute for Research, Education & Training in Addictions, Pittsburgh, PA 15219, USA
| | - Jenna Brager
- Life Bridge Health, Sinai Hospital of Baltimore, Baltimore, MD 21215, USA
| | - Tamar Rodney
- Johns Hopkins School of Nursing, Baltimore, MD 21205, USA
| | | | - Bryan R Hansen
- Johns Hopkins School of Nursing, Baltimore, MD 21205, USA
| | | | - J Paul Seale
- Mercer University, School of Medicine, Department of Family Medicine, Macon, GA 31206, USA
| | - Ann M Mitchell
- University of Pittsburgh School of Nursing, Pittsburgh, PA 15261, USA
| | - J Aaron Johnson
- Augusta University, Department of Psychological Sciences and School of Graduate Studies, Institute of Public & Preventative Health, Augusta, GA 30912, USA
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9
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Richardson GB, Smith R, Lowe L, Acquavita SP. Structure and longitudinal invariance of the Short Alcohol and Alcohol Problems Perception Questionnaire. J Subst Abuse Treat 2020; 115:108041. [PMID: 32600628 DOI: 10.1016/j.jsat.2020.108041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022]
Abstract
Many studies have employed the Short Alcohol Attitudes Problem Perception Questionnaire (SAAPPQ) to measure professionals' attitudes toward working with people experiencing alcohol problems. However, research has not confirmed the internal structure of the SAAPPQ, leaving open the possibility that scale scores are not valid empirical proxies for underlying attitudes. It is also unclear if measurement invariance holds over time or across groups. This is an important gap in light of evidence that (a) experiences can change the structure of scales and (b) structures of some popular scales differ dramatically between groups. Thus, measurement bias may confound comparisons of composite SAAPPQ scores between measurement occasions or groups. To address these gaps in the literature, we conducted a longitudinal examination of the psychometrics of the SAAPPQ using data from 241 human services professionals-in-training. We found a four-factor structure, rather than the previously reported five factors. Configural, metric, and a strong degree of scalar invariance held longitudinally. Few factor intercorrelations were significant at time one and they strengthened over time, suggesting that the SAAPPQ should not be aggregated at higher-order levels (i.e., global scores should not be used). Findings suggest four SAAPPQ subscale scores may be used as valid proxies for attitudes toward alcohol users; however, additional confirmatory studies are needed to ensure that measurement bias does not compromise inferences based on SAAPPQ scores.
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Affiliation(s)
- George B Richardson
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America.
| | - Rachel Smith
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
| | - Linnea Lowe
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
| | - Shauna P Acquavita
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, OH 45221, United States of America
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10
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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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11
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Kikkert M, Goudriaan A, de Waal M, Peen J, Dekker J. Effectiveness of Integrated Dual Diagnosis Treatment (IDDT) in severe mental illness outpatients with a co-occurring substance use disorder. J Subst Abuse Treat 2018; 95:35-42. [PMID: 30352668 DOI: 10.1016/j.jsat.2018.09.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/20/2018] [Accepted: 09/23/2018] [Indexed: 11/24/2022]
Abstract
Integrating substance use disorder treatment with psychiatric treatment is considered more favourable then treating these disorders parallel or sequential, but the evidence base is inconclusive. We examined the effectiveness of Integrated Dual Diagnosis Treatment (IDDT) on substance use in severe mental illness outpatients with substance use disorders. IDDT is a collaborative, multidisciplinary team approach in which motivational interviewing is a key element. In addition, we also examined the effects of IDDT implementation on skills and knowledge of mental health care professionals. A randomized controlled stepped-wedge cluster trial was performed in 6 functional assertive cummunity treatment teams. We included 37 clinicians who were given a three-day IDDT training. Our primary outcome was days of substance use at follow up, 12 months after IDDT implementation. This was assessed in 154 included patients and was measured with the Measurement in the Addiction for Triage and Evaluation. After implementation of IDDT we found a reduction in the number of days patients used alcohol or drugs, but no improvements on other secondary outcomes such as psychopathology, functioning, therapeutic alliance or motivation to change. Also, IDDT training did not seem to improve clinicians' knowledge, attitudes and motivational interviewing skills. Effects on our secondary outcomes may have been limited by the absence of a training effect in our clinicians. Our study clearly underlines the complexity of disseminating IDDT and in particular motivational interviewing.
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Affiliation(s)
- Martijn Kikkert
- Arkin, Amsterdam, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands.
| | - Anneke Goudriaan
- Arkin, Amsterdam, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands; Academic Medical Center, Department of Psychiatry, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Marleen de Waal
- Arkin, Amsterdam, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands; Academic Medical Center, Department of Psychiatry, University of Amsterdam, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands
| | - Jaap Peen
- Arkin, Amsterdam, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands
| | - Jack Dekker
- Arkin, Amsterdam, Klaprozenweg 111, 1033 NN Amsterdam, The Netherlands; VU University of Amsterdam, Clinical Psychology, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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12
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Louie E, Giannopoulos V, Baillie A, Uribe G, Byrne S, Deady M, Teesson M, Baker A, Haber PS, Morley KC. Translating Evidence-Based Practice for Managing Comorbid Substance Use and Mental Illness Using a Multimodal Training Package. J Dual Diagn 2018; 14:111-119. [PMID: 29488830 DOI: 10.1080/15504263.2018.1437496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Comorbid mental health and substance use problems are highly prevalent in substance use treatment settings and generally lead to poorer treatment outcomes. Pathways to Comorbidity Care (PCC) is a multimodal training program developed to encourage an integrated service approach to improve clinicians capacity to identify and manage comorbid substance use and mental health outcomes within public drug and alcohol treatment settings. METHODS In this paper we describe the concepts underlying the PCC package and the use of implementation science to assess and overcome potential barriers, including clinicians preferences, knowledge about best practice, and professional culture. RESULTS The training components include didactic seminars, group workshops run by a local clinical champion on relevant subjects such as motivational interviewing and cognitive behavioral therapy, individual clinical consultation, and feedback with a senior clinical psychologist. The PCC also includes an online portal containing comorbidity resources including manuals, guidelines, and booster webinars. Finally, we describe the evaluation of PCC implementation. CONCLUSIONS Drug and alcohol services need to be equipped to treat the majority of comorbid mental health conditions in their clients. We anticipate that this multimodal training package, which applies the principles of implementation science, will facilitate effective and integrated care for these vulnerable clients.
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Affiliation(s)
- Eva Louie
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Vicki Giannopoulos
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Andrew Baillie
- b Faculty of Health Sciences , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Gabriela Uribe
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Simon Byrne
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
| | - Mark Deady
- c National Drug and Alcohol Research Centre , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, University of New South Wales (UNSW) , Australia
| | - Maree Teesson
- c National Drug and Alcohol Research Centre , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, University of New South Wales (UNSW) , Australia
| | - Amanda Baker
- d School of Medicine and Public Health University of Newcastle , New South Wales , Australia
| | - Paul S Haber
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia.,e Drug Health Services , Royal Prince Alfred Hospital , Camperdown , New South Wales , Australia
| | - Kirsten C Morley
- a Discipline of Addiction Medicine , National Health and Medical Research Council (NHMRC) Centre for Excellence in Mental Health and Substance Use, The University of Sydney , New South Wales , Australia
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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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14
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Affiliation(s)
- K Gournay
- Institute of Psychiatry, King's College, London, UK. .,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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15
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16
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Searby A, Maude P, McGrath I. Prevalence of co-occurring alcohol and other drug use in an Australian older adult mental health service. Int J Ment Health Nurs 2016; 25:151-8. [PMID: 26834037 DOI: 10.1111/inm.12215] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/03/2015] [Accepted: 12/06/2015] [Indexed: 01/26/2023]
Abstract
Co-occurring mental illness and substance use disorder, known as dual diagnosis, is a significant challenge to mental health services. Few older adult specific alcohol and other drug treatment services exist, meaning older adult mental health services may become the default treatment option for many. Evidence suggests that dual diagnosis leads to substandard treatment outcomes, including higher rates of psychiatric relapse, higher costs of care and poorer treatment engagement. This paper explores the prevalence of co-occurring alcohol and other drug (AOD) use in an older adult community mental health service in inner Melbourne, Australia. This aim was accomplished by using a retrospective file audit of clinical intake assessments (n = 593) performed on consumers presenting to the service over a two-year period, June 2012-2014. Of consumers presenting to the service, 15.5% (n = 92) were assessed by clinicians as having co-occurring AOD use. Depression predominated in the dual diagnosis group as the primary mental health disorder. Dual diagnosis consumers in this sample were statistically more likely to be male and younger than their non-dual diagnosis counterparts. A limitation of this audit was the lack of implementation of screening tools, leaving assessment to clinical judgement or the interest of the clinician. This may also explain the discrepancy between the results of this study and previous work. Although appearing to be a relatively small percentage of assessments, the results accounted for 92 individuals with complex mental health, AOD and medical issues. Poor screening procedures in a population that is traditionally difficult to assess need to be rectified to meet the future challenges inherent in the ageing baby boomer generation, changing drug use trends and extended lifespans through harm reduction initiatives and medical advancements.
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Affiliation(s)
- Adam Searby
- Alfred Psychiatry, Alfred Health, Melbourne, Australia.,RMIT University School of Health and Biomedical Sciences, Melbourne, Australia
| | - Phil Maude
- Alfred Psychiatry, Alfred Health, Melbourne, Australia.,University of Tasmania School of Health Sciences, Hobart, Tasmania.,RMIT University School of Health and Biomedical Sciences, Melbourne, Australia
| | - Ian McGrath
- RMIT University School of Health and Biomedical Sciences, Melbourne, Australia
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17
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18
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Elison S, Weston S, Dugdale S, Ward J, Davies G. A Qualitative Exploration of U.K. Prisoners’ Experiences of Substance Misuse and Mental Health Difficulties, and the Breaking Free Health and Justice Interventions. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/0022042616630013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study explored prisoners’ lived experiences of substance use and mental health difficulties and aimed to examine perceived links between these two areas and how they might be associated with recovery during engagement with the Breaking Free Health and Justice (BFHJ) treatment programs. Interviews were conducted with 32 prisoners receiving treatment for substance use in North-West England. Emerging from prisoners’ interviews were themes relating to difficult life experiences from childhood into adulthood, how these experiences played a role in the emergence of their multiple and complex difficulties, their treatment experiences, and how their current involvement with the criminal justice system acted as a catalyst for positive change, including engagement with the BFHJ programs. This study identified the roles of substance use and mental health difficulties in the lives of participants, identified how their multiple and complex difficulties might be addressed, and provided insights into prisoners’ interpretations of their life experiences.
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19
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Stewart D, Warren J, Odubanwo A, Bowers L. Nursing interventions for substance use during psychiatric hospital admissions: Clinical context and predictors. Int J Ment Health Nurs 2015; 24:527-37. [PMID: 26300518 DOI: 10.1111/inm.12152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Empirical information about how nurses manage substance use on psychiatric wards is lacking. The aims of the study were to identify the frequency and clinical features of incidents among a sample of inpatients over a 12-month period and how nursing staff intervened. Electronic, anonymized inpatient records were searched for incidents of substance use on 17 acute psychiatric wards in four hospitals in London. Searches were conducted for all patients admitted during 2012 and details of incidents and patient characteristics were extracted for analysis. Substance use was reported for 291 patients, with 25 incidents per 100 patients admitted to hospital. Only half of the incidents were followed by a response that specifically addressed the patients' substance use behaviour. These interactions usually concerned the circumstances and reasons for use, but rarely involved specific support for patients' substance use problems. The likelihood of staff taking any form of action was increased if the patient had been formally admitted, and was reduced if the patient was subject to containment during the shift or had a history of self-harm. The results demonstrate that nurses require specific training and guidance on supporting substance using patients.
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Affiliation(s)
- Duncan Stewart
- School of Psychology, Social Work and Human Sciences, University of West London, London, UK
| | | | | | - Len Bowers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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20
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Feasibility Randomized Controlled Trial of Cognitive and Behavioral Interventions for Depression Symptoms in Patients Accessing Drug and Alcohol Treatment. J Subst Abuse Treat 2015; 55:6-14. [DOI: 10.1016/j.jsat.2015.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/19/2015] [Accepted: 02/22/2015] [Indexed: 11/30/2022]
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21
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Stewart D, Bowers L. Substance use and violence among psychiatric inpatients. J Psychiatr Ment Health Nurs 2015; 22:116-24. [PMID: 24661801 DOI: 10.1111/jpm.12144] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2014] [Indexed: 11/30/2022]
Abstract
Nursing staff on psychiatric wards often attribute patient violence and aggression to substance use. This study examined incidents of alcohol and illicit drug use among acute psychiatric inpatients and associations between substance use and violence or other forms of aggression. A sample of 522 adult psychiatric inpatients was recruited from 84 acute psychiatric wards in England. Data were collected from nursing and medical records for the first 2 weeks of admission. Only a small proportion of the sample was reported to have used or been under the influence of alcohol (5%) or drugs (3%). There was no physical violence during a shift when a patient had used alcohol or drugs. Substance using patients were also no more likely than others to behave violently at any point during the study period. However, incidents of substance use were sometimes followed by verbal aggression. Beliefs that substance using patients are likely to be violent were not supported by this study, and could impact negatively on therapeutic relationships between nurses and this patient group. Future studies are needed to examine how staff intervene and interact with intoxicated patients.
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Affiliation(s)
- D Stewart
- Institute of Psychiatry, Kings College London, London, UK
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22
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Roussy V, Thomacos N, Rudd A, Crockett B. Enhancing health-care workers' understanding and thinking about people living with co-occurring mental health and substance use issues through consumer-led training. Health Expect 2013; 18:1567-81. [PMID: 24118841 DOI: 10.1111/hex.12146] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Stigma and judgemental assumptions by health workers have been identified as key barriers to accessing health care for people living with co-occurring mental health and substance use issues (dual diagnosis). OBJECTIVE To evaluate the effectiveness of consumer-led training by people with dual diagnosis in improving the knowledge, understanding and role adequacy of community health staff to work with this consumer group. METHODS A controlled before-and-after study design with four waves of quantitative data collection was used. Qualitative data were collected to explore participants' views about training. Participants were staff from two community health services from Victoria, Australia. Recruitment occurred across various work areas: reception, oral health, allied health, counselling and health promotion. At baseline, all participants attended a 4-h clinician-led training session. The intervention consisted of a 3-h consumer-led training session, developed and delivered by seven individuals living with dual diagnosis. Outcome measures included understanding of dual diagnosis, participants' feelings of role adequacy and role legitimacy, personal views, and training outcomes and relevance. RESULTS Consumer-led training was associated with a significant increase in understanding. The combination of clinician-led and consumer-led training was associated with a positive change in role adequacy. CONCLUSIONS Consumer-led training is a promising approach to enhance primary health-care workers' understanding of the issues faced by dual-diagnosis consumers, with such positive effects persisting over time. Used alongside other organizational capacity building strategies, consumer-led training has the potential to help address stigma and judgemental attitudes by health workers and improve access to services for this consumer group.
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Affiliation(s)
| | - Nikos Thomacos
- Department of Occupational Therapy, School of Primary Health Care, Monash University, Frankston, VIC, Australia
| | - Annette Rudd
- Knox Community Health Service, Ferntree Gully, VIC, Australia
| | - Belinda Crockett
- Eastern Melbourne Medicare Local, Croydon, VIC, Australia.,School of Public Health and Preventive Medicine, Monash University, VIC, Australia
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23
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Hunt GE, Siegfried N, Morley K, Sitharthan T, Cleary M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 2013:CD001088. [PMID: 24092525 DOI: 10.1002/14651858.cd001088.pub3] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [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 For this update (2013), the Trials Search Co-ordinator of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (July 2012), which is based on regular searches of major medical and scientific databases. The principal authors conducted two further searches (8 October 2012 and 15 January 2013) of the Cochrane Database of Systematic Reviews, MEDLINE and PsycINFO. A separate search for trials of contingency management was completed as this was an additional intervention category for this update. 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 We independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of relative risk (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. For all meta-analyses 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 We included 32 trials with a total of 3165 participants. Evaluation of long-term integrated care included four RCTs (n = 735). We found no significant differences on loss to treatment (n = 603, 3 RCTs, RR 1.09 CI 0.82 to 1.45, low quality of evidence), death by 3 years (n = 421, 2 RCTs, RR 1.18 CI 0.39 to 3.57, low quality of evidence), alcohol use (not in remission at 36 months) (n = 143, 1 RCT, RR 1.15 CI 0.84 to 1.56,low quality of evidence), substance use (n = 85, 1 RCT, RR 0.89 CI 0.63 to 1.25, low quality of evidence), global assessment of functioning (n = 171, 1 RCT, MD 0.7 CI 2.07 to 3.47, low quality of evidence), or general life satisfaction (n = 372, 2 RCTs, MD 0.02 higher CI 0.28 to 0.32, moderate quality of evidence).For evaluation of non-integrated intensive case management with usual treatment (4 RCTs, n = 163) we found no statistically significant difference for loss to treatment at 12 months (n = 134, 3 RCTs, RR 1.21 CI 0.73 to 1.99, very low quality of evidence).Motivational interviewing plus cognitive behavioural therapy compared to usual treatment (7 RCTs, total n = 878) did not reveal any advantage for retaining participants at 12 months (n = 327, 1 RCT, RR 0.99 CI 0.62 to 1.59, low quality of evidence) or for death (n = 493, 3 RCTs, RR 0.72 CI 0.22 to 2.41, low quality of evidence), and no benefit for reducing substance use (n = 119, 1 RCT, MD 0.19 CI -0.22 to 0.6, low quality of evidence), relapse (n = 36, 1 RCT, RR 0.5 CI 0.24 to 1.04, very low quality of evidence) or global functioning (n = 445, 4 RCTs, MD 1.24 CI 1.86 to 4.34, very low quality of evidence).Cognitive behavioural therapy alone compared with usual treatment (2 RCTs, n = 152) showed no significant difference for losses from treatment at 3 months (n = 152, 2 RCTs, RR 1.12 CI 0.44 to 2.86, low quality of evidence). No benefits were observed on measures of lessening cannabis use at 6 months (n = 47, 1 RCT, RR 1.30 CI 0.79 to 2.15, very low quality of evidence) or mental state (n = 105, 1 RCT, Brief Psychiatric Rating Scale MD 0.52 CI -0.78 to 1.82, low quality of evidence).We found no advantage for motivational interviewing alone compared with usual treatment (8 RCTs, n = 509) in reducing losses to treatment at 6 months (n = 62, 1 RCT, RR 1.71 CI 0.63 to 4.64, very low quality of evidence), although significantly more participants in the motivational interviewing group reported for their first aftercare appointment (n = 93, 1 RCT, RR 0.69 CI 0.53 to 0.9). Some differences, favouring treatment, were observed in abstaining from alcohol (n = 28, 1 RCT, RR 0.36 CI 0.17 to 0.75, very low quality of evidence) but not other substances (n = 89, 1 RCT, RR -0.07 CI -0.56 to 0.42, very low quality of evidence), and no differences were observed in mental state (n = 30, 1 RCT, MD 0.19 CI -0.59 to 0.21, very low quality of evidence).We found no significant differences for skills training in the numbers lost to treatment by 12 months (n = 94, 2 RCTs, RR 0.70 CI 0.44 to 1.1, very low quality of evidence).We found no differences for contingency management compared with usual treatment (2 RCTs, n = 206) in numbers lost to treatment at 3 months (n = 176, 1 RCT, RR 1.65 CI 1.18 to 2.31, low quality of evidence), number of stimulant positive urine tests at 6 months (n = 176, 1 RCT, RR 0.83 CI 0.65 to 1.06, low quality of evidence) or hospitalisations (n = 176, 1 RCT, RR 0.21 CI 0.05 to 0.93, low quality of evidence).We were unable to summarise all 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 due to high or unclear risks of bias because of poor trial methods, or poorly reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals. AUTHORS' CONCLUSIONS We included 32 RCTs and found no compelling evidence to support any one psychosocial treatment over another for people to remain in treatment or to reduce substance use or improve mental state in people with serious mental illnesses. 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
- Discipline of Psychiatry, The University of Sydney, Concord Centre for Mental Health, Hospital Road, Sydney, NSW, Australia, 2139
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Terhorst L, Gotham HJ, Puskar KR, Mitchell AM, Talcott KS, Braxter B, Hagle H, Fioravanti M, Woomer GR. Confirming the factor structure of the alcohol and alcohol problems questionnaire (AAPPQ) in a sample of baccalaureate nursing students. Res Nurs Health 2013; 36:412-22. [DOI: 10.1002/nur.21537] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Lauren Terhorst
- Community Care Behavioral Health Organization; University of Pittsburgh Medical Center; 112 Washington Place, Suite 700 Pittsburgh, PA 15219 PA
| | - Heather J. Gotham
- Mid-America Addiction Technology Transfer Center; University of Missouri-Kansas City; Kansas City, MO
| | | | | | | | - Betty Braxter
- University of Pittsburgh School of Nursing; Pittsburgh PA
| | - Holly Hagle
- Institute for Research, Education and Training in Addictions (IRETA); Pittsburgh PA
| | | | - Gail R. Woomer
- University of Pittsburgh School of Nursing; Pittsburgh PA
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Carrà G, Johnson S, Bebbington P, Angermeyer MC, Heider D, Brugha T, Azorin JM, Toumi M. The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European Schizophrenia Cohort (EuroSC). Eur Arch Psychiatry Clin Neurosci 2012; 262:607-16. [PMID: 22427152 DOI: 10.1007/s00406-012-0305-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 02/29/2012] [Indexed: 01/03/2023]
Abstract
Relatively little is known about rates of comorbid drug and alcohol problems in people with schizophrenia outside the USA. Most studies have recruited from single countries. Newly available data provided an unmatched opportunity to investigate the prevalence of comorbid dependence on alcohol and other psychoactive substances in people with schizophrenia in France, Germany and the UK at the same time. The European Schizophrenia Cohort study data set used semi-structured clinical interviews to establish DSM-IV diagnoses. 1,208 patients were interviewed in nine centres. The lifetime rate for comorbid dependence on any substance was highest in the UK (35 %), but considerably lower in Germany (21 %) and in France (19 %), and generally more than double the past-year rates. Dependence on alcohol and on other psychoactive substances showed similar variations (comorbid alcohol dependence: UK 26 %; Germany 18 %; France 14 %; comorbid drug dependence: UK 18 %; Germany 8 %; France 7 %). Differences within countries persisted after controlling for individual characteristics. The relative odds of dependence were higher than in the general population, but varied between countries and centres. Dependence disorders are a common problem in people with schizophrenia in Western Europe, although effective service configurations have yet to be developed. Overall, these European rates are less than those reported from the USA. Research comparing people with current comorbidity with those who are no longer dependent is needed.
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Affiliation(s)
- Giuseppe Carrà
- Department of Mental Health Sciences, University College London, UK.
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Davis K, O'Neill S, Devitt T, Baerentzen B, Little N, Wilkniss S. Consulting in Action: A Case Study of Six Community Support Teams Sustaining Integrated Dual Disorder Treatment. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2012. [DOI: 10.1080/15487768.2012.733284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
A training course on dual diagnosis was developed within the Irish forensic mental health service, to bridge the gap in the lack of training on dual diagnosis in Ireland. The course was designed for service providers within mental health and addiction services. Twenty participants involving nursing, social work, police and social welfare disciplines attended the first training course. A mixed methodology research design was adapted to describe participants' evaluation of the training course. Data were collected using multiple methods: pre- and post-test, daily evaluation and focus group interviews. Quantitative data were analysed using the spss Version 16.0 and qualitative data were analysed thematically. Findings from the pre- and post-test suggest an increase in participants' knowledge of dual diagnosis and an increase in confidence in conducting groups. Daily evaluation indicates that the course content largely met participants' needs. Finally, three themes emerged from the focus group interview: increased confidence, the training course/teaching methods and personal/organizational challenges. This study implies that service providers within mental health and addiction services benefit from inter-professional, needs and skills based courses incorporating a variety of teaching methods. The way forward for future dual diagnosis training course developments would be working in partnership with service users and carers.
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Affiliation(s)
- S Rani
- Training and Development Department, Central Mental Hospital, Dundrum, Dublin, Ireland.
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“Acute concerns”: is the mental health workforce equipped and supported to meet complex needs? ADVANCES IN DUAL DIAGNOSIS 2012. [DOI: 10.1108/17570971211225136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abou Saleh M, Crome I. National Institute for Health and Clinical Excellence (NICE) guideline: psychosis with coexisting substance misuse. Addiction 2012; 107:1-3. [PMID: 21939460 DOI: 10.1111/j.1360-0443.2011.03542.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Roche M, Duffield C, White E. Factors in the practice environment of nurses working in inpatient mental health: A partial least squares path modeling approach. Int J Nurs Stud 2011; 48:1475-86. [DOI: 10.1016/j.ijnurstu.2011.07.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2010] [Revised: 05/26/2011] [Accepted: 07/03/2011] [Indexed: 01/07/2023]
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Lee NK, Cameron J, Harney A, Roeg S. Dual diagnosis capability after an AOD workforce initiative. ADVANCES IN DUAL DIAGNOSIS 2011. [DOI: 10.1108/17570971111197201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeDissemination of good practice information to practitioners is one of the great challenges of the substance abuse treatment sector. The authors' understanding of the process by which research is translated is limited, but a whole of workforce approach is considered best practice. This paper aims to examine organisational change as a result of a workforce capacity‐building program over six months.Design/methodology/approachA total of 195 staff (nine service managers, 39 supervisors and 147 clinicians) in 13 alcohol and other drug (AOD) services across Australia participated in mental health screening and brief intervention training using PsyCheck. PsyCheck is designed to detect and address common mental health symptoms among drug treatment clients. The Dual Diagnosis Capability in Addiction Treatment (DDCAT) index was used to measure capacity before and after training.FindingsThere was no significant difference between baseline and follow‐up DDCAT scores; however, the level of PsyCheck implementation indicated improvement in DDCAT scores.Practical implicationsThe results show that where organisations implement the program successfully, capacity improves; where the program is not well implemented, capacity reduces. Successful implementers report a number of common elements: the screening tool was implemented into routine assessment; there was a single onsite “champion” supporting the implementation; and they worked with the staff and persisted with the implementation even where there was initial worker resistance.Originality/valueThis paper provides the opportunity to assess workforce capacity building and the feasibility of utilising the DCCAT to measure co‐occurring mental health and substance use disorders in Australian AOD services.
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NEHLIN CHRISTINA, FREDRIKSSON ANDERS, GRÖNBLADH LEIF, JANSSON LENNART. Three hours of training improve psychiatric staff's self-perceived knowledge and attitudes toward problem-drinking patients. Drug Alcohol Rev 2011; 31:544-9. [DOI: 10.1111/j.1465-3362.2011.00373.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Meeting the training needs of staff working with older people with dual diagnosis. ADVANCES IN DUAL DIAGNOSIS 2011. [DOI: 10.1108/17570971111155603] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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. ICM evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (less than 20) and high intensity input. OBJECTIVES To assess the effects of Intensive Case Management (caseload <20) in comparison with non-Intensive Case Management (caseload > 20) and with standard community care in people with severe mental illness. To evaluate whether the effect of ICM on hospitalisation depends on its fidelity to the ACT model and on the setting. SEARCH STRATEGY For the current update of this review we searched the Cochrane Schizophrenia Group Trials Register (February 2009), which is compiled by systematic searches of major databases, hand searches and conference proceedings. 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 Intensive Case Management, non-Intensive Case Management or standard care were compared. Outcomes such as service use, adverse effects, global state, social functioning, mental state, behaviour, quality of life, satisfaction and costs were sought. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes we calculated relative risk (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% confidence interval (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. MAIN RESULTS We included 38 trials (7328 participants) in this review. The trials provided data for two comparisons: 1. ICM versus standard care, 2. ICM versus non-ICM.1. ICM versus standard care Twenty-four trials provided data on length of hospitalisation, and results favoured Intensive Case Management (n=3595, 24 RCTs, MD -0.86 CI -1.37 to -0.34). There was a high level of heterogeneity, but this significance still remained when the outlier studies were excluded from the analysis (n=3143, 20 RCTs, MD -0.62 CI -1.00 to -0.23). Nine studies found participants in the ICM group were less likely to be lost to psychiatric services (n=1633, 9 RCTs, RR 0.43 CI 0.30 to 0.61, I²=49%, p=0.05).One global state scale did show an Improvement in global state for those receiving ICM, the GAF scale (n=818, 5 RCTs, MD 3.41 CI 1.66 to 5.16). Results for mental state as measured through various rating scales, however, were equivocal, with no compelling evidence that ICM was really any better than standard care in improving mental state. No differences in mortality between ICM and standard care groups occurred, either due to 'all causes' (n=1456, 9 RCTs, RR 0.84 CI 0.48 to 1.47) or to 'suicide' (n=1456, 9 RCTs, RR 0.68 CI 0.31 to 1.51).Social functioning results varied, no differences were found in terms of contact with the legal system and with employment status, whereas significant improvement in accommodation status was found, as was the incidence of not living independently, which was lower in the ICM group (n=1185, 4 RCTs, RR 0.65 CI 0.49 to 0.88).Quality of life data found no significant difference between groups, but data were weak. CSQ scores showed a greater participant satisfaction in the ICM group (n=423, 2 RCTs, MD 3.23 CI 2.31 to 4.14).2. ICM versus non-ICM The included studies failed to show a significant advantage of ICM in reducing the average length of hospitalisation (n=2220, 21 RCTs, MD -0.08 CI -0.37 to 0.21). They did find ICM to be more advantageous than non-ICM in reducing rate of lost to follow-up (n=2195, 9 RCTs, RR 0.72 CI 0.52 to 0.99), although data showed a substantial level of heterogeneity (I²=59%, p=0.01). Overall, no significant differences were found in the effects of ICM compared to non-ICM for broad outcomes such as service use, mortality, social functioning, mental state, behaviour, quality of life, satisfaction and costs.3. Fidelity to ACT Within 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 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 CI -0.32 to -0.10). Combining both these variables within the model, 'organisation fidelity' is no longer significant, but 'baseline hospital use' result is still significantly influencing time in hospital (regression coefficient -0.18 CI -0.29 to -0.07, p=0.0027). AUTHORS' CONCLUSIONS ICM was found effective in ameliorating many outcomes relevant to people with severe mental illnesses. Compared to standard care ICM was shown to 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. ICM is of value at least to people with severe mental illnesses who are in the sub-group of those with a high level of hospitalisation (about 4 days/month in past 2 years) and the intervention should be performed close to the original model.It is not clear, however, what 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, but currently we know of no review comparing non-ICM with standard care and this should be undertaken.
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Affiliation(s)
- Marina Dieterich
- Department of Mental Health, Azienda USL 6 Livorno, Livorno, Italy
| | - Claire B Irving
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Bert Park
- The University of Nottingham, Nottingham, UK
| | - Max Marshall
- University of Manchester, The Lantern Centre, Preston., UK
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Lee N, Jenner L, Baker A, Ritter A, Hides L, Norman J, Kay-Lambkin F, Hall K, Dann F, Cameron J. Screening and intervention for mental health problems in alcohol and other drug settings: Can training change practitioner behaviour? DRUGS-EDUCATION PREVENTION AND POLICY 2010. [DOI: 10.3109/09687631003727847] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hughes L. Editorial. ADVANCES IN DUAL DIAGNOSIS 2008. [DOI: 10.1108/17570972200800010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hughes L, Tobin D, McGlynn P, Heffernan K. A pilot of team‐based dual diagnosis training for assertive Outreach teams. ADVANCES IN DUAL DIAGNOSIS 2008. [DOI: 10.1108/17570972200800011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assertive outreach teams are working with a significant proportion of people with complex needs, including dual diagnosis. Government policy has highlighted the role of assertive outreach in engaging and intervening with this group. This paper reports on the development and evaluation of a specific team‐focused training package and its trial in the Eastern and West Midlands regions.
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Gorry A, Dodd T. Overview of the NIMHE/CSIP National Dual Diagnosis Programme in England. ADVANCES IN DUAL DIAGNOSIS 2008. [DOI: 10.1108/17570972200800003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper reviews the work of the national dual diagnosis programme established in England in response to recommendations for improvements in the way that services treat people with mental health problems and substance misuse issues. National policy drivers are explained, as well as the aims and achievements of the programme to date.
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