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Friedman NR, Watkins L, Barnard-Brak L, Barber A, White SW. De-implementation of Low-Value Practices for Autism Spectrum Disorder. Clin Child Fam Psychol Rev 2023; 26:690-705. [PMID: 37452164 DOI: 10.1007/s10567-023-00447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Due to a variety of factors, Autism Spectrum Disorder (ASD) has long been tethered to use of low-value practice (LVP), arguably moreso than any other psychiatric or neurodevelopmental condition. Although dissemination of empirically supported treatments (EST) for autistic individuals has expanded markedly over the past decade, there has not been concomitant reduction in the use of LVP. It is critical that clinicians and scientists not only promote the implementation of EST, but also facilitate the de-implementation (abandonment and/or divestment) of ineffective or harmful practices. In this review, we describe a data-driven approach that can be used to identify LVP, drawing from established criteria for identification of evidence-based treatments (e.g., APA Division 12, National Clearinghouse on Autism Evidence and Practice; SAMHSA), as well as broader considerations such as social validity, cost, and parsimony. Herein, a data-based approach to LVP identification is proposed with a goal of improving quality of service access. Within an implementation science framework, we identify specific facilitators that sustain LVP use, and recommendations for subsequent de-implementation strategies are offered.
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Affiliation(s)
- Nicole R Friedman
- Center for Youth Development and Intervention, University of Alabama, 101 McMillan Bldg, Box 870348, Tuscaloosa, AL, 35487, USA
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Laci Watkins
- Department of Special Education, University of Alabama, Tuscaloosa, AL, USA
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Lucy Barnard-Brak
- Department of Special Education, University of Alabama, Tuscaloosa, AL, USA
| | - Angela Barber
- Department of Communication Sciences and Disorders, Samford University, Birmingham, AL, USA
| | - Susan W White
- Center for Youth Development and Intervention, University of Alabama, 101 McMillan Bldg, Box 870348, Tuscaloosa, AL, 35487, USA.
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
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Siddiq H, Ajrouch K, Elhaija A, Kayali N, Heilemann M. Addressing the mental health needs of older adult refugees: Perspectives of multi-sector community key informants. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100269. [PMID: 37811357 PMCID: PMC10559761 DOI: 10.1016/j.ssmqr.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Affiliation(s)
| | | | - Ahmad Elhaija
- University of California, School of Medicine, Los Angeles, USA
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Mullen JN, Levitt A, Markoulakis R. Supporting Individuals with Mental Health and/or Addictions Issues Through Patient Navigation: A Scoping Review. Community Ment Health J 2023; 59:35-56. [PMID: 35648257 DOI: 10.1007/s10597-022-00982-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 05/01/2022] [Indexed: 01/07/2023]
Abstract
Pathways through the mental health care system can be complex and laden with barriers that prevent individuals from finding the most appropriate care. Navigation has been proposed as a solution for improving access to and transition through complex health care systems. While several MHA navigation programs have emerged in the past decade, no study has explored the core themes of MHA navigation, which was the goal of the current review. A scoping review was conducted; the search yielded 11,525 unique results, of which 26 were entered into extraction and subsequent descriptive and thematic analysis. Barrier reduction, client-centered support, and integrated care emerged as the distinct themes underlying MHA services, and overall, navigation significantly improved outcomes for individuals experiencing MHA issues. These findings may support evidence-based implementation of navigation services and point to a need for increased exploration and reporting of MHA navigation outcomes in the literature.
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Affiliation(s)
- Jennifer N Mullen
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Anthony Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada.
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
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Duggal S, Miller R, Tanner D. Implementing Asset-Based Integrated Care: A Tale of Two Localities. Int J Integr Care 2021; 21:19. [PMID: 34824568 PMCID: PMC8603861 DOI: 10.5334/ijic.5621] [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: 10/01/2020] [Accepted: 10/21/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND To date, few studies have examined the implementation of asset-based integrated care in the UK. This paper aims to address this gap in knowledge through examining the implementation of one model of asset-based integrated care, Local Area Coordination (LAC), within two localities in England. METHODS This paper draws upon data collected from two local authorities (site A and site B), which had both implemented LAC. Using a case study approach, qualitative data was collected from interviews with relevant stakeholders both internal and external to the local authorities. Data was analysed thematically. RESULTS The findings demonstrate the marked differences between the two sites' approaches to LAC, especially in relation to: the implementation process; impact; and their collaboration with other agencies and communities. DISCUSSION The evidence presented in this paper demonstrates that the implementation of LAC, as with most complex service innovations, is dependent on the interplay of organisational and people-based components. In particular, successful implementation depends on maintaining a common vision of what an intervention will achieve and how it will work in practice, continual engagement with the political and organisational leaders of influence, positively addressing the anxieties of existing services and professions, and working with community groups.
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Frerichs J, Billings J, Barber N, Chhapia A, Chipp B, Shah P, Shorten A, Stefanidou T, Johnson S, Evans BL, Pinfold V. Influences on participation in a programme addressing loneliness among people with depression and anxiety: findings from the Community Navigator Study. BMC Psychiatry 2020; 20:565. [PMID: 33243222 PMCID: PMC7689977 DOI: 10.1186/s12888-020-02961-x] [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: 05/18/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions. METHODS Semi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study's working group, which included experts by experience, clinicians and researchers. RESULTS The narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant's relationship with the Community Navigator. CONCLUSIONS We found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual's participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes.
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Affiliation(s)
- Johanna Frerichs
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Jo Billings
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Nick Barber
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Anjie Chhapia
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Beverley Chipp
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Prisha Shah
- grid.490917.2McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR UK
| | - Anna Shorten
- grid.439468.4Complex Depression, Anxiety & Trauma Team, St Pancras Hospital, London, NW1 0PE UK
| | - Theodora Stefanidou
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Sonia Johnson
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Brynmor Lloyd Evans
- grid.83440.3b0000000121901201Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Vanessa Pinfold
- McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK.
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The Community Navigator Study: Results from a feasibility randomised controlled trial of a programme to reduce loneliness for people with complex anxiety or depression. PLoS One 2020; 15:e0233535. [PMID: 32469922 PMCID: PMC7259554 DOI: 10.1371/journal.pone.0233535] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/07/2020] [Indexed: 01/04/2023] Open
Abstract
Background Loneliness is common among people with mental health problems and predicts poorer recovery from depression and anxiety. Needs for support with loneliness and social relationships are often under-addressed in mental health services. The Community Navigator programme was designed to reduce loneliness for adults (aged 18 and above) with complex depression or anxiety who were using secondary mental health services. Acceptability and feasibility of the programme and a trial evaluation were tested in a feasibility randomised controlled trial with qualitative evaluation. Methods Forty participants with depression or anxiety using secondary mental health services were recruited from mental health services in two London sites and randomised to receive: the Community Navigator programme over six months in addition to routine care (n = 30); or routine care (n = 10). Measures of loneliness, depression, other clinical and social outcomes and service use were collected at baseline and six-months follow-up. Levels of engagement in the programme and rates of trial recruitment and retention were assessed. Programme delivery was assessed through session logs completed by Community Navigators. The acceptability of the programme was explored through qualitative interviews (n = 32) with intervention group participants, their family and friends, programme providers and other involved staff. Results Forty participants were recruited in four months from 65 eligible potential participants asked. No one withdrew from the trial. Follow-up interviews were completed with 35 participants (88%). Process records indicated the programme was delivered as intended: there was a median of seven meetings with their Community Navigator (of a maximum ten) per treatment group participant. Qualitative interviews indicated good acceptability of the programme to stakeholders, and potential utility in reducing loneliness and depression and anxiety. Conclusions A definitive, multi-site randomised controlled trial is recommended to evaluate the effectiveness and cost-effectiveness of the Community Navigator programme for people with complex anxiety and depression in secondary mental health services.
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Collom JRD, Davidson J, Sweet D, Gillard S, Pinfold V, Henderson C. Development of a peer-led, network mapping intervention to improve the health of individuals with severe mental illnesses: protocol for a pilot study. BMJ Open 2019; 9:e023768. [PMID: 31256018 PMCID: PMC6609054 DOI: 10.1136/bmjopen-2018-023768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Adults with severe mental illness (SMI) have reduced life expectancy and many have comorbid physical health conditions. Primary care providers are experiencing increased demands for care for people with SMI. Barriers to accessing physical healthcare have been identified which negatively affect quality of care. We propose that peer support workers (PSWs) could deliver an intervention to service users to promote their physical health by drawing on existing social support. The aim of this research was to pilot a novel PSW-led intervention, including personal well-being network mapping, to improve access to primary care for physical health needs. METHODS AND ANALYSIS Twenty-four participants will be recruited from community-based mental health teams in two boroughs of London. Each participant will be offered a six-session intervention. Quantitative data will be collected before and after intervention (at 4-month follow-up). Qualitative interviews will be conducted with PSWs after completion of the intervention and with participants at a 4-month follow-up. Some intervention sessions will be observed by a member of the research team. This is a pilot study with a small sample aiming to assess acceptability and feasibility of an intervention. We aim to use the results to refine the existing theory of change and to optimise the intervention and its evaluation in a future randomised controlled trial. This study is strengthened by its potential clinical importance and origin in previous research where service users engaged with well-being network mapping. ETHICS AND DISSEMINATION This study has been approved by the London-Chelsea Regional Ethics Committee (ref: 17/LO/0585). The findings will be disseminated to participants, the National Health Service trusts that we recruited from, primary care mental health leads, commissioners and in peer-reviewed journals and academic conferences.
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Affiliation(s)
| | - Jonathan Davidson
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | | | - Steve Gillard
- Division of Population Health Sciences and Education, St George's University of London, London, UK
| | | | - Claire Henderson
- King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Conceptual framework for social connectedness in mental disorders: Systematic review and narrative synthesis. J Affect Disord 2019; 245:188-199. [PMID: 30396057 DOI: 10.1016/j.jad.2018.10.359] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/05/2018] [Accepted: 10/27/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Adults with mental disorders are at a high risk of loneliness. Loneliness has been implicated in a wide variety of physical and mental health problems. Social connectedness interventions are one means to tackle loneliness but have shown mixed effectiveness. This study aims to: (1) identify existing measures of social connectedness and (2) develop a conceptual framework of social connectedness to inform future measurement and the development of new interventions. METHODS A systematic review of studies from six bibliographic databases was conducted. Studies were included if a quantitative measure of social connectedness was used amongst samples of adults with a mental disorder. Two analyses were conducted: a best evidence synthesis of measurement properties for identified measures and a narrative synthesis of items from these measures. RESULTS Twenty-eight papers were included, employing 21 different measures. Measurement properties were of poor or unknown quality. Data synthesis identified a five-dimension conceptual framework of social connectedness: Closeness, Identity and common bond, Valued relationships, Involvement and Cared for and accepted (giving the acronym CIVIC). LIMITATIONS The majority of studies were conducted in high-income countries. It was not possible to validate the conceptual framework using the identified psychometric data. CONCLUSIONS The new five-dimension framework of social connectedness in mental disorders provides the theoretical foundation for developing new measures and interventions for social connectedness.
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Sheridan A, O'Keeffe D, Coughlan B, Frazer K, Drennan J, Kemple M. Friendship and money: A qualitative study of service users' experiences of participating in a supported socialisation programme. Int J Soc Psychiatry 2018. [PMID: 29536792 DOI: 10.1177/0020764018763692] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Social opportunities can be limited in the lives of people with enduring mental illness (EMI) due to psychiatric stigma, restricted home environments and employment barriers. Supported socialisation programmes have the potential to redress the impact of social isolation. AIM To explore the experiences of service users with EMI taking part in a supported socialisation programme, using written diary entries. METHODS This article reports on the qualitative component of a randomised controlled trial of supported socialisation for people with EMI (published previously in this journal). Trial participation involved (1) being matched with a volunteer partner and engaging in social/leisure activities while receiving a stipend of €20 or (2) receiving this stipend only and engaging in self-driven socialisation. Participants completed written diaries documenting their perspectives on their experiences of supported socialisation. Data were analysed using Thematic Analysis. RESULTS Experiences of participation were characterised by involvement 'normalising' life, fostering a sense of connectedness, improving physical health, and facilitating engagement with culture. Taking part helped participants integrate socialising into their identity, enhanced their perceived capacity to be social, and cemented/expanded social networks. Participants also experienced significant obstacles to socialisation. CONCLUSION Supported socialisation can increase confidence, social competence and self-agency; buffer against psychiatric stigma; build social capital; and afford opportunities to enhance social integration, inclusion and belonging.
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Affiliation(s)
- Ann Sheridan
- 1 UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Donal O'Keeffe
- 2 DETECT Early Intervention Psychosis Services, Cluain Mhuire Community Mental Health Services, Dublin, Ireland
| | - Barbara Coughlan
- 1 UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Kate Frazer
- 1 UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Johnathan Drennan
- 3 School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mary Kemple
- 1 UCD School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Abstract
Purpose Within public services there is a widely recognised role for workers who operate across organisational and professional boundaries. Much of this literature focusses on the organisational implications rather than on how boundary spanners engage with citizens. An increased number of public service roles require boundary spanning to support citizens with cross-cutting issues. The purpose of this paper is to explicate the emotional labour within the interactions that boundary spanners have with citizens, requiring adherence to display rules and building trust. Design/methodology/approach This is a conceptual paper which draws on illustrative examples to draw out the emotional labour within two types of boundary spanning: explicit and emergent. Findings Emotional labour theory offers a way to classify these interactions as requiring high, medium or low degrees of emotional labour. Boundary spanning theory contributes an understanding of how emotional labour is likely to be differently experienced depending on whether the boundary spanning is an explicit part of the job, or an emergent property. Originality/value Drawing on examples from public service work in a range of advanced democracies, the authors make a theoretical argument, suggesting that a more complete view of boundary spanning must account for individual-level affect and demands upon workers. Such a focus captures the "how" of the boundary spanning public encounter, and not just the institutional, political and organisational dimensions examined in most boundary spanning literatures.
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Affiliation(s)
- Catherine Needham
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Sharon Mastracci
- Political Science Department, David Eccles School of Business, University of Utah, Salt Lake City, Utah, USA
| | - Catherine Mangan
- Institute of Local Government Studies, University of Birmingham, Birmingham, UK
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