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Luehring MC, Romani PW, Ariefdjohan M. Preliminary evaluation of behavior technician burnout when working with boarded and traditional psychiatric inpatients diagnosed with developmental disabilities. J Child Adolesc Psychiatr Nurs 2024; 37:e12461. [PMID: 38564318 DOI: 10.1111/jcap.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/22/2024] [Accepted: 03/23/2024] [Indexed: 04/04/2024]
Abstract
PROBLEM The COVID-19 pandemic has led to a youth mental health crisis, with research demonstrating an increased prevalence of depression, anxiety, and disruptive behavior in youth compared to pre-pandemic years. Consequently, the insurgence of emergency psychiatric evaluations has increased the demands for extended inpatient stay (or patient boarding) at various licensed treatment facilities. Questions remain about the extent of burnout being experienced by behavior technicians who are caring for these patients. METHODS The Shirom-Melamed Burnout Measure was used to evaluate symptoms of burnout of behavior technicians practicing at a specialized psychiatric inpatient unit. Comparisons were made for instances of caring for boarded (meeting criteria for discharge but unable to be discharged due to disposition) and traditional patients (short-term treatment). FINDINGS Behavior technicians caring for boarded patients reported significantly higher scores in overall stress, physical exhaustion, cognitive fatigue, and emotional exhaustion than those managing patients getting traditional care. CONCLUSIONS Extensive burnout can have adverse impacts at both the personal level (staff well-being, individual staff-patient interactions) and clinic level (daily operations and service, general quality of care). Efforts need to be made to address this issue to prevent staff turnover.
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Affiliation(s)
- Mathew C Luehring
- Department of Psychiatry, Child and Adolescent Mental Health Division, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Patrick W Romani
- Department of Psychiatry, Child and Adolescent Mental Health Division, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Pediatric Mental Health Institute, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Merlin Ariefdjohan
- Department of Psychiatry, Child and Adolescent Mental Health Division, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Bilder DA, Mthembu M, Worsham W, Aguayo P, Knight JR, Deng SW, Singh TP, Davis J. Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity. JMIR Ment Health 2024; 11:e50907. [PMID: 38551644 PMCID: PMC11015367 DOI: 10.2196/50907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. OBJECTIVE This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey's clinical implementation and evaluation of validity. METHODS Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers' psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. RESULTS Focus group members (n=17) expressed positive feedback overall about the survey's content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. CONCLUSIONS Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey's impact on the psychiatric and medical management of distress in individuals with DD.
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Affiliation(s)
- Deborah A Bilder
- University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Mariah Mthembu
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Whitney Worsham
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Patricia Aguayo
- University of Utah Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Jacob R Knight
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Steven W Deng
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Tejinder P Singh
- University of Utah School of Medicine, Salt Lake City, UT, United States
| | - John Davis
- University of Utah, Salt Lake City, UT, United States
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Cassivi C, Sergerie-Richard S, Saint-Pierre B, Goulet MH. Crisis plans in mental health: A scoping review. Int J Ment Health Nurs 2023; 32:1259-1273. [PMID: 37098744 DOI: 10.1111/inm.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023]
Abstract
Crisis situations are frequent among people with mental health disorders. Several interventions have been developed to act in prevention, including crisis plans recognized as particularly effective in reducing coercive measures. In the literature, several models of crisis plans are proposed with similar aims and contents. Based on the methodology proposed by the Joanna Briggs Institute, a scoping review was conducted to map the state of knowledge on crisis plans in adult mental health settings. The literature search conducted on six databases (CINAHL, PubMed, Medline, EMBASE, PsychINFO and Cochrane) yielded 2435 articles. Of these, 122 full-text articles were assessed for eligibility, and 78 met the inclusion criteria. Studies were critically appraised using the Joanna Briggs Institute appraisal tools, and data were extracted by two independent reviewers. Content analysis identified a typology of crisis plans: (1) the legal crisis plan and (2) the formal crisis plan. Five modalities were identified for its completion: the sections, the moment, the completion steps, the people involved and the training of key actors. Most identified outcomes are consistent with the main purpose of the intervention, which is crisis prevention. However, the most identified outcomes focused on the service user's recovery and indicated that crisis plans could provide an opportunity to operationalize recovery in mental healthcare, thus suggesting an evolution in the aim of the intervention. Future research should further focus on the modalities of crisis plans to guide the implementation in clinical practice.
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Affiliation(s)
- Christine Cassivi
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
| | - Sophie Sergerie-Richard
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Institut universitaire en santé mentale de Montréal (IUSMM), Québec, Montréal, Canada
| | - Benoît Saint-Pierre
- Centre intégré universitaire de Santé et Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Québec, Montréal, Canada
| | - Marie-Hélène Goulet
- Faculty of Nursing, University of Montréal, Québec, Montréal, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CRIUSMM), Québec, Montréal, Canada
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Tavares S, Ribeiro J, Graça S, Araújo B, Puchivailo M, Pereira JG. The first Portuguese Open Dialogue pilot project intervention. Front Psychol 2023; 14:1175700. [PMID: 37767212 PMCID: PMC10520700 DOI: 10.3389/fpsyg.2023.1175700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/24/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction In 2020, the Directorate General of Health (DGS), a central service of the Ministry of Health in Portugal, approved and co-financed the first Open Dialogue program in the country. The present report aims to demonstrate the preliminary results of the first year of the project, implemented in the northern interior region of Alentejo. Methods Seven people at the Center of Concern (PCC) and 21 family members/social networks received care through Open Dialogue; four external social workers and psychologists were also involved in the project as members of the support network. A total of 160 network meetings were undertaken, reaching as many as 27 per month in the busiest periods. Based on a previous Italian Research Protocol, developed by Pocobello et al. (non-published manuscript), quantitative and qualitative data were collected in and after the clinical meetings involving PCC and their family/social network, through a multi-method approach: clinical history interview (e.g., generic research on sociodemographic data, duration of untreated symptoms, reasons for requesting help, possible hospitalizations, and/or treatments/therapies) and the following scales applied every five sessions (e.g., CORE-OM, BSI, GAF, and LSNS-6). Results The preliminary results indicate an improvement in global functioning and the enlargement of social network size/support, a decrease in symptoms, and a negative correlation between the number of sessions and the LSNS6. Medication use remained largely unchanged at the end of the project. Discussion In general, even with a small sample, the results are considered satisfactory and seem to be aligned with the vast majority of Open Dialogue studies, which for several decades have consistently pointed toward better recovery rates than treatment as usual as well as increased client satisfaction. We expect that the results presented can boost further research and help strengthen the OD approach.
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Affiliation(s)
- Sofia Tavares
- Department of Psychology, Évora University, Évora, Portugal
- Department of Psychology, CIEP, University of Évora, Évora, Portugal
| | - Joana Ribeiro
- Instituto Universitário de Ciências Psicológicas, Sociais e da Vida (ISPA)—Instituto Universitário, Lisbon, Portugal
| | - Sofia Graça
- Romão de Sousa Foundation, Estremoz, Portugal
| | | | - Mariana Puchivailo
- Department of Psychology, FAE University Center, Curitiba, Paraná, Brazil
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Abstract
In the debate on coercion in psychiatry, care and control are often juxtaposed. In this article we argue that this dichotomy is not useful to describe the more complex ways service users, care professionals and the specific care setting interrelate in a community mental health team (CMHT). Using the ethnographic approach of empirical ethics, we contrast the ways in which control and care go together in situations of a psychiatric crisis in two CMHT's: one in Trieste (Italy) and one in Utrecht (the Netherlands). The Dutch and Italian CMHT's are interesting to compare, because they differ with regard to the way community care is organized, the amount of coercive measures, the number of psychiatric beds, and the fact that Trieste applies an open door policy in all care settings. Contrasting the two teams can teach us how in situations of psychiatric crisis control and care interrelate in different choreographies. We use the term choreography as a metaphor to encapsulate the idea of a crisis situation as a set of coordinated actions from different actors in time and space. This provides two choreographies of handling a crisis in different ways. We argue that applying a strict boundary between care and control hinders the use of the relationship between caregiver and patient in care.
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Affiliation(s)
- Christien Muusse
- Trimbos Institute, Utrecht, Netherlands.,Department Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands
| | - Hans Kroon
- Trimbos Institute, Utrecht, Netherlands.,Department of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands
| | - Cornelis Lambert Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, Netherlands.,Antes, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Jeannette Pols
- Department Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands.,Department of Anthropology, University of Amsterdam, Amsterdam, Netherlands
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Abstract
The boarding of children and adolescents with identified psychiatric conditions at medical facilities has numerous negative effects on the patients and the systems that treat them. Efforts to minimize boarding times serves to increase patients' access to appropriate levels of care, redirect medical resources to patients who need them most, and reduce safety risks to people and property. This study explores the role Clinical Social Workers can play in facilitation of care and highlights the advantages of a coordinated data collection process facilitated by the effective use of the Electronic Medical Record. A retrospective chart analysis of 100 patients admitted to the Emergency department at a pediatric hospital in Central Florida was conducted for patients seen between 1 January 2015 and 30 June 2016. The data suggest key correlates that may impact the boarding times of pediatric patients presenting in a psychiatric crisis and the average duration of boarding time in hours (M = 5.11, SD = 2.07) was found to be significantly lower than prior published studies in the adult and pediatric literature. Discussion of these data implications on behavioral health practice is discussed.
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Affiliation(s)
- Michael Campbell
- a Graduate Social Work Program, Saint Leo University , Saint Leo , USA
| | - Jessica Pierce
- b Behavioral Health Division, Nemours Children's Health System , Clinical Psychologist , Orlando , USA
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Tint A, Lunsky Y. Individual, social and contextual factors associated with psychiatric care outcomes among patients with intellectual disabilities in the emergency department. J Intellect Disabil Res 2015; 59:999-1009. [PMID: 26041621 DOI: 10.1111/jir.12201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 02/25/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Individuals with intellectual disabilities (ID) are disproportionately high users of psychiatric emergency services. Despite the demand for psychiatric assessments in the emergency department (ED), no clear guidelines have been established as to what factors should guide clinical decision-making processes. The current study aimed to explore individual, social and contextual factors related to psychiatric care outcomes among patients with ID in the emergency department. METHOD Emergency department charts were reviewed for 66 individuals with ID who visited the emergency department during a psychiatric crisis. RESULTS Standardised crisis severity scores were significantly higher in patients seen by psychiatrists as compared with patients who did not receive psychiatric consultations in the emergency department. A significantly greater proportion of patients with moderate or severe levels of ID (vs. borderline/mild) received psychiatric consultations. Emergency department visits resulting in inpatient hospital admission did not differ from those that did not, with the exception of the level of ID: patients admitted to psychiatric inpatient care were more likely to have moderate or severe levels of ID. CONCLUSIONS The psychiatric care experiences of patients with ID in the emergency department appear highly variable. Further research focused on emergency department clinical decision-making practices concerning this population is warranted.
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Affiliation(s)
- A Tint
- Department of Psychology, York University, Toronto, ON, Canada
| | - Y Lunsky
- Underserved Populations Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
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