Staff Training Reduces the Use of Physical Restraint in Mental Health Service, Evidence-based Reflection for China

2018 ◽  
Vol 32 (3) ◽  
pp. 488-494 ◽  
Author(s):  
Junrong Ye ◽  
Aixiang Xiao ◽  
Lin Yu ◽  
Jianxiong Guo ◽  
Huawei Lei ◽  
...  
Author(s):  
Joyce H. L. Lui ◽  
Lauren Brookman-Frazee ◽  
Alejandro L. Vázquez ◽  
Julia R. Cox ◽  
Debbie Innes-Gomberg ◽  
...  

AbstractThe current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.


2003 ◽  
Vol 27 (07) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran

Aims and Method To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis. Results Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001). Clinical Implications Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.


2003 ◽  
Vol 27 (7) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran

Aims and MethodTo compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.ResultsFive-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001).Clinical ImplicationsPrescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.


2015 ◽  
Vol 24 (2) ◽  
pp. 185-189 ◽  
Author(s):  
Frances Dark ◽  
Ellie Newman ◽  
Meredith Harris ◽  
Alice Cairns ◽  
Michael Simpson ◽  
...  

1999 ◽  
Vol 29 (4) ◽  
pp. 761-767 ◽  
Author(s):  
GRAHAM THORNICROFT ◽  
MICHELE TANSELLA

Background. Mental health service research continues to use only outcome measures that are available rather than develop measures that are important. This paper argues that it is necessary to select and then define a set of ethical principles that can be operationalized and validated as outcome measures to provide a wider balance of information for health policy and clinical service decisions.Methods. The method used is to adopt a five stage procedure: (i) to select ethical principles most directly relevant for mental health services and their evaluation at the local level; (ii) to propose definitions of these principles; (iii) to validate these definitions; (iv) to translate the defined principles into operationalized outcome measures; and (v) to use these outcome measures in mental health services research, within the context of evidence-based medicine.Results. We address steps (i) and (ii) of this five-stage procedure. Nine principles are selected and defined: autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, coordination and efficiency. These principles can together be referred to as the three ACEs.Conclusions. Of these nine principles, only two (effectiveness and efficiency) have so far been fully translated into quantitative outcome measures, upon which the evidence-based medicine approach depends. We propose that further concepts also be developed into a more complete multi- dimensional range of fully operationalized outcome measures.


2020 ◽  
Author(s):  
Isabel Zbukvic ◽  
Demee Rheinberger ◽  
Hannah Rosebrock ◽  
Jaclyn Lim ◽  
Lauren McGillivray ◽  
...  

Abstract Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support implementation, sustainment and scale-up of an evidence-based suicide prevention intervention - Collaborative Assessment and Management of Suicidality (CAMS) - in an Australian public mental health service.Methods: This study took place within a larger randomised stepped-wedge design suicide prevention trial. Approximately 150 mental health staff working within a regional and remote community Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework. This was followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology.Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia.Trial registration: This study was conducted as part of the LifeSpan suicide prevention trial. Trial registration for LifeSpan in Australia New Zealand Clinical Trials Register, ID: ACTRN12617000457347. Prospectively registered on 28 March 2017.


2001 ◽  
Vol 52 (2) ◽  
pp. 179-182 ◽  
Author(s):  
Robert E. Drake ◽  
Howard H. Goldman ◽  
H. Stephen Leff ◽  
Anthony F. Lehman ◽  
Lisa Dixon ◽  
...  

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