Modernizing mental health services for older people: a case study

2010 ◽  
Vol 23 (1) ◽  
pp. 10-19 ◽  
Author(s):  
Niall McCrae ◽  
Sube Banerjee
Keyword(s):  
Mental Health ◽  
Older People ◽  
Professional Training ◽  
Quantitative Methods ◽  
Resistance To Change ◽  
Longitudinal Design ◽  
Complex Interventions ◽  
Service Planning ◽  
Service Development

ABSTRACTBackground: This paper describes an evaluation of a redevelopment program in a mental health service for older people, stimulated by U.K. Department of Health policy. IQCOL (Improving Quality of Care for Older People in Lambeth) was a two-year program to modernize and expand an inner-city service, with objectives to improve access, embed new functions, and tune the service towards the needs of the local community. The program evaluation aimed to contribute to knowledge on service planning and methodology for evaluating complex interventions.Methods: The study evaluated the progress and outcomes of this multifaceted program. The realist model of evaluation was followed, with a dual emphasis on utility and generalizability. With an iterative approach, the pragmatic, longitudinal design comprised a combination of qualitative and quantitative methods to explain the process of change and to measure achievement of objectives.Results: A high level of participation in evaluation activities was achieved. The workforce generally responded well to the program. However, progress in one team was hindered by understaffing and resistance to change, emphasizing that while localized provision may be desirable, team viability requires adequate resources and professional support. Improved access was indicated by a 13% increase of referrals. Data suggested earlier referral of dementia cases. Carer support was implemented, but assertive outreach was impeded by professional boundary issues. Ethnicity data showed that the service was responding to demographic trends. Positive views towards the program were associated with team resources and recent professional training.Conclusions: This case study demonstrates how whole system change can be achieved if sufficient attention is given to the needs of staff implementing the program. The evaluation emphasizes the importance of context in producing generalizable evidence on service development, and contributes useful methodological insights.

Case Study of Cluster Analysis in Intercity Passenger Rail Planning and Marketing

2011 ◽  
Author(s):  
Ben Sperry ◽  
Curtis Morgan
Keyword(s):  
Cluster Analysis ◽  
Development Planning ◽  
Lessons Learned ◽  
Service Planning ◽  
Service Development ◽  
Valuable Insight ◽  
Passenger Rail ◽  
Analysis Methodology ◽  
Rail Service

Recent policy and regulatory initiatives have established new momentum for intercity passenger rail among planners, policymakers, and the general public. As a result, there is a great interest in developing new passenger rail lines and expanding existing routes in intercity corridors across the country. Moving forward, there exists a need to understand how current passenger rail services are being utilized, who is riding them, and what changes could be implemented to existing routes to attract ridership — as well as to document lessons learned from existing lines that can aid service development planning for newly proposed routes. In this paper, cluster analysis is applied to passenger survey data obtained in 2007 from riders of three Amtrak routes in the state of Michigan, USA. Cluster analysis is a multivariate data analysis method used extensively in marketing and customer profile research which seeks to identify similarities among potential customers that are not immediately evident using traditional grouping techniques. Data used in the formation of the passenger clusters include traveler alternatives to the passenger rail service and the importance of service attributes, on-board activities, and station amenities. These variables and other data from the passenger survey are then used to characterize the identified clusters in terms of what kinds of passengers are in each cluster and how these passengers benefit from the rail service. The passenger clusters are also analyzed for their potential response to service improvements such as reduced travel time, increased service frequencies, or improved intermodal connections. The findings of this case study can be applied in a number of activities related to intercity passenger rail service planning for existing as well as proposed routes. The findings provide valuable insight into the needs and preferences of current passengers and can be used to formulate strategies for equipment investments or the development of new on-board amenities. From a policy perspective, passengers’ preferences for alternative travel modes in the absence of the rail service reveal how the rail service supports intercity mobility for each of the clusters. Finally, from the cluster profile, potential strategies to attract new riders can be identified. The results show that clustering analysis methodology applied in this case study is a valuable tool for intercity passenger rail planning.

Bridging the ocean: Kiribati Australia alliance in mental health

2017 ◽  
Vol 25 (5) ◽  
pp. 474-477
Author(s):  
Brigid Ryan ◽  
Manrenga Viane ◽  
Fran Timmins ◽  
Alex Smith ◽  
Claire Anstey
Keyword(s):  
Mental Health ◽  
Psychiatric Treatment ◽  
Service Planning ◽  
International Exchange ◽  
Service Development ◽  
Community Based ◽  
Custodial Care ◽  
General Training ◽  
Short Time ◽  
Acute Psychiatric Treatment

Objective: The objective of this study was to demonstrate the benefits of collaboration between Australia and Kiribati, a Pacific island nation, to enhance Kiribati’s mental health system. Method: The collaboration involved a training program for a Kiribati senior mental health leader in Melbourne, Australia, and service planning including prioritisation of key areas for development. Results: As well as receiving general training in community-based mental health, the Kiribati mental health leader gained skills in modification of the inpatient environment, with plans for implementation in Kiribati within the current limited resources. Future planning will focus on shifting from an emphasis on acute psychiatric treatment and custodial care to a recovery-oriented approach. Conclusion: The international exchange was a positive experience for both the Kiribati participants and their Australian colleagues. Knowledge transfer was achieved in a short time, and service development appropriate and realistic for the Kiribati environment was planned.

scholarly journals Developing a theory-informed complex intervention to improve nurse–patient therapeutic engagement employing Experience-based Co-design and the Behaviour Change Wheel: an acute mental health ward case study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e047114
Author(s):  
Sarah McAllister ◽  
Alan Simpson ◽  
Vicki Tsianakas ◽  
Nick Canham ◽  
Vittoria De Meo ◽  
...  
Keyword(s):  
Mental Health ◽  
Behaviour Change ◽  
Design Process ◽  
Complex Interventions ◽  
Intervention Development ◽  
Behaviour Change Techniques ◽  
Service Users ◽  
Therapeutic Engagement ◽  
Behaviour Change Wheel

ObjectivesOur objectives were threefold: (1) describe a collaborative, theoretically driven approach to co-designing complex interventions; (2) demonstrate the implementation of this approach to share learning with others; and (3) develop a toolkit to enhance therapeutic engagement on acute mental health wards.Design and participantsWe describe a theory-driven approach to co-designing an intervention by adapting and integrating Experience-based Co-design (EBCD) with the Behaviour Change Wheel (BCW). Our case study was informed by the results of a systematic integrative review and guided by this integrated approach. We undertook 80 hours of non-participant observations, and semistructured interviews with 14 service users (7 of which were filmed), 2 carers and 12 clinicians from the same acute ward. The facilitated intervention co-design process involved two feedback workshops, one joint co-design workshop and seven small co-design team meetings. Data analysis comprised the identification of touchpoints and use of the BCW and behaviour change technique taxonomy to inform intervention development.SettingThis study was conducted over 12 months at an acute mental health organisation in England.ResultsThe co-designed Let’s Talk toolkit addressed four joint service user/clinician priorities for change: (1) improve communication with withdrawn people; (2) nurses to help service users help themselves; (3) nurses to feel confident when engaging with service users; (4) improving team relations and ward culture. Intervention functions included training, education, enablement, coercion and persuasion; 14 behaviour change techniques supported these functions. We detail how we implemented our integrated co-design-behaviour change approach with service users, carers and clinicians to develop a toolkit to improve nurse–patient therapeutic engagement.ConclusionsOur theory-driven approach enhanced both EBCD and the BCW. It introduces a robust theoretical approach to guide intervention development within the co-design process and sets out how to meaningfully involve service users and other stakeholders when designing and implementing complex interventions.

scholarly journals Implementing a complex psychosocial intervention for unstably housed Veterans: A realist-informed evaluation case study

2021 ◽  
Vol 2 ◽  
pp. 263348952110494
Author(s):  
Vera Yakovchenko ◽  
Megan B. McCullough ◽  
Jeffery L. Smith ◽  
Sonya Gabrielian ◽  
Thomas Byrne ◽  
...  
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Implementation Research ◽  
Psychosocial Intervention ◽  
Complex Interventions ◽  
Peer Pressure ◽  
Relative Advantage ◽  
Treatment Modalities ◽  
Plain Language

Background Only 7% of individuals with co-occurring mental health and substance use disorder (COD) receive services for both conditions. We implemented and evaluated maintaining independence and sobriety through systems integration, outreach and networking-Veteran's edition (MISSION-Vet), an evidence-based manualized psychosocial intervention for Veterans with CODs. This paper identifies the generative mechanisms that explain “how, for whom, and under what conditions” MISSION-Vet adoption, implementation, and fidelity work when applied in a complex adaptive system with facilitation support. Methods Within two VA healthcare systems (Sites A and B), a hybrid III trial tested facilitation to implement MISSION-Vet. We conducted a two-site case study based on 42 semi-structured consolidated framework for implementation research (CFIR) guided interviews with site leadership, implementers (social workers, peer specialists), and team members (facilitators, site leads). Interviews were coded and CFIR constructs used to generate “Context  +  Mechanism  =  Outcome” configurations to understand the conditions of MISSION-Vet adoption, implementation, and fidelity. Results Site A was low, and Site B was high in adoption, implementation, and fidelity. Adoption hesitancy/eagerness (outcome) resulted from the interaction of “external policy” (context) dampening/encouraging a “tension for change” (mechanism). Implementation intensity (outcome) was based on how “peer pressure” or practice culture (context) activated staff “self-efficacy” (mechanism) to engage with MISSION-Vet and appraise its “relative advantage” over current practices (mechanism). Fidelity relied on how “staffing structure and availability” (context) activated/muted “facilitation” (mechanism) to result in strategy and intervention adaptation (outcome). Conclusions We delineated how specific contexts activated certain mechanisms to drive the different stages of implementation of a multi-faceted COD treatment intervention. Trial registration ClinicalTrials.gov, NCT02942979. Plain language abstract Implementation is inherently dynamic and influenced by interdependent factors operating at the individual, organizational, and system levels. This is especially true for complex interventions addressing co-occurring mental health and substance use disorders because such interventions involve multiple treatment modalities delivered simultaneously, in busy practice settings, with challenging populations. This paper pairs consolidated framework for implementation research (CFIR) constructs with a realist evaluation approached to generate configurations important to the adoption, implementation, and adaptation stages of a highly complex intervention addressing the behavioural health and housing needs of a vulnerable population. Each configuration describes how contextual factors trigger mechanisms to generate implementation outcomes and answers “what works for whom, in what circumstances and in what respects, and how?” These findings further our understanding of possible mechanisms of change and push us to be more precise about identifying causal relationships among constructs that contribute to the success of implementing complex interventions. This work also moves us to think theoretically and methodologically in a more dynamic fashion, thereby leading to more responsive implementation practice.

scholarly journals Supported Independent Accommodation for Older New Zealanders: a Review of Current Policy and Innovative Practice

2021 ◽  
Author(s):  
◽  
Maxwell F Reid
Keyword(s):  
New Zealand ◽  
Older People ◽  
Models Of Care ◽  
Policy Implications ◽  
Service Development ◽  
Intersectoral Collaboration ◽  
Study Approach ◽  
The Cost ◽  
Care For Older People

<p>Existing research establishes a clear link between poor housing and poor health. There is also growing evidence that the physical, mental and social wellbeing of individuals and households can be improved by ensuring their access to suitable accommodation. Despite the growing body of research documenting the benefits of supported independent accommodation (SIA) as a means of maintaining the independence and wellbeing particularly of older people, there is little research evaluating the place of such accommodation within the New Zealand context. This thesis aims to address that gap. It reviews the existing body of literature surrounding this topic - exploring population and accommodation demographics, and analysing government policy in relation to both housing and health. It considers six New Zealand examples of SIA - each selected on the basis of their distinctiveness and innovation - documents these, and compares them using a case study approach. Adopting a general inductive methodology, each case study is then analysed against themes identified in the literature review, identifying any further trends, and the implications of these for ongoing policy and service development. Intersectoral collaboration is identified as having had particular bearing upon the development of SIA within the New Zealand context. This thesis concludes that SIA will play an increasingly important role in the continuum of accommodation and care for older people. It offers an alternative to more institutionalised models of care for older people, maintaining their independence and social integration within their own community. As demographic and economic factors drive up the cost of more traditional models of residential care, SIA offers government an equally important alternative. However, ongoing development in this area is not without it challenges. To this end, a number of policy implications are also identified and discussed.</p>

scholarly journals Supported Independent Accommodation for Older New Zealanders: a Review of Current Policy and Innovative Practice

2021 ◽  
Author(s):  
◽  
Maxwell F Reid
Keyword(s):  
New Zealand ◽  
Older People ◽  
Models Of Care ◽  
Policy Implications ◽  
Service Development ◽  
Intersectoral Collaboration ◽  
Study Approach ◽  
The Cost ◽  
Care For Older People

<p>Existing research establishes a clear link between poor housing and poor health. There is also growing evidence that the physical, mental and social wellbeing of individuals and households can be improved by ensuring their access to suitable accommodation. Despite the growing body of research documenting the benefits of supported independent accommodation (SIA) as a means of maintaining the independence and wellbeing particularly of older people, there is little research evaluating the place of such accommodation within the New Zealand context. This thesis aims to address that gap. It reviews the existing body of literature surrounding this topic - exploring population and accommodation demographics, and analysing government policy in relation to both housing and health. It considers six New Zealand examples of SIA - each selected on the basis of their distinctiveness and innovation - documents these, and compares them using a case study approach. Adopting a general inductive methodology, each case study is then analysed against themes identified in the literature review, identifying any further trends, and the implications of these for ongoing policy and service development. Intersectoral collaboration is identified as having had particular bearing upon the development of SIA within the New Zealand context. This thesis concludes that SIA will play an increasingly important role in the continuum of accommodation and care for older people. It offers an alternative to more institutionalised models of care for older people, maintaining their independence and social integration within their own community. As demographic and economic factors drive up the cost of more traditional models of residential care, SIA offers government an equally important alternative. However, ongoing development in this area is not without it challenges. To this end, a number of policy implications are also identified and discussed.</p>

Development of an operational manual for a consultation–liaison psychiatry service

2018 ◽  
Vol 26 (5) ◽  
pp. 503-507 ◽  
Author(s):  
Anne PF Wand ◽  
Swapnil Sharma ◽  
Lindsay J Carpenter ◽  
Mike Gatsi
Keyword(s):  
Mental Health ◽  
General Hospital ◽  
Service Planning ◽  
Service Development ◽  
Mental Health Systems ◽  
Liaison Psychiatry ◽  
Procedural Information ◽  
Hospital Executives ◽  
Consultation Liaison Psychiatry

Objectives: Consultation–liaison psychiatry (CLP) services sit between mental health and the general hospital, and risk being poorly understood by both systems. The aim of this study was to develop an operational manual for a CLP service, which defined functions and governance. Methods: The CLP literature was reviewed with a focus on descriptions of CLP roles, organisational processes, quality measures and service development. The CLP team held service planning meetings and met with members of the mental health and hospital executives. Site visits and collaboration with other CLP services occurred in defining the roles of the CLP service and organisational governance. Results: A CLP operational document was developed, including a description of the service, its functions, staff roles and governance. Procedural information such as the CLP timetable, referral process, triage and assessment, documentation, activity recording, quality assurance and relevant policies were outlined. Conclusions: The development of a dedicated operational manual for CLP clarified the roles, functions and governance of CLP within the general hospital and mental health systems. The development process facilitated the engagement of key clinicians and administrators of these systems, the determination of quality improvement targets and greater transparency and accountability.

scholarly journals Carers as partners in mental health services for older people

2005 ◽  
Vol 11 (4) ◽  
pp. 297-304 ◽  
Author(s):  
Jan R. Oyebode
Keyword(s):  
Mental Health ◽  
Older People ◽  
Psychosocial Interventions ◽  
Research Literature ◽  
Health Needs ◽  
Service Development ◽  
Continuing Care ◽  
Mental Health Needs ◽  
Potential Benefits ◽  
Further Development

The role that carers play in supporting older people with mental health needs in the community is well recognised by professionals and in current government policy. This article promotes the view that a systematic planned approach that engages the carer as an integral part of the system of care has potential benefits for patients, carers and services. Ways of working in partnership are outlined and evidence that psychosocial interventions with carers are effective is briefly reviewed. Examples of individual and group interventions for dementia carers are given, drawing on clinical experience and research literature. Areas for further development are highlighted, including greater partnerships with carers in primary and continuing care, as well as at the level of planning and service development.

Developing mental health interventions

2015 ◽  
Author(s):  
Abhijit Nadkarni ◽  
Mary J. De Silva ◽  
Vikram Patel
Keyword(s):  
Mental Health ◽  
Complex Interventions ◽  
Intervention Development ◽  
Health Interventions ◽  
Theory Of Change ◽  
Complex Process ◽  
Mrc Framework ◽  
Mental Health Interventions ◽  
Structured Approach

Most mental health interventions are complex as they are made up of a number of interconnected components, acting both independently and interdependently. This inherent complexity makes the development and evaluation of such interventions a complex process. Following a structured approach to the development and evaluation of complex interventions helps ensure that the process is systematic, rigorous, and replicable. In this chapter we demonstrate how systematically conducted formative research, consistent with the MRC framework, will ensure that due consideration is given to the sociocultural and health systems context. We use the case study of an ongoing complex intervention development and evaluation program in India (PREMIUM) to illustrate the application of the development and feasibility/piloting phases of the MRC framework. We describe two complementary frameworks, the Normalization Process Theory and the Theory of Change that can be used to strengthen the MRC framework for the development of mental health interventions.

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