Therapy discontinuation in a primary care psychological service: why patients drop out

2020 ◽  
Vol 13 ◽  
Author(s):  
Aisan Ghaemian ◽  
Mahdi Ghomi ◽  
Miles Wrightman ◽  
Colm Ellis-Nee
Keyword(s):  
Drop Out ◽  
Treatment Withdrawal ◽  
List Type ◽  
Structured Interviews ◽  
Group Settings ◽  
Psychological Therapies ◽  
Psychological Service ◽  
Wide Range ◽  
Key Factor ◽  
Therapy Services

Abstract The present study aimed to explore patients’ experience with an Improving Access to Psychological Therapies (IAPT) service, and to investigate the reasons for discontinuing their treatment. A qualitative approach was adopted using thematic analysis of semi-structured interviews carried out with 818 patients attending for treatment in Talking Change from November 2015 to January 2019, retrospectively. The five main themes that emerged from the study were: ‘Felt better’, ‘Issues with group settings’, ‘Therapeutic alliance breakdown’, ‘Miscommunication’ and ‘Impracticalities’. The qualitative study uncovered a wide range of reasons for people who had dropped out from their treatment. The findings mainly emphasised general dissatisfaction and inconvenient appointments. However, improvement in symptoms of depression and anxiety was also identified as a key factor among patients who discontinued their treatment. This recovery is known as ‘progress withdrawal’ in which patients withdraw from treatment early due to good therapeutic progress. We present clinical and procedural implications arising from these themes. Key learning aims (1) To explore what can cause discontinuation of therapy. (2) To obtain the experience of people who have received treatment and dropped out from Talking Change Psychological Therapy services. (3) To explore whether people recovered as part of the treatment withdrawal and what may have helped towards that recovery.

scholarly journals Culture and therapist self-disclosure

2019 ◽  
Vol 12 ◽  
Author(s):  
Peter Phiri ◽  
Shanaya Rathod ◽  
Mary Gobbi ◽  
Hannah Carr ◽  
David Kingdon
Keyword(s):  
Drop Out ◽  
List Type ◽  
Behaviour Therapy ◽  
Data Set ◽  
Self Disclosure ◽  
Psychological Therapies ◽  
Cognitive Behaviour ◽  
Lay Members ◽  
Poor Outcomes ◽  
The Impact

AbstractCognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist’s reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists’ cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training.Key learning aims(1)To develop a dialogue and practice with confidence when addressing issues of self-disclosure with diverse populations.(2)To appreciate the impact therapist self-disclosure has in early stages of engagement, in particular when working with patients from BME communities.(3)To understand the impact and role of self-disclosure as initiated by patients.(4)To increase therapist awareness on cultural differences in self-disclosure and develop ways to address this in therapy.(5)To challenge therapists to adapt psychological therapies to diverse cultures and be cognisant that ‘one size does not fit all’.

scholarly journals Patient experiences of the pandemic; exploring the effect of COVID-19 on patients detained under the Mental Health Act

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S299-S300
Author(s):  
Emily Watson ◽  
Samuel Rowles
Keyword(s):  
Mental Health ◽  
Free Time ◽  
List Type ◽  
Service Users ◽  
Structured Interviews ◽  
Team Members ◽  
Delivery Of Care ◽  
Mental Health Act ◽  
Group Settings ◽  
Huge Impact

AimsThe current pandemic and the restrictions on liberty that it has necessitated has had a huge impact on society as a whole. We were interested to learn how the constraints of sequential lockdowns and social distancing measures had affected inpatients in a mental health setting, many of whom were already contending with significant restrictions on their freedom.MethodWe conducted structured interviews with 24 service users across the Low Secure and Locked Rehabilitation Division at St Andrews Healthcare Northampton. We interviewed male and female inpatients with diverse diagnoses including emotionally unstable personality disorder, anorexia nervosa, schizophrenia and offending behaviours. All participants were detained under the Mental Health Act throughout the pandemic. Service users were asked the following questions: How has the pandemic affected your mood?How has it affected your relationship with your family?How has it affected your treatment?How has the pandemic affected your leave?How has it affected how you use your free time?Are there any other ways the pandemic has affected you?We performed thematic analysis to identify ways the pandemic has affected service users.ResultFour major themes were identified: 1)Mental healthParticipants reported a decline in mood.2)Changing relationshipsService users reported that relationships with loved ones in the community had suffered from lack of contact and missing significant life events, however several participants felt that their relationships with peers had strengthened.3) Delivery of careResponses were split on the increased reliance on technology to replace face-to-face interaction between patients and team members, with some respondents reporting this as 'less intimidating', while others found this ‘isolating’. Respondents reported reduced contact with MDT members and delays to recovery and step-down placements due to decreased leave.4) RoutineRespondents reported an increase in free time throughout the pandemic. Some used this to develop hobbies whereas others reported becoming ‘lazy’ and expressed disappointment with the lack of exercise provision.ConclusionThe pandemic has had significant emotional and psychological effects on society as a whole, but perhaps no group has been more affected than detained patients who have had their lives restricted to a massive degree. This group has been largely marginalised by government guidelines which often fail to consider individuals living in large group settings. By learning from the experiences of these service users we can adapt our practices to alleviate these issues in any future lockdowns and ensure our practices are the least restrictive possible.

Comparison of Deterministic and Linear Cosine Spatial Filtering of Transmission Electron Micrographs

1972 ◽  
Vol 30 ◽  
pp. 596-597
Author(s):  
David A. Ansley
Keyword(s):  
Spherical Aberration ◽  
Focal Length ◽  
Chromatic Aberration ◽  
Spatial Filter ◽  
Operating Conditions ◽  
Objective Lens ◽  
List Type ◽  
Spatial Filters ◽  
Transmission Electron ◽  
Wide Range

The coherence of the electron flux of a transmission electron microscope (TEM) limits the direct application of deconvolution techniques which have been used successfully on unmanned spacecraft programs. The theory assumes noncoherent illumination. Deconvolution of a TEM micrograph will, therefore, in general produce spurious detail rather than improved resolution.A primary goal of our research is to study the performance of several types of linear spatial filters as a function of specimen contrast, phase, and coherence. We have, therefore, developed a one-dimensional analysis and plotting program to simulate a wide 'range of operating conditions of the TEM, including adjustment of the:(1) Specimen amplitude, phase, and separation(2) Illumination wavelength, half-angle, and tilt(3) Objective lens focal length and aperture width(4) Spherical aberration, defocus, and chromatic aberration focus shift(5) Detector gamma, additive, and multiplicative noise constants(6) Type of spatial filter: linear cosine, linear sine, or deterministic

Triply-periodic nanostructures in surfactant, block copolymer, and biomembrane systems, and simulation of TEMs

1993 ◽  
Vol 51 ◽  
pp. 884-885
Author(s):  
David M. Anderson ◽  
Tomas Landh
Keyword(s):  
Liquid Crystalline ◽  
Diblock Copolymers ◽  
Cubic Phase ◽  
List Type ◽  
Interpenetrating Networks ◽  
Triply Periodic ◽  
Wide Range ◽  
Bicontinuous Cubic ◽  
Phase Liquid ◽  
Dividing Surface

First discovered in surfactant-water liquid crystalline systems, so-called ‘bicontinuous cubic phases’ have the property that hydropnilic and lipophilic microdomains form interpenetrating networks conforming to cubic lattices on the scale of nanometers. Later these same structures were found in star diblock copolymers, where the simultaneous continuity of elastomeric and glassy domains gives rise to unique physical properties. Today it is well-established that the symmetry and topology of such a morphology are accurately described by one of several triply-periodic minimal surfaces, and that the interface between hydrophilic and hydrophobic, or immiscible polymer, domains is described by a triply-periodic surface of constant, nonzero mean curvature. One example of such a dividing surface is shown in figure 5.The study of these structures has become of increasing importance in the past five years for two reasons:1)Bicontinuous cubic phase liquid crystals are now being polymerized to create microporous materials with monodispersed pores and readily functionalizable porewalls; figure 3 shows a TEM from a polymerized surfactant / methylmethacrylate / water cubic phase; and2)Compelling evidence has been found that these same morphologies describe biomembrane systems in a wide range of cells.

Model Pembinaan Remaja Putus Sekolah Terlantar di Provinsi Lampung (Studi Pada Uptd Pelayanan Sosial Bina Remaja (PSBR) Raden Intan Lampung

2020 ◽  
Vol 2 (2) ◽  
pp. 231-241
Author(s):  
Maulita Daniar Anom ◽  
◽  
Novita Tresiana ◽  
Intan Fitri Meutia ◽  
◽  
...  
Keyword(s):  
Youth Development ◽  
Formal Education ◽  
Social Protection ◽  
Development Program ◽  
Rehabilitation Program ◽  
Drop Out ◽  
Structured Interviews ◽  
Youth Development Program ◽  
Coaching Activities ◽  
Out Of School

Education is a mandatory thing that must be obtained for every child. However, not all children are able to get education due to several factors, one of which is the economic condition of the family which causes them to drop out of school. Guidance for neglected drop-out teenagers is an action that is taken to overcome one of the social problems, which is neglected teenagers who have dropped out of school with the purpose of directing their personality, abilities and skills through non-formal education. This research was conducted at UPTD PSBR Raden Intan Lampung. The purpose of this research is to describe and analyze how the models and coaching programs are carried out to overcome neglected dropout teenagers.The method used in this research is descriptive with a qualitative approach with the use of data collection techniques, such as: structured interviews, documentation and observation. The data analysis technique used in this study was data reduction, data presentation and drawing conclusions, and for data validity techniques are the extension of observations and triangulation. Based on the research results, it shows that the model that is used as a reference in the implementation of coaching activities for neglected dropouts teenagers is the Youth Development Program (YDP) Model which has 3 approaches, that are: Institutional Based, Family Based and Community. The conclusion of this research is based on the analysis, namely the Youth Development Program (YDP) Model which is the reference applied through 4 programs by the UPTD PSBR Raden Intan Lampung, that are Social Rehabilitation Program, Social Security Program, Social Empowerment Program and the last Social Protection Program with the hope that this effort can solve the problem of neglected dropouts teenagers, especially in Lampung Province.

scholarly journals 332 The diagnostic role of shunt series radiographs (SSR) in children presenting to the children’s emergency department (CED) with suspected ventriculoperitoneal (VP) shunt failure

2020 ◽  
Vol 37 (12) ◽  
pp. 852.3-853
Author(s):  
Angharad Griffiths ◽  
Ikechukwu Okafor ◽  
Thomas Beattie
Keyword(s):  
Clinical Outcome ◽  
Sensitivity And Specificity ◽  
Clinical Information ◽  
Flow Diagram ◽  
List Type ◽  
Shunt Failure ◽  
Vp Shunt ◽  
Wide Range ◽  
Diagnostic Role

Aims/Objectives/BackgroundVP shunts are used to drain CSF from the cranial vault because of a wide range of pathologies and, like any piece of hardware, can fail. Traditionally investigations include SSR and CT. This project examines the role of SSR in evaluating children with suspected VP shunt failure.Primary outcome: Sensitivity and specificity of SSR in children presenting to the CED with concern for shunt failure.Methods/DesignConducted in a single centre, tertiary CED of the national Irish Neurosurgical(NS) referral centre (ED attendance:>50,000 patients/year). 100 sequential SSR requested by the CED were reviewed. Clinical information was extracted from electronic requests. Shunt failure was defined by the need for NS intervention(Revision).Abstract 332 Figure 1Abstract 332 Figure 2Results/ConclusionsSensitivity and specificity is presented in figure 1 (two by two table).100 radiographs performed in 84 children.22% shunts revised (see flow diagram).7 SSR’s were abnormal.85% (n=6) shunts revised. [5 following abnormal CT].Of the normal SSR’s; 16 had abnormal CT and revised.85/100 received CT.64 of 85 CT’s (75%) were normal.□6 of the 64 had focal shunt concern.SSR’s shouldn’t be used in isolation. NPV&PPV, Sensitivity&Specificity is low.SSR’s are beneficial where there’s concern over focal shunt problems (injury/pain/swelling) or following abnormal CT.VP shunt failure is not well investigated with SSR alone.SSR’s could be omitted where there is no focal shunt concern/after normal CT (without impacting clinical outcome) reducing radiation exposure and reduce impact on CED’s.59 SSR’s could have been avoided without adverse clinical outcome.

scholarly journals Using Satellite Data for CBRN (Chemical, Biological, Radiological, and Nuclear) Threat Detection, Monitoring, and Modelling

2021 ◽  
Author(s):  
Gary Sutlieff ◽  
Lucy Berthoud ◽  
Mark Stinchcombe
Keyword(s):  
Satellite Data ◽  
Meteorological Data ◽  
Atmospheric Composition ◽  
Chemical Detection ◽  
List Type ◽  
Data Types ◽  
Wide Range ◽  
Future Technologies ◽  
The Impact ◽  
Near Future

Abstract CBRN (Chemical, Biological, Radiological, and Nuclear) threats are becoming more prevalent, as more entities gain access to modern weapons and industrial technologies and chemicals. This has produced a need for improvements to modelling, detection, and monitoring of these events. While there are currently no dedicated satellites for CBRN purposes, there are a wide range of possibilities for satellite data to contribute to this field, from atmospheric composition and chemical detection to cloud cover, land mapping, and surface property measurements. This study looks at currently available satellite data, including meteorological data such as wind and cloud profiles, surface properties like temperature and humidity, chemical detection, and sounding. Results of this survey revealed several gaps in the available data, particularly concerning biological and radiological detection. The results also suggest that publicly available satellite data largely does not meet the requirements of spatial resolution, coverage, and latency that CBRN detection requires, outside of providing terrain use and building height data for constructing models. Lastly, the study evaluates upcoming instruments, platforms, and satellite technologies to gauge the impact these developments will have in the near future. Improvements in spatial and temporal resolution as well as latency are already becoming possible, and new instruments will fill in the gaps in detection by imaging a wider range of chemicals and other agents and by collecting new data types. This study shows that with developments coming within the next decade, satellites should begin to provide valuable augmentations to CBRN event detection and monitoring. Article Highlights There is a wide range of existing satellite data in fields that are of interest to CBRN detection and monitoring. The data is mostly of insufficient quality (resolution or latency) for the demanding requirements of CBRN modelling for incident control. Future technologies and platforms will improve resolution and latency, making satellite data more viable in the CBRN management field

scholarly journals Stress and burnout in Improving Access to Psychological Therapies (IAPT) trainees: a systematic review

2021 ◽  
Vol 14 ◽  
Author(s):  
Joel Owen ◽  
Louise Crouch-Read ◽  
Matthew Smith ◽  
Paul Fisher
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Future Research ◽  
List Type ◽  
Dual Roles ◽  
Eligibility Criteria ◽  
Psychological Therapies ◽  
Current State

Abstract For more than a decade, Improving Access to Psychological Therapies (IAPT) has been training a new workforce of psychological therapists. Despite evidence of stress and burnout both in trainee mental health professionals, and qualified IAPT clinicians, little is known about these topics in IAPT trainees. Consequently, this systematic review sought to establish the current state of the literature regarding stress and burnout in IAPT trainees. Electronic databases were searched to identify all published and available unpublished work relating to the topic. On the basis of pre-established eligibility criteria, eight studies (including six unpublished doctoral theses) were identified and assessed for quality. This review identifies that research into the experience of IAPT trainees is under-developed. Existing evidence tentatively suggests that IAPT trainees may experience levels of stress and burnout that are higher than their qualified peers and among the higher end of healthcare professionals more generally. The experience of fulfilling dual roles as mental health professionals and university students concurrently appears to be a significant source of stress for IAPT trainees. More research regarding the levels and sources of stress and burnout in IAPT trainees is urgently needed to confirm and extend these findings. Recommendations for future research in the area are given. Key learning aims (1) To establish the current state of the literature regarding stress and burnout in IAPT trainees. (2) To raise practitioner, service and education-provider awareness regarding the levels and perceived sources of stress and burnout in IAPT trainees. (3) To make recommendations regarding future research on the topic.

scholarly journals DFT calculation and assignment of vibrational spectra of aryl and alkyl chlorophosphates

2014 ◽  
Vol 12 (2) ◽  
pp. 153-163
Author(s):  
Viktor Anishchenko ◽  
Vladimir Rybachenko ◽  
Konstantin Chotiy ◽  
Andrey Redko
Keyword(s):  
Vibrational Spectra ◽  
Basis Sets ◽  
Heavy Atoms ◽  
Wide Range ◽  
Complete Assignment ◽  
Key Factor ◽  
Polarization Functions ◽  
Experimental Values ◽  
Semi Empirical ◽  
Good Agreement

AbstractDFT calculations of vibrational spectra of chlorophosphates using wide range of basis sets and hybrid functionals were performed. Good agreement between calculated and experimental vibrational spectra was reached by the combination of non-empirical functional PBE0 with both middle and large basis sets. The frequencies of the stretching vibrations of the phosphate group calculated using semi-empirical functional B3LYP for all basis sets deviate significantly from the experimental values. The number of polarization functions on heavy atoms was shown to be a key factor for the calculation of vibrational frequencies of organophosphates. The importance of consideration of all the stable rotamers for a complete assignment of fundamental modes was shown.

scholarly journals Social work support for employment of people with learning disabilities: Findings from the English Jobs First demonstration sites

2016 ◽  
Vol 17 (2) ◽  
pp. 167-185 ◽  
Author(s):  
Martin Stevens ◽  
Jess Harris
Keyword(s):  
Learning Disabilities ◽  
Social Work ◽  
Social Workers ◽  
Social Inclusion ◽  
Secondary Analysis ◽  
Social Work Practice ◽  
Structured Interviews ◽  
Active Labour Market Policy ◽  
Case Record ◽  
Wide Range

Summary This article brings together two key themes in recent public policy in England affecting social work practice: the value of having a paid job for social inclusion and increasing self-worth, and the personalisation of public services. The article draws on a mixed method evaluation of Jobs First, which was a government-funded demonstration site project that aimed to show how personal budgets (a key mechanism for personalisation) could be used by people with learning disabilities, often with their families, to purchase employment support. The evaluation involved secondary analysis of case record data and 142 semi-structured interviews with a wide range of participants (we mainly draw on 79 interviews with professionals for this article). Jobs First is placed within the frame of Active Labour Market Policy. Findings The attitudes of social workers to Jobs First were broadly positive, which was an important factor supporting employment outcomes. However, social workers’ involvement was often limited to a coordinating role, undertaking basic assessments linked to resource allocation and ensuring that support plans, which had often been developed by non-social work practitioners, were ‘signed off’ or agreed by the local authority. Applications The study points to important elements of the role of social workers in this new field of practice and explores potential tensions that might emerge. It highlights a continuing theme that social workers are playing more of a coordinating, managing role, rather than working directly with individuals to support their choices.

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