scholarly journals Clinicians’ ratings of the Health of the Nation Outcome Scales (HoNOS) show sensitivity/bias that may affect patients’ progress: analyses of routine administrative data

2020 ◽  
Author(s):  
Jonathan Williams
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Measures ◽  
Rational Design ◽  
Inpatient Admission ◽  
Bipartite Network ◽  
Health Board ◽  
List Type ◽  
Chronic Patients

ABSTRACTObjectives(1) To estimate clinician sensitivity/bias in rating the HoNOS. (2) To test if high or low clinician sensitivity determines slower resolution of patients’ problems or earlier inpatient admission.DesignThe primary analysis used many-facet Item Response Theory to construct a multi-level Graded Response Model that teased apart clinician sensitivity/bias from the severity of patients’ problems in routine HoNOS records. Secondary analyses then tested if patients’ outcomes depend on their clinicians’ sensitivity/bias.Outcome measuresThe outcome measures were (1) overall differences in sensitivity/bias between (a) individual clinicians and (b) different Community Mental Health Teams (CMHTs); (2) clinical outcomes, comprising (a) the rate of resolution of patients’ problems and (b) the dependence of the time to inpatient admission on clinician sensitivity/bias.SettingAll archival electronic HoNOS records for all new referrals to all CMHTs providing mental health services in secondary care in a New Zealand District Health Board during 2007-2015.ParticipantsThe initial sample comprised 2170 adults of working age who received 5459 HoNOS assessments from 186 clinicians. From these initial data, I derived an opportunistic, connected, bipartite, longitudinal network, in which (i) every patient received HoNOS ratings from 2 or more clinicians and (ii) every clinician assessed more than 5 patients. The bipartite network comprised 88 clinicians and 778 patients; 112 patients underwent later inpatient admission.ResultsSensitivity/bias differed importantly between individual clinicians and CMHTs. Patients whose clinicians had more extreme sensitivity/bias showed slower resolution of their problems and earlier inpatient admission.ConclusionsRaw HoNOS ratings reflect the sensitivity/bias of clinicians almost as much as the severity of patients’ problems. Additionally, low or high clinician sensitivity can adversely affect patients’ outcomes. Hence, the HoNOS’s main value may be to measure clinician sensitivity. Accounting for clinician sensitivity could enable the HoNOS to fulfil its goal of improving mental health services.Strengths and limitations of the studyThe study derived a connected network of clinicians and patients that approximates a rational design for estimating clinicians’ sensitivity/bias.The opportunistic network sample was atypical, with chronic patients and experienced clinicians – so the study may under-estimate clinician bias.The study’s statistical methods were appropriate to the ordinal nature of HoNOS ratings.The study used earlier estimates of clinician sensitivity/bias to predict later outcomes – so that effects of clinician sensitivity/bias on outcomes may be causalThe study assumed that all HoNOS items tap a single dimension of the severity of patients’ problems.

Making sense of child and adolescent mental health services (CAMHS): An audit of the referral journey and the use of routine outcome measures (ROMS)

2021 ◽  
pp. 135910452199970
Author(s):  
Naomi Gibbons ◽  
Emma Harrison ◽  
Paul Stallard
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Measures ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Completion Rates ◽  
Making Sense ◽  
North East ◽  
Over Time

Background: There is increased emphasis on the national reporting of Routine Outcome Measures (ROMS) as a way of improving Child and Adolescent Mental Health Services (CAMHS). This data needs to be viewed in context so that reasons for outcome completion rates are understood and monitored over time. Method: We undertook an in-depth prospective audit of consecutive referrals accepted into the Bath and North East Somerset, Swindon and Wiltshire (BSW) CAMHS service from November 2017 to January 2018 ( n = 1074) and April to September 2019 ( n = 1172). Results: Across both audits 90% of those offered an appointment were seen with three quarters completing baseline ROMS. One in three were not seen again with around 30% still being open to the service at the end of each audit. Of those closed to the service, paired ROMS were obtained for 46% to 60% of cases. There were few changes in referral problems or complexity factors over time. Conclusion: Understanding the referral journey and the reasons for attrition will help to put nationally collected data in context and can inform and monitor service transformation over time.

Implementing a national case-management training program in Portugal

2011 ◽  
Vol 26 (S2) ◽  
pp. 555-555
Author(s):  
P. Mateus ◽  
M. Xavier ◽  
J. Caldas-Almeida
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Case Management ◽  
Training Program ◽  
National Level ◽  
Management Training ◽  
Role Playing ◽  
List Type ◽  
Program Content

IntroductionIn Portugal, a new National Mental Health Plan has been launched with the following objectives: equal access to care, decentralisation of mental health services and integration of mental health services in the general health services. In order to change the operational model for mental health teams, a case-management training program has been launched by the Ministry of Health.ObjectivesThis study aims to evaluate: a)the feasibility of implementing the program on a national level,b)the quality of the training program andc)the satisfaction of the trainees.MethodsThe study was carried out at 36 public mental health services in mainland Portugal. The professionals attended a case management course (SAMHSA procedures), in which they were trained by means of guidelines, demonstrative audios, scenarios and role-playing. The assessment was conducted with a questionnaire addressing logistics, program content, acquisition of skills, usefulness and overall satisfaction.Results135 professionals from the whole country have been involved. The trainees’ acquisition of competences was found rather satisfactory. Results of the training were impressive regarding satisfaction and motivation of the trainees (69% were highly satisfied). Dimensions such as organization (35% highly satisfied, 52% satisfied), program content (41% highly satisfied, 43% satisfied), practical skills gaining (35% highly satisfied, 58% satisfied) and usefulness (58% highly satisfied, 31% satisfied) were also very well rated.ConclusionsOf upmost relevance, it was possible to implement a case management training program at a national level, with no particular difficulties. The impact of courses on trainees was overall impressive.

scholarly journals Structured Professional Judgment to Assist the Evaluation and Safety Planning of Suicide Risk: The Risk of Suicide Protocol (RoSP)

2021 ◽  
Vol 12 ◽  
Author(s):  
Nicola S. Gray ◽  
Ann John ◽  
Aimee McKinnon ◽  
Stephanie Raybould ◽  
James Knowles ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Clinical Evaluation ◽  
Suicide Risk ◽  
Professional Judgment ◽  
Health Board ◽  
Safety Planning ◽  
Nice Guidelines ◽  
Structured Professional Judgment

Background: The Risk of Suicide Protocol (RoSP) is a structured professional judgment (SPJ) scheme designed in line with NICE guidelines to improve clinicians' ability to evaluate and manage suicide risk.Aims: This study aimed to evaluate the efficacy of RoSP in two settings: (1) unexpected deaths of people in the community who were known to mental health services; and (2) an inpatient hospital specializing in the assessment and treatment of patients with personality disorder.Method: In Study 1, information from a database of unexpected deaths (N = 68) within an NHS health board was used to complete a RoSP assessment (blind to cause of death) and information from the Coroner's Court was used to assign people to suicide vs. natural causes/accidental death. In Study 2, patients (N = 62) were assessed on the RoSP upon admission to hospital and their self-injurious behaviors were recorded over the first 3 months of admission.Results: (1) Evaluations using RoSP were highly reliable in both samples (ICCs 0.93–0.98); (2) professional judgment based on the RoSP was predictive of completed suicide in the community sample (AUC = 0.83) and; (3) was predictive of both suicide attempts (AUC = 0.81) and all self-injurious behaviors (AUC = 0.80) for the inpatient sample.Conclusion: RoSP is a reliable and valid instrument for the structured clinical evaluation of suicide risk for use in inpatient psychiatric services and in community mental health services. RoSP's efficacy is comparable to well-established structured professional judgment instruments designed to predict other risk behavior (e.g., HCR-20 and the prediction of violence). The use of RoSP for the clinical evaluation of suicide risk and safety-planning provides a structure for meeting NICE guidelines for suicide prevention and is now evidence-based.

scholarly journals Do CAMHS collect less PROM data from certain sociodemographic groups?

2020 ◽  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Measures ◽  
Treatment Efficacy ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Outcome Monitoring ◽  
Patient Reported ◽  
Low Rate

Patient-reported outcome measures (PROMs) are routinely used to inform clinicians and policymakers on clinical need and treatment efficacy. Yet despite their great value and utility, it seems that there is a low rate of outcome monitoring in Child and Adolescent Mental Health Services (CAMHS).

scholarly journals Evaluating mental health services. A world perspective

1997 ◽  
Vol 6 (S1) ◽  
pp. 239-245
Author(s):  
Norman Sartorius
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
World Wide ◽  
List Type ◽  
Type Number ◽  
Evaluative Research ◽  
World Perspective

Evaluations of mental health services are much in demand. Their results are supposed to help in improving the quality of mental health care and in making them economically better viable.Yet, world-wide there is: 1)little agreement about the content of terms such as evaluation, mental health service, outcome of an activity although these and other terms are widely used;2)uncertainty about the best use of results of evaluative research;3)lack of consensus about who should evaluate what and by what method.

scholarly journals The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Charlotte L Hall ◽  
Maria Moldavsky ◽  
Laurence Baldwin ◽  
Michael Marriott ◽  
Karen Newell ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Outcome Measures ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Audit Cycle

scholarly journals Beyond the COVID-19 pandemic: ‘Learning the hard way’ – adapting long-term IAPT service provision using lessons from past outbreaks

2020 ◽  
Vol 13 ◽  
Author(s):  
Lilian Skilbeck ◽  
Christopher Spanton ◽  
Ian Roylance
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Mental Health Services ◽  
Health Service ◽  
Health Services ◽  
Service Provision ◽  
World Health ◽  
List Type ◽  
Long Term Effects

Abstract Infectious disease outbreaks have occurred sporadically over the centuries. The most significant ones of this century, as reported by the World Health Organization, include the EVD epidemic, SARS pandemic, Swine Flu pandemic and MERS pandemic. The long-term mental health consequences of outbreaks are as profound as physical ones and can last for years post-outbreak. This highlights the need for enhancing the preparedness of pragmatic mental health service provision. Due to its magnitude, the novel COVID-19 pandemic has proven to be the most impactful. Compared with previous outbreaks, COVID-19 has also occurred at higher rates in frontline staff in addition to patients. As COVID-19 is more contagious than earlier outbreaks, there is a need to identify infected people quickly and isolate them and their contacts. This is the current context in which mental health services including IAPT have had to operate. Evidently, Improving Access to Psychological Therapies (IAPT) services are a major mental health service provider in the UK that have demonstrated variability in their response to COVID-19. While some IAPT services quickly adapted their existing strengths and resources (e.g. remote working), other services were less prepared. To date, there are no clear unitary guidelines on how IAPT services can use their pre-existing resources to respond to the long-term effects of outbreaks. In light of this, the current paper aims to reflect on the lessons learned from past outbreaks in order to consider how an enhanced remit of IAPT might integrate with other services to meet the long-term needs of patients and staff affected by COVID-19. Key learning aims (1) To understand the development of IAPT within the NHS mental health services. (2) To understand the nature of past outbreaks and COVID-19. (3) To reflect on lessons from past outbreaks in order to understand how IAPT can respond to the long-term effects of COVID-19.

scholarly journals Funding approaches for mental health services: is there still a role for clustering?

2018 ◽  
Vol 24 (6) ◽  
pp. 412-421 ◽  
Author(s):  
Rowena Jacobs ◽  
Martin Chalkley ◽  
María José Aragón ◽  
Jan R. Böhnke ◽  
Michael Clark ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Healthcare ◽  
List Type ◽  
Robust Model ◽  
Starting Point ◽  
Mental Health Activity ◽  
Health Services Need ◽  
Rapid Pace

SUMMARYFunding for mental health services in England faces many challenges, including operating under financial constraints where it is not easy to demonstrate the link between activity and funding. Mental health services need to operate alongside and collaborate with acute physical hospital services, where there is a well-established system for paying for activity. The funding landscape is shifting at a rapid pace and we outline the distinctions between the three main options – block contracts, episodic payment and capitation. Classification of treatment episodes via clustering presents an opportunity to demonstrate activity and reward it within these payment approaches. We discuss the results of our research into how well the clustering system is performing against a number of fundamental criteria. We find that, according to these criteria, clusters are falling short of providing a sound basis for measuring and financing services. Nevertheless, we argue that clustering is the best available option and is essential for a more transparent funding approach for mental healthcare to demonstrate its claim on resources, and that clusters should therefore be a starting point for evolving a better funding system.LEARNING OBJECTIVES•Understand the different payment models currently being used and proposed in mental health services in England•Understand the role of clustering in measuring mental health activity and providing a basis for funding•Understand how a robust model of clustering can benefit the provision of mental health servicesDECLARATION OF INTERESTNone.

scholarly journals An evaluation of predictors of dropout from an Emotional Coping Skills programme in a community mental health service

2019 ◽  
Vol 12 ◽  
Author(s):  
Shalini Raman ◽  
Thomas Richardson
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Coping Skills ◽  
Evidence Base ◽  
Drop Out ◽  
List Type ◽  
Client Retention ◽  
Emotional Coping

Abstract Drop-out from mental health services is a significant problem, leading to inefficient use of resources and poorer outcomes for clients. Adapted dialectical behaviour therapy (DBT), often termed Emotional Coping Skills (ECS) programmes, show some of the highest rates of drop-out from therapy recorded in the literature. The present study aimed to add to the evidence base, by evaluating predictors of drop-out from an ECS programme in a UK-based Community Mental Health Team (CMHT). An existing data set of 49 clients, consisting of clients’ responses on a number of questionnaires, was evaluated for predictors of drop-out. Predictors of drop-out included symptom severity, substance use and client demographics. Independent-samples t-tests and chi-square cross tabs analyses revealed no significant differences between drop-outs and completers of therapy on any of the variables. This suggests that contrary to common assumptions and previous findings, clients using substances, who are highly anxious, or who experience a greater degree of emotion dysregulation, are not more likely to drop out from ECS programmes compared with other individuals. The clinical implications of these findings and future research are discussed within the wider context of the evidence base. Key learning aims (1) To be familiar with common predictors of drop-out from psychological therapies, as indicated by the literature. (2) To understand the theories underlying factors that impact drop-out and the associated consequences for mental health services. (3) To understand the potential impact of staff assumptions of factors that affect drop-out on client retention. (4) To have an understanding of initiatives and strategies that may improve client-retention and engagement in services.

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