scholarly journals Improving multiple exclusion homelessness (MEH) services: frontline worker responses to insecure attachment styles

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Nikoletta Theodorou ◽  
Sarah Johnsen ◽  
Beth Watts ◽  
Adam Burley
Keyword(s):  
Attachment Styles ◽  
Support Staff ◽  
Insecure Attachment ◽  
Cognitive Responses ◽  
Service Users ◽  
Frontline Staff ◽  
Content Type ◽  
Service Support ◽  
Case Vignettes ◽  
Constructive Engagement

Purpose This study aims to examine the emotional and cognitive responses of frontline homelessness service support staff to the highly insecure attachment styles (AS) exhibited by people experiencing multiple exclusion homelessness (MEH), that is, a combination of homelessness and other forms of deep social exclusion. Design/methodology/approach Focus groups were conducted with frontline staff (N = 19) in four homelessness support services in Scotland. Hypothetical case vignettes depicting four insecure AS (enmeshed, fearful, withdrawn and angry-dismissive) were used to facilitate discussions. Data is analysed thematically. Findings Service users with AS characterised by high anxiety (enmeshed or fearful) often evoked feelings of compassion in staff. Their openness to accepting help led to more effective interactions between staff and service users. However, the high ambivalence and at times overdependence associated with these AS placed staff at risk of study-related stress and exhaustion. Avoidant service users (withdrawn or angry-dismissive) evoked feelings of frustration in staff. Their high need for self-reliance and defensive attitudes were experienced as hostile and dismissing. This often led to job dissatisfaction and acted as a barrier to staff engagement, leaving this group more likely to “fall through the net” of support. Originality/value Existing literature describes challenges that support staff encounter when attempting to engage with people experiencing MEH, but provides little insight into the causes or consequences of “difficult” interactions. This study suggests that an attachment-informed approach to care can promote more constructive engagement between staff and service users in the homelessness sector.

scholarly journals Mental health nurses’ perceptions of attachment style as a construct in a medium secure hospital: a thematic analysis

2015 ◽  
Vol 10 (4) ◽  
pp. 218-233 ◽  
Author(s):  
Nikki Boniwell ◽  
Leanne Etheridge ◽  
Ruth Bagshaw ◽  
Joanne Sullivan ◽  
Andrew Watt
Keyword(s):  
Attachment Theory ◽  
Attachment Style ◽  
Thematic Analysis ◽  
Service User ◽  
Attachment Styles ◽  
Personality Development ◽  
Educational Interventions ◽  
Service Users ◽  
Structured Interviews ◽  
Content Type

Purpose – Attachment Theory can be regarded as central to the concept of relational security. There is a paucity of research examining the coherence of this construct for ward-based staff. The paper aims to discuss these issues. Design/methodology/approach – Five female nurses from the acute admission and assessment ward of a UK medium secure unit acted as participants. Semi-structured interviews were conducted, and inductive thematic analysis was applied. Findings – Six themes; “staff-service user relationships”, “staff diversities”, “service user backgrounds”, “variability in service users’ presentations”, “service users with personality disorder are problematic” and “nurses do not use attachment” emerged from the data. The nurses used heuristic models of attachment-related behaviour and they lacked knowledge of constructs associated with Attachment Theory. Research limitations/implications – Acute admissions may not be representative of all treatment contexts. Traditional models of attachment style may have only limited relevance in forensic services. Practical implications – Limited knowledge and confidence in the nurses regarding how Attachment Theory might apply to service users is interesting because it may limit the extent to which care, treatment and risk management might be informed by an understanding of service user representations of therapeutic relationships. Training and educational interventions for nurses that enhance understanding of personality development and attachment styles are warranted. Originality/value – The importance of nurses for achieving relational security is emphasised and the adequacy of their training is questioned.

A systemic response to supporting frontline inpatient mental health staff in coping with the COVID-19 outbreak

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Padraig Cotter ◽  
Nicola Jhumat ◽  
Eshia Garcha ◽  
Eirini Papasileka ◽  
Jennifer Parker ◽  
...  
Keyword(s):  
Mental Health ◽  
Support Staff ◽  
Health Staff ◽  
Mental Health Staff ◽  
Frontline Staff ◽  
Content Type ◽  
Health Care Workforce ◽  
Inpatient Mental Health ◽  
The Many ◽  
The Impact

Purpose This paper aims to outline the process of supporting frontline inpatient mental health staff in developing ways of coping with COVID-19. Design/methodology/approach A whole system approach was used in formulating and developing support structures with particular focus on relationship-focused coping. Findings Interventions were developed to support staff in coping with problem-focused (e.g. systemic changes) and emotion-focused challenges (e.g. deaths of colleagues). These included psychoeducation, mindfulness-based meditation and rituals to mark the deaths of colleagues. Staff SPACE (Stopping to Process and Consider Events) sessions were used to support staff in managing the many emotions they were experiencing. Positive psychology-based interventions were used to keep morale up and help people to stay motivated. The process of seeking feedback and making changes was introduced to support staff in feeling heard and having a voice. The maternal or master intervention within each of the above was the relational component. Practical implications This work aimed to boost the emotional and psychological literacy of the system. This will be important in the aftermath of the pandemic and could have many benefits thereafter. Social implications The post-COVID-19 health-care workforce will experience significant challenges in terms of readjustment and recovery. It is important that appropriate measures are put in place to ameliorate this. Originality/value An innovative systemic formulation of the impact of COVID-19 on frontline staff, and a coordinated way of dealing with this, is outlined.

Commentary on “Can active support improve job satisfaction?”

2016 ◽  
Vol 21 (2) ◽  
pp. 61-64 ◽  
Author(s):  
Roy Deveau
Keyword(s):  
Job Satisfaction ◽  
Support Staff ◽  
Disability Services ◽  
Positive Outcomes ◽  
Frontline Staff ◽  
Support Intervention ◽  
Content Type ◽  
Service Staff ◽  
Direct Support ◽  
Service User Experience

Purpose – The purpose of this paper is to provide a commentary on Rhodes and Toogood’s article on the possible relationship between Active Support training and staff job satisfaction. Design/methodology/approach – Rhodes and Toogood unusually and importantly include outcomes for both frontline staff and service users following an Active Support intervention. This commentary builds upon this approach by drawing on ideas recently raised by Deveau and McGill (2015). Findings – A number of important themes are identified including the mutuality of direct support staff (DSS) and service user experience, the significance of considering both the formal and informal aspects of organisational culture and the value of employing a complexity theory perspective. Originality/value – Effective public services require an understanding of the factors influencing the behaviour of public service staff. In intellectual disability services, positive outcomes can only be obtained through a broader appreciation of the drivers of DSS behaviour, especially the roles played by culture and leadership.

Consolidated performance measurement framework for government e-procurement focusing on internal stakeholders

2016 ◽  
Vol 29 (2) ◽  
pp. 354-380 ◽  
Author(s):  
Suvil Chomchaiya ◽  
Vatcharaporn Esichaikul
Keyword(s):  
Performance Measurement ◽  
Performance Measures ◽  
New Public Management ◽  
Performance Metrics ◽  
Support Staff ◽  
Content Type ◽  
Service Support ◽  
Measurement Framework ◽  
Internal Stakeholder ◽  
Internal Stakeholders

Purpose – The purpose of this paper is to develop a consolidated framework for government e-procurement (e-GP) performance measurement based on the importance internal stakeholders attach to performance measures and metrics, providing in-depth understanding of their interest in e-GP performance. Design/methodology/approach – This study is divided into two main phases: internal stakeholder identification and consolidation of performance measures and metrics. The mixed-methods approach follows semi-structured expert interviews with questionnaires collected from 413 internal stakeholders. Findings – Five internal stakeholder groups were identified: management, auditors, financial officers, service users, and service support staff. Eight measures and 44 corresponding metrics were consolidated, and 21 significantly distinct performance metrics were identified from stakeholders’ perceptions. As expected, financial measures were most important to financial officers, while contract management was most important to service support staff. Practical implications – Although e-GP processes can vary by country, this study’s approach to developing an e-GP performance measurement framework is adaptable, offering beneficial guidelines for designing e-GP performance measurement systems. Originality/value – This paper goes beyond the existing literature by magnifying the internal stakeholder roles and perceptions of importance, as reflected in the consolidated e-GP performance measurement framework. The consolidation approach with theoretical references (new public management, transaction cost economics, and institutional theory) yielded comprehensive e-GP-specific performance measures and metrics, providing a rigorous approach to measuring e-GP performance.

Now they’re listening: involvement in clinical psychology training

2019 ◽  
Vol 23 (1) ◽  
pp. 23-29
Author(s):  
Laura Lea ◽  
Sue Holttum ◽  
Victoria Butters ◽  
Diana Byrne ◽  
Helen Cable ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Professionals ◽  
Clinical Psychology ◽  
Health Professionals ◽  
Service User ◽  
Health Workers ◽  
Psychology Training ◽  
Service Users ◽  
Clinical Psychology Training ◽  
Content Type

PurposeThe 2014/2015 UK requirement for involvement of service users and carers in training mental health professionals has prompted the authors to review the work of involvement in clinical psychology training in the university programme. Have the voices of service users and carers been heard? The paper aims to discuss this issue.Design/methodology/approachThe authors update the paper of 2011 in which the authors described the challenges of inclusion and the specific approaches the authors take to involvement. The authors do this in the context of the recent change to UK standards for service user and carer involvement, and recent developments in relation to partnership working and co-production in mental healthcare. The authors describe the work carried out by the authors – members of a service user involvement group at a UK university – to ensure the voices of people affected by mental health difficulties are included in all aspects of training.FindingsCareful work and the need for dedicated time is required to enable inclusive, effective and comprehensive participation in a mental health training programme. It is apparent that there is a group of service users whose voice is less heard: those who are training to be mental health workers.Social implicationsFor some people, involvement has increased. Trainee mental health professionals’ own experience of distress may need more recognition and valuing.Originality/valueThe authors are in a unique position to review a service-user-led project, which has run for 12 years, whose aim has been to embed involvement in training. The authors can identify both achievements and challenges.

An outcomes study of eTherapy for dual diagnosis using Breaking Free Online

2014 ◽  
Vol 7 (2) ◽  
pp. 52-62 ◽  
Author(s):  
Sarah Elison ◽  
Jonathan Ward ◽  
Glyn Davies ◽  
Nicky Lidbetter ◽  
Daniel Hulme ◽  
...  
Keyword(s):  
Mental Health ◽  
Dual Diagnosis ◽  
Substance Dependence ◽  
Clinical Effectiveness ◽  
Outcome Data ◽  
Post Treatment ◽  
Service Users ◽  
Original Cohort ◽  
Content Type ◽  
Self Help

Purpose – In recent years there has been a proliferation of computer-based psychotherapeutic interventions for common mental health difficulties. Building on this, a small number of such interventions have now been developed to address substance dependence, one of which is Breaking Free Online (BFO). A new “eTherapy” self-help service, which was set up by the UK mental health charity Self-Help Services, has provided access to BFO to service users presenting with comorbid mental health and substance misuse difficulties. The purpose of this paper is to evaluate a range of clinical outcomes in the first cohort of service users accessing this dual diagnosis service. Design/methodology/approach – A number of standardised psychometric assessments were conducted with service users at baseline and post-treatment at discharge from the service. Outcome data were available for 47 service users out of an original cohort of 74. Findings – Statistically significant improvements were found in terms of measures of social functioning, depression, anxiety, alcohol and drug use and social anxiety. Clinically relevant gains were also identified, with fewer service users reaching threshold scores for depression and anxiety at post-treatment compared to baseline. Effect sizes also indicated that the identified improvements across the psychometric measures were robust and significant. Research limitations/implications – These findings provide further support for the clinical effectiveness of BFO, and also provide evidence that an eTherapy self-help service may be appropriate for some individuals presenting with dual diagnosis. Further research is underway with larger and alternative clinical populations to examine the effectiveness of BFO and also this novel eTherapy self-help approach. Originality/value – This paper has provided initial data to support effectiveness of a novel eTherapy service for dual diagnosis.

scholarly journals Measuring attachment and parental bonding in psychosis and its clinical implications

2014 ◽  
Vol 25 (2) ◽  
pp. 142-149 ◽  
Author(s):  
S. Mathews ◽  
J. Onwumere ◽  
S. Bissoli ◽  
M. Ruggeri ◽  
E. Kuipers ◽  
...  
Keyword(s):  
Attachment Theory ◽  
Attachment Style ◽  
Attachment Styles ◽  
Parental Bonding ◽  
Insecure Attachment ◽  
Self Report ◽  
Future Research ◽  
Clinical Implications ◽  
Term Outcome ◽  
Long Term Outcome

Background.Attachment theory proposes that psychological functioning and affect regulations are influenced by the attachment we form with others. Early relationships with parents or caregivers lay the foundations for attachment styles. These styles are proposed to influence how we relate to others during our life can be modified by the relationships and events we experience in our lifespan. A secure attachment style is associated with a capacity to manage distress, comfort with autonomy and the ability to form relationships with others, whereas insecure attachment can lead to dysfunctional relationships, emotional and behaviour avoidance. Attachment theory provides a useful framework to inform our understanding of relationship difficulties in people with psychosis. This paper aims to complement recent systematic reviews by providing an overview of attachment theory, its application to psychosis, including an understanding of measurement issues and the clinical implications offered.Method.A narrative review was completed of the measures of attachment and parental bonding in psychosis. Its clinical implications are also discussed. The paper also explores the link between insecure attachment styles and illness course, social functioning and symptomatology. The following questions are addressed: What are the key attachment measures that have been used within the attachment and psychosis literature? What are the results of studies that have measured attachment or parental bonding in psychosis and what clinical implications can we derive from it? What are some of the key questions for future research from these findings in relation to the onset of psychosis research field?Results.The most commonly used measures of attachment in psychosis research are reviewed. Self-report questionnaires and semi-structured interviews have mainly been used to examine attachment styles in adult samples and in recent years comprise a measure specifically developed for a psychosis group. The review suggests that insecure attachment styles are common in psychosis samples. Key relationships were observed between insecure, avoidant and anxious attachment styles and psychosis development, expression and long-term outcome.Conclusions.Attachment theory can provide a useful framework to facilitate our understanding of interpersonal difficulties in psychosis that may predate its onset and impact on observed variability in outcomes, including treatment engagement. Greater attention should be given to the assessment of attachment needs and to the development of interventions that seek to compensate for these difficulties. However, further investigations are required on specifying the exact mechanisms by which specific attachment styles impact on the development of psychosis and its course.

Security and the social mind: attachment and therapeutic communities

2015 ◽  
Vol 36 (1) ◽  
pp. 12-20 ◽  
Author(s):  
Gwen Adshead
Keyword(s):  
Attachment Theory ◽  
Design Methodology ◽  
Insecure Attachment ◽  
Therapeutic Communities ◽  
Content Type ◽  
The Social ◽  
Social Mind ◽  
Basic Features ◽  
Practical Implications ◽  
Attachment Process

Purpose – The purpose of this paper is to describe some of the basic features of attachment theory, and explore how they relate to the development of the “social mind” and the work of therapeutic communities (TC). Design/methodology/approach – The author describes the essentials of attachment theory in humans; and the development of both secure and insecure states of mind. The author will set out how insecure attachment systems are associated with deficits in mentalising processes which are fundamental to the activity of the social mind. Findings – The author suggests how attachment to a TC can promote mentalising processes. The author draws on the work of other speakers in the conclusions about how to “grow” secure minds and societies. Research limitations/implications – This paper is a brief over view only and does not address attachment process to TC in any depth. Practical implications – Attachment theory could help both service users and therapists who work in TCs understand some of the difficulties people have in engaging at the start. Attachment theory also gives a guide to what a “good enough” experience in a TC might look like. Originality/value – There is little existing discussion of the application of attachment theory to TCs.

Satisfaction of tuberculosis patients with health services in Ghana

2017 ◽  
Vol 30 (6) ◽  
pp. 545-553 ◽  
Author(s):  
Frank Bonsu ◽  
Felix Afutu ◽  
Nii Nortey Hanson-Nortey ◽  
Mary-Anne Ahiabu ◽  
Joshua Amo-Adjei
Keyword(s):  
Client Satisfaction ◽  
Service Providers ◽  
Healthcare Providers ◽  
Large Body ◽  
Service Users ◽  
Content Type ◽  
Sputum Production ◽  
Interview Guide

Purpose Within human services, client satisfaction is highly prioritised and considered a mark of responsiveness in service delivery. A large body of research has examined the concept of satisfaction from the perspective of service users. However, not much is known about how service providers construct client satisfaction. The purpose of this paper is to throw light on healthcare professionals’ perspectives on patient satisfaction, using tuberculosis (TB) clinics as a case study. Design/methodology/approach In-depth interviews were conducted with 35 TB clinic supervisors purposively sampled from six out of the ten regions of Ghana. An unstructured interview guide was employed. The recorded IDIs were transcribed, edited and entered into QSR NVivo 10.0 and analysed inductively. Findings Respondents defined service satisfaction as involving education/counselling (on drugs, nature of condition, sputum production, caregivers and contacts of patients), patient follow-up, assignment of reliable treatment supporters as well as being attentive and receptive to patients, service availability (e.g. punctuality at work, availability of commodities), positive assurances about disease prognosis and respect for patients. Practical implications Complementing opinions of health service users with those of providers can offer key performance improvement areas for health managers. Originality/value To the best of the authors’ knowledge, this is a first study that has examined healthcare providers’ views on what makes their clients satisfied with the services they provide.

Human rights of people with mental illness diagnosis: perceptions among service users, family members and health professionals in Tunisia

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Mayssa Rekhis ◽  
Sami Ouanes ◽  
Abir Ben Hamouda ◽  
Rym Rafrafi
Keyword(s):  
Mental Illness ◽  
Human Rights ◽  
Family Members ◽  
Mental Illnesses ◽  
Service Users ◽  
Content Type ◽  
People With Mental Illness ◽  
The Family ◽  
The Right ◽  
Main Factor

Purpose This study aims to assess the awareness about the rights of people with mental illness in the main psychiatric hospital in Tunisia among the service users, the family members and the staff. Design/methodology/approach The Convention of Rights of People with Disabilities mandates that State Parties initiate and maintain campaigns and human rights training to promote understanding of the rights of people with mental illnesses, considered as a main factor for their fulfillment. Service users, family members and staff evaluated, through a survey, the importance of ten rights for persons with mental illness, stated in the convention. Findings Disparities were found in the perception of the different rights by and between the three groups. The highest levels of awareness were associated with the freedom from torture or degrading treatment and the right to live with dignity and respect, whereas the lower importance were assigned to the right to participation in recovery plans, to give consent and to exercise legal capacity. Originality/value The lack of awareness and the poor perception of rights of people with mental illness is one of the barriers to their achievement. More training and awareness raising is necessary.

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