A 360° evaluation of stepped-care psychotherapy: APSI yrs 4-5

2020 ◽  
Vol 25 (2) ◽  
pp. 127-138
Author(s):  
Padraig Collins ◽  
Zara Walsh ◽  
Aimee Walsh ◽  
Amy Corbett ◽  
Roisin Finnegan ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Stepped Care ◽  
Service Users ◽  
Primary Care Psychology ◽  
Content Type ◽  
Low Mood ◽  
Clinical Recovery ◽  
Speed Of Response ◽  
Psychology Service

Purpose This paper aims to evaluate the effectiveness of a stepped-care primary care psychology service through triangulating clinical outcome data, service user satisfaction ratings and feedback from referrers. Design/methodology/approach A mixed method approach including a repeated measures design (pre- and post-clinical data on standardised psychometrics) for clinical outcomes and an online and postal survey with quantitative and qualitative elements offered to all service users and referrers to the service. Findings In total, 125 service users completed a full intervention with the service with 56% treatment completers demonstrating a reliable reduction in the symptoms of low mood and 49.6% in anxiety. Of those within the clinical range for depression at assessment, 66.67% achieved clinical recovery following an intervention. Of those within the clinical range for an anxiety disorder at assessment, 62.03% achieved clinical recovery following an intervention. Service users reported high levels of satisfaction with the service specifying particular interpersonal qualities of the therapists and the individualisation of service provision as crucial positive factors. Referrers similarly reported high levels of overall satisfaction with the service, specifying that the speed of response to referral and length of intervention was of greatest importance to them. Practical implications Stepped-care psychological interventions reduce psychological distress in treatment completers with mild to moderate symptoms of anxiety and low mood. The overall interpersonal experience may be of greater importance to service users in their evaluation of a service than clinical outcomes. In their relationship to a Psychology service, referrers value speed of response and ongoing feedback. Building a robust, highly valued service may require the triangulation of evidence from all key stakeholders. Originality/value This paper provides a pragmatic template of how a rigorous evaluation of a primary care psychology service requires evidence from multiple stakeholders.

scholarly journals A social construction of remission for people with a diagnosis of schizophrenia

2018 ◽  
Vol 22 (2) ◽  
pp. 94-107
Author(s):  
Keith Ford
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Mental Health Services ◽  
Health Services ◽  
Social Construction ◽  
Service Users ◽  
Content Type ◽  
Professional Groups ◽  
Practical Implications

Purpose The purpose of this paper is to provide a social construction of remission in relation to schizophrenia by the people affected most. The qualitative perspective utilised is a contrast to the majority of papers around, which have been quantitative when addressing the concept of remission for people with a diagnosis of schizophrenia. This paper acknowledges and demonstrates evidence of listening to the stakeholder groups affected by the issues associated with remission and recovery, and delivers clarity around the phenomena of remission in relation to recovery. Design/methodology/approach A constructivist grounded theory approach was employed, exploring participants’ interpretation of the concept of remission in schizophrenia. A purposive sample, of nine professionals, ten service users and seven carers, was recruited from two community mental health teams in the UK. Semi-structured interviews were employed to yield the data and all interview transcripts were analysed utilising “qualitative codes” thereby defining what is seen in the data. Diagramming and concept mapping was employed. Theoretical sensitivity was applied to demonstrate remission in abstract terms and to illustrate the openness, transparency and intention of the study. Findings The findings resulted in a conceptual map of the themes generated from the data. From this map four possible trajectories were developed, each highlighting a route which could be taken and the issues faced along the way. Positive and negative aspects of the trajectories offer discussion points for service users and practitioners alike to consider in their professional relationship. In addition a representation of the current interplay between recovery and remission is highlighted to offer clarity in relation to present service provision. Research limitations/implications The perspective and opinion from practitioners in Primary Care services was not proposed or included within this study. To gain an improved and realistic insight into this perspective a range of practitioners from primary care could provide valuable data for any future study as this would prove to be a valuable enhancement. This study offered a broad overview of professional groups with the ability to discuss mental health services, although it did not allow for a concentration from specific professional groups and therefore they were not able to fully represent their professional group. Practical implications This paper has illuminated the area of remission for people with schizophrenia and will therefore have practical implications in respect of on-going service development. In particular the interface between primary and secondary services which have struggled to employ consistent terminology serving only to confuse service users and service providers alike. The trajectories illustrated in this study offer clarity and understanding and direction for improved practice to facilitate recovery for people with a diagnosis of schizophrenia. Shared understanding of concepts between service users and providers could be a large move in a positive direction. Social implications The movement of people formerly diagnosed with schizophrenia from secondary mental health services back to primary care may have huge social implications. Resistance, stigma and ignorance play a large part in services “having to” retain people within secondary mental health services. Misunderstandings around diagnosis, and terms such as remission and recovery fuel such confusion resulting in a risk averse position for most. This study clarifies some of the issues in relation to the transition back to society and citizenship for people and offers scope for further research of a qualitative nature too. Originality/value Previous studies around the concept of remission for people with a diagnosis of schizophrenia have centred on medication efficacy, utilising remission criteria to determine changes in symptomolotolgy. These quantitative papers have not addressed service users, carers or practitioners in healthcare in relation to their understanding of the term remission, in relation to recovery; or whether they feel it would be of use in clinical practice. This study addressed those issues gaining valuable in-depth data from participants, deriving the social construction of remission and the impact it may have in clinical practice in a non-pathologising perspective.

People powered primary care: learning from Halton

2017 ◽  
Vol 25 (3) ◽  
pp. 162-173 ◽  
Author(s):  
Mark Swift
Keyword(s):  
Primary Care ◽  
Clinical Outcomes ◽  
Social Action ◽  
Social Enterprise ◽  
Active Role ◽  
Social Needs ◽  
Medical Community ◽  
Content Type ◽  
Community Assets ◽  
The Way

Purpose A community-centred approach to health called Community Wellbeing Practices (CWP) is being offered to patients at all 17 GP practices in Halton in order to respond more appropriately to patients’ social needs, which are often an underlying reason for their presentation at primary care services. The paper aims to discuss these issues. Design/methodology/approach Delivered in partnership with a local social enterprise this approach is centred on the integration of community assets and non-medical community-based support provided by the voluntary, community and social enterprise sector. The core elements include community navigation, social prescribing and social action approaches. Findings The CWP initiative has supported more than 5,000 patients over the last four years and has evidenced demonstrable improvements in a range of health and social outcomes for patients. Research limitations/implications The initiative has been well received by clinicians and social care professionals and has contributed to a cultural transformation in the way health and care professionals are responding to the identified needs of the community. Practical implications Using community-centred approaches in this way may help to augment clinical outcomes as well as reduce demand on over stretched public services. Social implications Community-centred models such as the one in Halton have the potential to empower citizens to play an active role in creating healthier communities by catalysing a “people powered” social movement for health. Originality/value The CWP model in Halton is a good example of the way community-centred approaches to health can be integrated with health and care pathways to augment clinical outcomes and reduce demand on over stretched services.

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 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.

Sign in / Sign up

Export Citation Format

Share Document