scholarly journals Access to specialist community alcohol treatment in England, and the relationship with alcohol-related hospital admissions: qualitative study of service users, service providers and service commissioners

BJPsych Open ◽  
2020 ◽  
Vol 6 (5) ◽  
Author(s):  
Emmert Roberts ◽  
Miriam Hillyard ◽  
Matthew Hotopf ◽  
Stephen Parkin ◽  
Colin Drummond
Keyword(s):  
Hospital Admissions ◽  
Service Providers ◽  
Alcohol Treatment ◽  
Service Level ◽  
Service Users ◽  
Risk Environment ◽  
Structured Interviews ◽  
Treatment Access ◽  
Health And Social Care ◽  
Specialist Treatment

Background Since 2012 England has seen year-on-year reductions in people accessing specialist community alcohol treatment, and year-on-year increases in alcohol-related hospital admissions. Aims We examined perceived barriers to accessing specialist treatment, and perceived reasons behind hospital admission increases. Method We conducted focus groups (n = 4) with service users and semi-structured interviews (n = 16) with service providers and service commissioners at four specialist community alcohol services in England, which experience either high or low rates of alcohol dependence prevalence and treatment access. Themes and subthemes were generated deductively drawing upon Rhodes’ risk environment thesis. Data were organised using the framework approach. Results Data reveal a treatment sector profoundly affected at all levels by changes implemented in the Health and Social Care Act (HSCA) 2012. Substantial barriers to access exist, even in services with high access rates. Concerns regarding funding cuts and recommissioning processes are at the forefront of providers’ and commissioners’ minds. The lack of cohesion between community and hospital alcohol services, where hospital services exist, has potentially created an environment enabling the reduced numbers of people accessing specialist treatment. Conclusions Our study reveals a treatment sector struggling with a multitude of problems; these pervade despite enaction of the HSCA, and are present at the national, service provider and individual service level. Although we acknowledge the problems are varied and multifaceted, their existence is echoed by the united voices of service users, service providers and service commissioners.

scholarly journals Evaluating the effectiveness of different approaches to home support for people in later stage dementia: a protocol for an observational study

2017 ◽  
Vol 29 (7) ◽  
pp. 1213-1221 ◽  
Author(s):  
Helen Chester ◽  
Paul Clarkson ◽  
Jane Hughes ◽  
Ian Russell ◽  
Joan Beresford ◽  
...  
Keyword(s):  
Observational Study ◽  
Service Providers ◽  
Geographical Area ◽  
National Study ◽  
Structured Interviews ◽  
Major Health Problem ◽  
Home Support ◽  
People With Dementia ◽  
Health And Social Care ◽  
Person With Dementia

ABSTRACTBackground:Dementia is a major health problem with a growing number of people affected by the condition, both directly and indirectly through caring for someone with dementia. Many live at home but little is known about the range and intensity of the support they receive. Previous studies have mainly reported on discrete services within a single geographical area. This paper presents a protocol for study of different services across several sites in England. The aim is to explore the presence, effects, and cost-effectiveness of approaches to home support for people in later stage dementia and their carers.Methods:This is a prospective observational study employing mixed methods. At least 300 participants (people with dementia and their carers) from geographical areas with demonstrably different ranges of services available for people with dementia will be selected. Within each area, participants will be recruited from a range of services. Participants will be interviewed on two occasions and data will be collected on their characteristics and circumstances, quality of life, carer health and burden, and informal and formal support for the person with dementia. The structured interviews will also collect qualitative data to explore the perceptions of older people and carers.Conclusions:This national study will explore the components of appropriate and effective home support for people with late stage dementia and their carers. It aims to inform commissioners and service providers across health and social care.

scholarly journals The legitimacy of offender management programmes in a post-TR landscape

2018 ◽  
Vol 17 (2) ◽  
pp. 69-80 ◽  
Author(s):  
Michael Rowe ◽  
Adele Irving ◽  
Sarah Soppitt
Keyword(s):  
Service Provision ◽  
Service User ◽  
Design Methodology ◽  
Service Providers ◽  
Service Users ◽  
Structured Interviews ◽  
Content Type ◽  
User Perceptions ◽  
Key Dimensions

Purpose The purpose of this paper is to explore the under-considered perspectives of service users engaged in various community sentences based on a “strengths-based” approach to desistance. Further to recent changes in the sector, the paper considers service user views for programmes delivered by combinations of agencies from private, public and third sectors. Design/methodology/approach The paper is based on analysis of 64 semi-structured interviews with users of four programmes, accompanied with informal fieldwork observations by the researchers as they carried out the research at the premises of service providers. Findings The research finds that service user perceptions of the legitimacy of programmes are closely related to their understanding of three key dimensions: first, the “authenticity” of those delivering the service; second, the instrumental (in broad terms) gains they expect from engagement; and third, their understanding of the identity and ethos of the programme. Originality/value The paper adds important understanding based on service user perceptions in a period when service provision is being diversified. Further directions for other research are identified and it is recognised that a limitation of the current study is that it incorporates a sample drawn from one area.

scholarly journals The relationship between alcohol-related hospital admission and specialist alcohol treatment provision across local authorities in England since passage of the Health and Social Care Act 2012

2020 ◽  
pp. 1-3 ◽  
Author(s):  
Emmert Roberts ◽  
Matthew Hotopf ◽  
Colin Drummond
Keyword(s):  
Hospital Admission ◽  
Social Care ◽  
Local Authority ◽  
Hospital Admissions ◽  
Alcohol Treatment ◽  
Data Sets ◽  
Treatment Provision ◽  
Health And Social Care ◽  
High Prevalence ◽  
The Uk

Summary To our knowledge no previous studies have been conducted at the local authority level assessing relationships between alcohol-related hospital admission, specialist alcohol treatment provision and socioeconomic deprivation since the UK government passed the Health and Social Care Act in 2012. Our results, using publicly available national data-sets, suggest that the local authority areas in England most in need of adequately funded specialist alcohol treatment, because of high prevalence of alcohol dependence and deprivation, are not receiving targeted increased funding, and that the national rise in alcohol-related hospital admissions may be fuelled by local authority funding cuts to specialist alcohol treatment.

scholarly journals Treatment challenges for alcohol service users in Kampala, Uganda

2017 ◽  
Vol 6 (1) ◽  
pp. 27-35 ◽  
Author(s):  
David Kalema ◽  
Wouter Vanderplasschen ◽  
Sofie Vindevogel ◽  
Peter K Baguma ◽  
Ilse Derluyn
Keyword(s):  
Service Providers ◽  
Qualitative Interviews ◽  
Alcohol Treatment ◽  
Capital City ◽  
Treatment Center ◽  
Service Users ◽  
Individual Level ◽  
Treatment Participation ◽  
Sub Saharan ◽  
The Individual

Kalema, D., Vanderplasschen, W., Vindevogel, S., Baguma, P., & Derluyn, I. (2017). Treatment challenges for alcohol service users in Kampala, Uganda. The International Journal Of Alcohol And Drug Research, 6(1), 27-35. doi:http://dx.doi.org/10.7895/ijadr.v6i1.240Background and Aims: Enhancing treatment participation of persons with substance use disorders is a challenge worldwide. Obstacles keeping people from entering or continuing treatment are well documented in Western countries, but such knowledge is scarce in majority countries that face particular challenges when implementing alcohol policies. This study aimed at identifying factors challenging treatment participation in Uganda, a Sub-Saharan country with a considerable alcohol problem.Methods: Data were collected during 30 in-depth, qualitative interviews on treatment challenges with 20 service providers and 10 male service users, who were recruited at one public and one private alcohol treatment center in the Ugandan capital city, Kampala. Men comprise about 90% of the total number of service users in these centers. Interview data were analyzed thematically, using Nvivo software, and were categorized around three levels of treatment challenges: societal, institutional, and personal challenges.Findings: Interview findings showed several treatment challenges relating to institutional aspects like inadequate human resources, overall insufficiency of services, and the treatment philosophy of available services. Respondents identified stigma and cultural interference as important challenges at the societal level, while limited awareness about addiction and denial of problems can be situated at the individual level.Conclusions: Institutional, societal, and personal challenges keep persons with AUD from participating in alcohol treatment in public and private services in Uganda. Alcohol regulation, sensitization, and prevention are needed to raise awareness at the societal and individual level, while appropriate training and additional financial resources may help to overcome institutional challenges.

scholarly journals Specialist alcohol inpatient treatment admissions and non-specialist hospital admissions for alcohol withdrawal in England: an inverse relationship

2020 ◽  
Vol 56 (1) ◽  
pp. 28-33
Author(s):  
Thomas Phillips ◽  
Chao Huang ◽  
Emmert Roberts ◽  
Colin Drummond
Keyword(s):  
Alcohol Withdrawal ◽  
Hospital Admissions ◽  
Significant Negative Correlation ◽  
Data Sets ◽  
Complex Needs ◽  
Specialist Services ◽  
Health And Social Care ◽  
Specialist Treatment ◽  
The Uk ◽  
The Relationship

ABSTRACT Aims We assessed the relationship between specialist and non-specialist admissions for alcohol withdrawal since the introduction of the UK government Health and Social Care Act in 2012. Methods Using publicly available national data sets from 2009 to 2019, we compared the number of alcohol withdrawal admissions and estimated costs in specialist and non-specialist treatment settings. Results A significant negative correlation providing strong evidence of an association was observed between the fall in specialist and rise in non-specialist admissions. Significant cost reductions within specialist services were displaced to non-specialist settings. Conclusions The shift in demand from specialist to non-specialist alcohol admissions due to policy changes in England should be reversed by specialist workforce investment to improve outcomes. In the meantime, non-specialist services and staff must be resourced and equipped to meet the complex needs of these service users.

Harm Reduction for Women in Treatment for Alcohol Use Problems: Exploring the Impact of Dominant Addiction Discourse

2020 ◽  
Vol 31 (1) ◽  
pp. 54-69
Author(s):  
Catrina Brown ◽  
Sherry H. Stewart
Keyword(s):  
Alcohol Use ◽  
Harm Reduction ◽  
Service Providers ◽  
Alcohol Treatment ◽  
Alcohol Addiction ◽  
Treatment Programs ◽  
Service Users ◽  
Narrative Interviews ◽  
Standardized Measures ◽  
The Impact

The objectives of this study were to profile the landscape of women’s alcohol use programs in Canada. We explored service users’ and providers’ beliefs about alcohol use problems and how this affected treatment choices for alcohol use problems. Data were collected through standardized measures alongside in-depth semi-structured narrative interviews in six women’s alcohol treatment sites in Canada. Findings demonstrated that service users and service providers often supported an abstinence choice and were ambivalent about the viability of controlled or managed use in both abstinence- and harm reduction–based programs. Findings showed that women service users in this study had significant rates of trauma and depression which were associated with their alcohol use; the majority still adopted dominant alcohol addiction discourse which emphasizes the need for abstinence. We offer a number of recommendations to improve the viability of harm reduction for alcohol use in women’s treatment programs.

scholarly journals Accessing and Utilizing One’s City Space: The Role of Specialized Community Mental Health Teams in Brazil and Canada

2020 ◽  
Vol 39 (1) ◽  
pp. 85-100
Author(s):  
Emmanuelle Khoury ◽  
Isabelle Ruelland
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Mental Health Professionals ◽  
Service Providers ◽  
Service Users ◽  
Structured Interviews ◽  
City Space ◽  
Mental Health Programs ◽  
The City

Community mental health programs have garnered significant attention during the last decade. In this paper we ask to what extent these programs impact the capacity of service users to move around in the city space. Drawing on case studies from ethnographic research conducted in Campinas (Brazil) and Montréal (Canada), which included semi-structured interviews with a total of 16 service users and 49 mental health professionals, we explore the significance of urban mobility as part of service users’ mental health recovery and service providers’ practice. Findings suggest that service providers play a key role in facilitating meaningful mobility in the city space.

scholarly journals Assessment of Policies and Harm Reduction Services for Young People Who Use Drugs in Kathmandu Valley of Nepal: Identifying Gaps and Opportunities

2022 ◽  
Author(s):  
Ishwor Maharjan
Keyword(s):  
Young People ◽  
Harm Reduction ◽  
Service Providers ◽  
People Who Use Drugs ◽  
Kathmandu Valley ◽  
Risk Environment ◽  
Structured Interviews ◽  
Donor Funding ◽  
Border Regions ◽  
Age Of Consent

Abstract Background: Young people under 30 represent the majority of people who use drugs in the Kathmandu Valley, Nepal. Young people who use drugs (YPWUD) may have particular needs and require different service and policy responses when compared to their older peers. This research examines the strengths and limitations of currently available policies and services; their effectiveness in meeting the needs of YPWUD and identifies gaps and opportunities for their improvement.Methodology: Semi-structured interviews (n=9) with key stakeholders and one focus group (n=5) discussion with YPWUD were conducted. Results were analyzed using the Rhodes Risk Environment framework which considers the ‘physical’, ‘social’, ‘economic’ and ‘policy’ level factors shaping risk at ‘micro’, ‘meso’ and ‘macro’ levels.Results: Drug use patterns among YPWUD in the Kathmandu Valley, Nepal are changing. Several trends have been identified including increased use of methamphetamine, diverted pharmaceuticals and ‘Southasian-Cocktail’ (a mixture of buprenorphine, benzodiazepine and antihistamines); use at the border regions and a move away from drug dealing ‘hotspots’ to online drug purchasing. YPWUD and service providers report a range of barriers to accessing services including stigma and discrimination; a lack of local services; a lack of knowledge of existing services; age of consent legislation and opening hours which may conflict with commitments such as school and college. YPWUD report a range of human rights violations including involuntary treatment, arbitrary detention, forced labour and public body searches. Service providers and policymakers report precarious international donor funding of services through HIV prevention programs with little to no youth-specific services for YPWUD.Conclusion: The findings of this study highlight the importance of youth-friendly harm reduction services that are relevant and responsive to the unique needs and experiences of YPWUD. These services should address current trends including the use of new substances (for example, methamphetamine and ‘Southasian Cocktail’) in diverse environments (including at the border regions and online). The perspectives of YPWUD are vital while developing and implementing harm reduction programs to ensure that the programs are effective, efficient and based on the diverse needs of YPWUD.

Online Stepped Care Mental Health System (TourHeart): A Qualitative Evaluation from Multiple Stakeholders’ Perspectives (Preprint)

2021 ◽  
Author(s):  
Emily W.S. Tsoi ◽  
Winnie W.S. Mak ◽  
Connie Y.Y. Ho ◽  
Gladys T.Y. Yeung
Keyword(s):  
Mental Health ◽  
User Experience ◽  
Service Providers ◽  
Qualitative Evaluation ◽  
Well Being ◽  
Stepped Care ◽  
Service Users ◽  
Personal Recovery ◽  
Structured Interviews ◽  
Online Platform

BACKGROUND Online stepped care mental health platform is a one-stop solution that integrates psychoeducation and other well-being promotional tools for mental health promotion and illness prevention and evidence-based low-intensity psychological interventions for treatment of people with anxiety and depressive symptoms. Rather than being strictly symptom-based, feedback from stakeholders is necessary for services to be person-centered and recovery-oriented. Thus, understanding from the perspectives of users and service providers is needed to fine-tune both the design and content of the services for enhanced service personalization and personal recovery. OBJECTIVE This is a qualitative study that evaluates the Jockey Club “TourHeart” stepped care mental health platform with both online and offline services targeting adults along the mental health spectrum based on the two-continua model of mental health and mental illness. This study incorporates perspectives from both service users and providers who administered the platform and provided coaching services. Offline services, design of the online platform, user experience, and views about the contents were explored using semi-structured interviews. METHODS The interview questions were designed based on the RE-AIM framework. A total of 37 service users and 22 service providers took part in the study. Analysis followed a hybrid thematic analysis to identify salient aspects of users and providers’ experience and views of the platform. RESULTS Three broad themes (namely, quality of the platform, drivers for platform usage, and coaching services) emerged from the interview data to illustrate the users’ views and experiences with the online platform. The platform’s general aesthetics, operations, and contents were all found to be critical features as well as drivers for continued usage. Coaching services were indispensable while participants preferred the autonomy and anonymity associated with online mental health services. CONCLUSIONS This study confirms existing design standards and recommendations and suggested that more rigorous user experience research and robust evaluation to be carried out in future adaptation of online stepped care services so that services can be more personalized and better promote personal recovery.

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