Therapeutic relationships within child and adolescent mental health inpatient services: A qualitative exploration of the experiences of young people, family members and nursing staff

Child and adolescent mental health services (CAMHS), especially inpatient units, have arguably never been more in demand and yet more in need of reform. Progress in psychotherapy and more broadly in mental health care is strongly predicted by the therapeutic relationship between professional and service user. This link is particularly pertinent in child and adolescent mental health inpatient services where relationships are especially complex and difficult to develop and maintain. This article describes a qualitative exploration of the lived experienced of 24 participants (8 young people, 8 family members/carers and 8 nursing staff) within inpatient CAMHS across four sites in the UK. We interviewed participants individually and analysed the transcripts using thematic analysis within a critical realist framework. We synthesised data across groups and present six themes, encapsulating the intricacies and impact of therapeutic relationships; their development and maintenance: Therapeutic relationships are the treatment, Cultivating connection, Knowledge is power, Being human, The dance, and It’s tough for all of us in here. We hope these findings can be used to improve quality of care by providing a blueprint for policy, training, systemic structures and staff support.

Delivering collaborative mental health care within supportive housing: implementation evaluation of a community-hospital partnership

Background Approaches to address unmet mental health care needs in supportive housing settings are needed. Collaborative approaches to delivering psychiatric care have robust evidence in multiple settings, however such approaches have not been adequately studied in housing settings. This study evaluates the implementation of a shifted outpatient collaborative care initiative in which a psychiatrist was added to existing housing, community mental health, and primary care supports in a women-centered supportive housing complex in Toronto, Canada. Methods The initiative was designed and implemented by stakeholders from an academic hospital and from community housing and mental health agencies. Program activities comprised multidisciplinary support for tenants (e.g. multidisciplinary care teams, case conferences), tenant engagement (psychoeducation sessions), and staff capacity-building (e.g. formal trainings, informal ad hoc questions). This mixed methods implementation evaluation sought to understand (1) program activity delivery including satisfaction with these activities, (2) consistency with team-based tenant-centered care and with pre-specified shared lenses (trauma-informed, culturally safe, harm reduction), and (3) facilitators and barriers to implementation over a one-year period. Quantitative data included reporting of program activity delivery (weekly and monthly), staff surveys, and tenant surveys (post-group surveys following tenant psychoeducation groups and an all-tenant survey). Qualitative data included focus groups with staff and stakeholders, program documents, and free-text survey responses. Results All three program activity domains (multidisciplinary supports, tenant engagement, staff capacity-building) were successfully implemented. Main program activities were multidisciplinary case conferences, direct psychiatric consultation, tenant psychoeducation sessions, formal staff training, and informal staff support. Psychoeducation for tenants and informal/formal staff support were particularly valued. Most activities were team-based. Of the shared lenses, trauma-informed care was the most consistently implemented. Facilitators to implementation were shared lenses, psychiatrist characteristics, shared time/space, balance between structure and flexibility, building trust, logistical support, and the embedded evaluation. Barriers were that the initial model was driven by leadership, confusion in initial processes, different workflows across organizations, and staff turnover; where possible, iterative changes were implemented to address barriers. Conclusions This evaluation highlights the process of successfully implementing a shifted outpatient collaborative mental health care initiative in supportive housing. Further work is warranted to evaluate whether collaborative care adaptations in supportive housing settings lead to improvements in tenant- and program-level outcomes.

Stepwise implementation of a cardiovascular risk management care program in primary care

Background Primary care plays a pivotal role in sustainable cardiovascular risk management (CVRM) but little is known about the organizational process of implementing the guidelines. The aim of the study was to describe the approach taken by a primary care group to implement the CVRM guideline. Methods Stepwise introduction and implementation of a programmatic CVRM care program was organized and facilitated by the care group between April 2010 and January 2013 in 137 affiliated general practices with 188 general practitioners (GPs), in the vicinity of Eindhoven, Netherlands. Care group support comprised sufficient staff, support with data extraction based on ICPC and ATC codes and with identification of eligible patients by scrutinizing patient health records and adequate coding of disease conditions. Results Patient selection based on availability of structured information on ICPC codes and risk factor levels from the electronic health records, led to 38,675 eligible patients in 2013. December 2019, the CVRM program was still running in 151 practices with 51,416 patients receiving programmatic CVRM care. Linking problems between 8 different electronic health record systems and the multidisciplinary information system for integrated care delayed adequate data collection until the beginning of 2013. Conclusion Commitment of affiliated GPs, a structured approach with adequate coding of diagnoses and risk factors, central data registration and additional funding for sufficient staff support are important conditions for the introduction and implementation of successful and sustainable programmatic CVRM care. This approach constitutes the basis for long-term follow up and annual evaluation.

Being a safe place: a qualitative study exploring perceptions as to how a rural community hospice could respond to enactment of voluntary assisted dying legislation

Background There is a lack of research to guide the implementation of voluntary assisted dying legislation within a hospice setting. Furthermore, there is limited published information related to the expectations of the community and staff to assist decision making regarding voluntary assisted dying in a community hospice. The aim of this study was to explore the expectations of staff, volunteers and members of the community as how a rural Australian community hospice could respond in relation to imminent enactment of Voluntary Assisted Dying legislation. Methods A total of 63 Hospice staff and volunteers and community members participated in 11 workshops. This qualitative study used the interpretive description method to analyse the workshop transcripts. Results While there was not a consensus view on community expectation, there was agreement among the participants for respect for a patient’s individuality and choices. Furthermore, care offered in hospice needs to remain non-judgemental and patient focused regardless of whether voluntary assisted dying policy was implemented or not. Both opportunities and risks associated with implementation were identified by the participants. Conclusion There was common ground around the respect for the dying person and the ideal of a “safe place” despite opposing views on what this may mean in practice. There is a need for clarity in organisational responses around policy, risk management, education, and staff support.

Library staff support with Fourth Industrial Revolution's application to provide information resources to remote clients during the COVID-19 library services

PurposeThe Fourth Industrial Revolution (4IR) and the Coronavirus Disease 2019 (COVID-19) have challenged the academic libraries system with a paradigm shift that has never been experienced before. This article highlights how the library staff offered support with the 4IR to the remote during the COVID-19 era; to ensure that the provision of information resources does not halt because of the imposed lockdown COVID-19 regulations. The purpose of this study was to examine the library staff support with 4IR's application to provide information resources to remote clients during the COVID-19 library services.Design/methodology/approachThe study was anchored by the positivism research paradigm and used a quantitative research approach. Microsoft Form was used to design an online questionnaire to collect data from the library staff working in a distance education environment in Gauteng Province of South Africa. The collected data were analyzed using the Statistical Package for the Social Sciences (SPSS).FindingsThe findings discovered that the library staff was keen on job innovation; however, the COVID-19 restrictions were a major cause for the library staff not to provide information resources to remote clients effectively.Research limitations/implicationsThe 4IR has both positive and negative effects on the library staff and the remote clients. To ensure that academic libraries fully embrace the 4IR; it is imperative to examine how the remote clients affected by digital divide can benefit from this revolution since they do not have access to adequate gadgets such as laptops/personal computers/tablets/smartphone/iPods and data for Internet connection.Practical implicationsThis study contributed to the Library and Information Science's (LIS) field by adding value to the knowledge base concerning how the library staff working in academic libraries operating in a distance education environment in Gauteng Province of South Africa offered support to the remote clients during the COVID-19 pandemic that impacted the drastic adoption of the 4IR.Social implicationsStakeholders, library management and policymakers gained insight to revisit the existing library staff support regarding mentoring, coaching training remote clients on how to access and download online information resources. This is inspired by the fact that COVID-19 significantly influenced library services' value for knowledge by facilitating policy changes and aligning with 4IR.Originality/valueThe study greatly influences policymakers and information practitioners to mobilize new methods of library staff support.

Identification of root causes of clinical coding problems in Iranian hospitals

Background Improving the quality of coded data requires the identification and evaluation of the root causes of clinical coding problems to inform appropriate solutions. Objective The objective of this study was to identify the root causes of clinical coding problems. Method Twenty-one clinical coders from three cities in Iran were interviewed. The five formal categories in Ishikawa's cause-and-effect diagram were applied as pre-determined themes for the data analysis. Results The study indicated 16 root causes of clinical coding problems in the five main themes: (i) policies, protocols, and processes (lack of clinical documentation guidelines; lack of audit of clinical coding and feedback to clinical coders; the long interval between documentation and clinical coding; and not using coded data for reimbursement; (ii) individual factors (shortage of clinical coders; low-skilled clinical coders; clinical coders' insufficient communication with physicians; and the lack of continuing education; (iii) equipment and materials (incomplete medical records; lack of access to electronic medical records and electronic coding support tools; (iv) working environment (lack of an appropriate, dynamic, and motivational workspace; and (v) management factors (mangers' inattention to the importance of coding and clinical documentation; and to providing the required staff support. Conclusion The study identified 16 root causes of clinical coding problems that stand in the way of clinical coding quality improvement. Implications The quality of clinical coding could be improved by hospital managers and health policymakers taking these problems into account to develop strategies and implement solutions that target the root causes of clinical coding problems.

Academic development through a pandemic crisis: Lessons learnt from three cases incorporating technical, pedagogical and social support

Distance or online learning is more than simply uploading and delivering learning resources to learners but in fact, it is a process that provides learners with autonomy, responsibility, flexibility and choice. This can be a challenge for many academic teachers. In 2020, as universities globally shifted to online learning, in response to the impact of the COVID-19 pandemic, a variety of staff have supported colleagues to develop e-learning techniques ‘just-in-time’ for effective delivery to students in fully online platforms. This has required a transformation of educational development and faculty support globally. This paper will reflect on mechanisms of support demonstrating tailored staff support to transform education in three case scenario contexts, during the impact of the COVID-19 pandemic in three different countries. Our case studies illustrate that support lies beyond technological capability building to also incorporate the essentials of holistic well-being and resilience reinforcement. This paper demonstrates temporary solutions to a global crisis in online education and reflects on lessons learnt and how eteaching and e-learning support may transform beyond the pandemic.

Implementation factors for patient navigation program success: a qualitative study

Background Patient navigation (PN) is an evidence-based practice that involves assessing and addressing individual barriers to care for patients. While PN has shown effectiveness in numerous studies, designing successful, sustainable PN programs has remained challenging for many healthcare organizations. The purpose of the present study was to examine implementation factors for successful PN programs to optimize the sustainability of PN services across cancer care settings in the USA. Methods Data were collected via semi-structured interviews with PN stakeholders (n=17) from diverse cancer care settings. Thematic content analysis was conducted by deductively coding major themes based on constructs from the Exploration-Preparation-Implementation-Sustainability framework and by inductively coding emergent themes. Results Facilitators in the outer context included payer guidelines, accreditation requirements, community partnerships, and demonstrated need and demand for services. Inner context factors such as alignment with organizational and leadership priorities, appropriate staff support and workloads, and relative advantage were important to program success. Innovation characteristics such as the presence of innovation champions, clear role and scope of practice, clear protocols, strong communication channels, and innovation fit were facilitators of program success. Community-Academic partnerships and funding stability also emerged as facilitators for program sustainability. Conclusion Our qualitative analysis from a diverse sample of PN stakeholders and programs across the USA supports intentional use of implementation theory to design PN programs to optimize implementation success.

Ethical advice in paediatric care

The need for local ethics advice during the COVID-19 pandemic has put a spotlight on clinical ethics committees (CECs) and services. In this review, we focus on paediatric CECs that raise both generic questions and specific issues. In doing this, we acknowledge the broader roles of education, research and staff support some bioethics teams have developed but focus on the main areas of clinical ethics support to clinical teams. We raise 12 questions about the role, remit and responsibilities of CECs, provide preliminary answers to these and set out the next steps for the development of ethics support both in paediatric practice and more generally.