The National Guideline for Assessment, Treatment and Social Rehabilitation of Persons with Concurrent Substance Use and Mental Health Disorders, launched in 2012, is to be implemented in mental health services in Norway. Audit and feedback (A&F) is commonly used as the starting point of an implementation process. It aims to measure the research-practice gap, but its effect varies greatly. Less is known of how audit and feedback is used in natural settings. The aim of this study was to describe and investigate what is discussed and thematised when Quality Improvement (QI) teams in a District Psychiatric Centre (DPC) work to complete an action form as part of an A&F cycle in 2014.
This was an instrumental multiple case study involving four units in a DPC in Norway. We used open non-participant observation of QI team meetings in their natural setting, a total of seven teams and eleven meetings.
The discussions provided health professionals with insight into their own and their colleagues' practices. They revealed insufficient knowledge of substance-related disorders and experienced unclear role expectations. We found differences in how professional groups sought answers to questions of clinical practice and that they were concerned about whether new tasks fitted in with their routine ways of working.
Acting on A&F provided an opportunity to discuss practice in general, enhancing awareness of good practice. There was a general need for arenas to relate to practice and QI team meetings after A&F may well be a suitable arena for this. Self-assessment audits seem valuable, particular in areas where no benchmarked data exists, and there is a demand for implementation of new guidelines that might change routines and develop new roles. QI teams could benefit from having a unit leader present at meetings. Nurses and social educators and others turn to psychiatrists or psychologists for answers to clinical and organisational questions beyond guidelines, and show less confidence or routine in seeking research-based information. There is a general need to emphasise training in evidence-based practice and information seeking behaviour for all professional groups.
Cites: JAMA. 1999 Oct 20;282(15):1458-65 PMID 10535437
Cites: J Health Serv Res Policy. 2016 Apr;21(2):91-100 PMID 26811374
Cites: Med Care. 2009 Mar;47(3):356-63 PMID 19194332
The BIA method, based on assessment of patients in activities, was developed to enable reliable assessment of clients' occupational functioning. The method evaluates the patient's ego functions and capacity for activity and participation. The aims of this study were to examine inter-rater reliability for the BIA method and to compare the experiences of staff working with the BIA with those of staff using standard assessment (SA). In SA, the patient's activity problems and capacities were assessed without using any structured protocol. Four staff members worked according to the BIA method and eight according to SA. The estimation of reliability was based on data from 14 patients who went through the BIA and were assessed by five staff members. These assessments resulted in all in about 400 statements, which were classified and compared for agreement between raters. In order to address the aim concerning staff experiences, a questionnaire was filled out anonymously by the staff. The inter-rater reliability of the nine ego functions varied from 0.76 to 1.00. The scale was deemed appropriate by the BIA staff and they had significantly higher median ratings on work satisfaction and appropriateness than the SA staff. In conclusion, the inter-rater reliability of the BIA was found to be good. The BIA method also seems to have a high degree of appropriateness, constituting a promising assessment tool when occupational functioning is addressed.
To evaluate an intervention aimed at enriching day centres for people with psychiatric disabilities by exploring staff experiences from developing and implementing the intervention.
Each staff group developed a tailor-made intervention plan, following a manual, for how to enrich the day centre. They received supervision and support from the research team. The study was based on focus-group interviews with a total of 13 staff members at four day centres. Narrative analysis with a thematic approach was used. A first round resulted in one narrative per centre. These centre-specific narratives were then integrated into a common narrative that covered all the data.
A core theme emerged: User involvement permeated the implementation process and created empowerment. It embraced four themes forming a timeline: "Mix of excitement, worries and hope", "Confirmation and development through dialogue, feedback and guidance", "The art of integrating new activities and strategies with the old", and "Empowerment-engendered future aspirations".
The users' involvement and empowerment were central for the staff in accomplishing the desired changes in services, as were their own reflections and learning. A possible factor that may have contributed to the positive outcomes was that those who were central in developing the plan were the same as those who implemented it.
[Admission of acute cases to an institution for the mentally deficient. A survey of fluctuation and possibilities for rehabilitation of the mentally deficient admitted to an acute ward during a two-year period].
This descriptive study of 120 girls removed temporarily from parental care during early adolescence raises questions regarding the efficiency and effectiveness of current intervention strategies. The findings suggest that clinical and legal efforts on behalf of girls such as these, who have been victims of neglect, deprivation, and abuse, are likely to remain unsatisfactory in the absence of a broad societal commitment to the needs and rights of children.
The high readmission rates of discharged psychiatric patients have forced mental health professionals to play closer attention to aftercare planning. A program was developed at a psychiatric hospital in Ontario in 1977 to deal with "problem patients"--those who were deemed difficult to place in the community by the referral person or department. The program was characterized by shared institutional-community staffing, systematic aftercare assessment and planning, a crisis intervention approach to discharge, the use of a transitional staff member with patients, and the development of close relationships with community agencies. Study data show that the program was effective in limiting the number of readmissions during its first two years to 20 per cent.
The development of coordinated systems for delivery of aftercare services to psychiatric patients has lagged far behind the theoretical emphasis on community maintenance. From a collaboration of 29 treatment and rehabilitation facilities, an independent agency was established to improve aftercare services in Metropolitan Toronto. Known as Community Resources Consultants, the agency was designed to facilitate and rationalize the use of existing services, to identify gaps in service, to initiate or cooperate in the development of new services, and to involve hospital and community service personnel in raising the level of expertise in the provision of aftercare. Formal and informal assessments indicate that CRC has had a positive effect on the provision of aftercare services and on professionals' level of awareness of aftercare priorities.