Showing papers by "Rob Whitley published in 2008"
TL;DR: High turnover most often had a negative impact on implementation, although some teams were able to use strategies to improve implementation through turnover, and implementation models must consider turbulent behavioral health workforce conditions.
Abstract: Objectives: This study examined turnover rates of teams implementing psychosocial evidence-based practices in public-sector mental health settings. It also explored the relationship between turnover and implementation outcomes in an effort to understand whether practitioner perspectives on turnover are related to implementation outcomes. Methods: Team turnover was measured for 42 implementing teams participating in a national demonstration project examining implementation of five evidence-based practices between 2002 and 2005. Regression techniques were used to analyze the effects of team turnover on penetration and fidelity. Qualitative data collected throughout the project were blended with the quantitative data to examine the significance of team turnover to those attempting to implement the practices. Results: High team turnover was common (M±SD=81%±46%) and did not vary by practice. The 24-month turnover rate was inversely related to fidelity scores at 24 months (N=40, beta=–.005, p=.01). A negative trend was observed for penetration. Further analysis indicated that 71% of teams noted that turnover was a relevant factor in implementation. Conclusions: The behavioral health workforce remains in flux. High turnover most often had a negative impact on implementation, although some teams were able to use strategies to improve implementation through turnover. Implementation models must consider turbulent behavioral health workforce conditions. (Psychiatric Services 59:732–737, 2008)
197 citations
TL;DR: The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation, and common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites.
Abstract: Objective: Approximately half of the people who have serious mental illnesses experience a co-occurring substance use disorder at some point in their lifetime. Integrated dual disorders treatment, a program to treat persons with co-occurring disorders, improves outcomes but is not widely available in public mental health settings. This report describes the extent to which this intervention was implemented by 11 community mental health centers participating in a large study of practice implementation. Facilitators and barriers to implementation are described. Methods: Trained implementation monitors conducted regular site visits over two years. During visits, monitors interviewed key informants, conducted ethnographic observations of implementation efforts, and assessed fidelity to the practice model. These data were coded and used as a basis for detailed site reports summarizing implementation processes. The authors reviewed the reports and distilled the three top facilitators and barriers for each site. The most prominent cross-site facilitators and barriers were identified. Results: Two sites reached high fidelity, six sites reached moderate fidelity, and three sites remained at low fidelity over the two years. Prominent facilitators and barriers to implementation with moderate to high fidelity were administrative leadership, consultation and training, supervisor mastery and supervision, chronic staff turnover, and finances. Conclusions: Common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites. The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation. Further research on service implementation is needed, including but not limited to clarifying strategies to overcome barriers. (Psychiatric Services 59:989–995, 2008)
104 citations
TL;DR: It is theorised that Anglophone Euro-Canadian mothers in their early 20s may now be experiencing aspects of social exclusion traditionally associated with 'teenage mothers,' which may have a deleterious effect on health.
86 citations
TL;DR: In this paper, the authors describe the implementation of supported employment in the National Evidence-Based Practices Project, examining and interpreting fidelity changes over two years of program implementation, concluding that most changes occurred within the first year.
Abstract: Purpose To describe the implementation of supported employment in the National Evidence-Based Practices Project, examining and interpreting fidelity changes over two years of program implementation. Method Nine new supported employment programs were evaluated by examining supported employment fidelity ratings at baseline and every 6 months thereafter. Site reports based on the nine case studies were used to interpret the fidelity findings. Results At two years, eight of nine sites achieved high fidelity. Most changes occurred within the first year. Twelve of the 15 supported employment fidelity items showed rapid improvement. Discussion A review of the site reports suggested four factors that facilitated movement toward high fidelity: (1) Discontinuing non-evidence-based vocational services, (2) Making rapid structural changes through administrative action, (3) Measuring key process indicators to move toward desired changes, and (4) Gradually improving integration of the employment specialists with clinical services, primarily through supervisor leadership.
70 citations
TL;DR: Using qualitative research methods, the study uncovered eight strategies that contributed to successful implementation in six sites of supported employment and integrated dual diagnosis treatment.
Abstract: This study reports on the strategies used to implement the evidence-based practices of supported employment and integrated dual diagnosis treatment. Using qualitative research methods, the study uncovered eight strategies that contributed to successful implementation in six sites.
66 citations
TL;DR: Three themes emerged, highlighting the importance of individualized interventions promoting engagement in the program; relationships with health-promotion program employees and self-confidence resulting from program participation, that may have better success in achieving health benefits for persons with SMI.
Abstract: Sedentary lifestyle, poor dietary behaviors and metabolic alterations associated with psychiatric medications contribute to poor health and high rates of obesity among individuals with serious mental illness (SMI). Interventions that increase engagement in physical exercise, dietary modifications, lifestyle changes and preventive health care can provide health benefits across the lifespan. These interventions have led to substantial physical improvements in some persons with SMI, while others have not improved or have experienced worsening physical health. We set out to identify characteristics of a health promotion program that persons with SMI associated with physical health improvements. Interviews were conducted with eight participants from the In SHAPE health-promotion program who lost at least 10 pounds or diminished their waist circumference by at least 10 cm. Interviews aimed to determine which aspects of the program were perceived to be most helpful in promoting physical health improvement. Among successful participants, three themes emerged, highlighting the importance of: (i) individualized interventions promoting engagement in the program; (ii) relationships with health-promotion program employees and (iii) self-confidence resulting from program participation. Health-promotion programs that target these areas may have better success in achieving health benefits for persons with SMI.
64 citations
TL;DR: The lived experience of residents with severe mental illness in a small-scale recovery-housing building in the inner city was examined, attempting to identify and understand factors that influenced adjustment and stability.
Abstract: OBJECTIVE: The authors examined the lived experience of residents with severe mental illness in a small-scale recovery-housing building in the inner city. They attempting to identify and understand factors that influenced adjustment and stability. METHODS: Four focus groups with 17 residents and participant observation with residents, case managers, and supervisory staff were conducted longitudinally over a two-year period. Data were analyzed according to the tenets of qualitative content analysis. RESULTS: Safety and security was the most prominent issue raised by residents. Serious concerns about this issue could be divided into three categories: threats raised by the behavior of other residents (and their associates), threats raised by strangers, and threats related to loss of self-control. A related theme involved ongoing tension between residents' desire for communal connections and their conflicting desire for a bounded private life. CONCLUSIONS: Ongoing attention to the issue of safety and security should be a key component of recovery-oriented housing in inner-city residential areas. Further research may need to compare the experience of safety and security among residents living in recovery housing with the experience of those in independent scatter-site housing and traditional congregate housing. Language: en
42 citations
TL;DR: Five key themes that arise out of sociological analysis of postmodernity and that may have special relevance to psychiatry are introduced and critically discussed and further integration of these themes into research may give a fresh perspective on important issues pertinent to contemporary psychiatry.
Abstract: Contemporary Western societies are characterized by rapid social transformations, the scope and pace of which are unprecedented in comparison to previous eras. This new era is often referred to as "postmodern." Social theory suggests that such transformations influence multifarious processes related to psychiatry, including risk factors, help-seeking behavior, the clinical encounter, and clinical outcomes. I introduce and critically discuss five key themes that arise out of sociological analysis of postmodernity and that may have special relevance to psychiatry: (1) individualization; (2) social roles and self-identity; (3) the culture of expertise; (4) the transformation of intimacy; and (5) future orientation. Although extant work implicitly corroborates the importance of the identified themes as influences relevant to psychiatry, little work in psychiatry has explicitly applied these themes or investigated their impact. Further integration of these themes into research may give a fresh perspective on important issues pertinent to contemporary psychiatry.
40 citations
TL;DR: Results suggest that four interrelated factors contributed to whether agencies successfully implemented Outcome Monitoring-agency data collection methods, agency culture, practitioner skill, and how well “consumer outcomes” are defined.
Abstract: Objective This study reports participating agencies use of a single fidelity dimension, Outcome Monitoring, during the 2-year National EBP Implementation Project. Method The study involved an emerging theme qualitative approach for analyzing the implementation of fidelity achieved for five EBPs in 49 sites across eight states. Results Twenty-seven percent of the sites reached a high level of implementation fidelity. Conclusion Results suggest that four interrelated factors contributed to whether agencies successfully implemented Outcome Monitoring-agency data collection methods, agency culture, practitioner skill, and how well “consumer outcomes” are defined.
37 citations
TL;DR: This work explored and elucidate whether components of intentional recovery communities appeared to assist recovery from the point of view of consumers, and if so which were the most important factors, and three themes strongly emerged as important factors within the communities influencing recovery.
Abstract: Background: Recovery amongst people with a severe mental illness is generally defined as a multi-dimensional process of transformation involving positive transitions across various psychosocial domains Recent work on recovery has focused on addressing deficits in social relationships, social skills and social support In an attempt to foster recovery and psycho-social rehabilitation amongst people with severe mental illness, four intentional recovery communities have been set up by a mental health services provider in Washington DC, guided by the principles underlying therapeutic communities developed elsewhereAims: We set out to explore and elucidate whether components of these communities appeared to assist recovery from the point of view of consumers, and if so which were the most important factorsMethods: Four focus groups were conducted, one for each community We analysed data using grounded theory techniquesResults: Three themes strongly emerged as important factors within the communities influ
34 citations
01 Jan 2008
TL;DR: The main methods utilized in qualitative research (either in conjunction or isolation) are interviews, focus groups and (participant) observation as discussed by the authors, which are particularly useful in accessing the lived day-to-day experience of the relevant population, allowing investigators to intimately explore and understand phenomena from a "native" point of view.
Abstract: Qualitative research is a broad umbrella term encompassing several specific methods and paradigms that rely on the collection, analysis and interpretation of non-statistical data. This is gathered principally through researcher-participant interaction and observation in real life settings (Whitley & Crawford, 2005). Qualitative research generally aims for depth rather than breadth in description and analysis, with researchers becoming closely acquainted with one particular community or study setting. The main methods utilized in qualitative research (either in conjunction or isolation) are interviews, focus groups and (participant) observation. These methods are particularly useful in accessing the lived day-to-day experience of the relevant population, allowing investigators to intimately explore and understand phenomena from a “native” point of view.
TL;DR: Analysis suggested three emerging challenges: concern regarding unmet practical and physical needs, the struggle to establish internal rules and corrective mechanisms, and frustration regarding differential participation.
Abstract: Recent calls for psychiatric services to focus upon psychosocial recovery for people with severe mental illness has led to a renewed interest in recovery communities. Hence, Community Connections (Washington DC) set up a Women’s Empowerment Center as an intentional recovery community. The aim of this paper is to qualitatively chronicle the development of this center to assess emerging challenges. Focus groups and participant observation were conducted regularly over a 16-month period. Analysis suggested three emerging challenges (i) concern regarding unmet practical and physical needs (ii) the struggle to establish internal rules and corrective mechanisms (iii) frustration regarding differential participation.
TL;DR: It is argued that psychiatry, and its handmaiden, clinical psychology, now constitutes an amorphous system of beliefs, behaviors and attitudes whose functions and doctrines are unsettlingly similar to those held by conventional religions.
Abstract: In the 19th century, Matthew Arnold famously wrote of the ‘melancholy long withdrawing roar of the sea of faith’.1 This referred to the decline of Christian belief and the influence of Christian institutions in the day-to-day life of European societies. Such a decline was predicted by the enlightenment, which promised the triumph of rational science over religious superstition.2 Predictions of the demise of religion have been somewhat validated by the course of history. Fewer people are attending religious services, religious institutions have lost much of their influence on the masses, and religious views are frequently mocked and vilified as archaic delusions more suited to a dark and distant past.3,4 GK Chesterton famously remarked that when people stop believing in God, they start believing in anything. This begs a simple question – is there a lay replacement for religion in contemporary societies? Is there any comparable system of beliefs, behaviours and attitudes that stands as a binding doctrine held ‘true’ by the populace at large? Is there any such comparable system marked by a proselytizing zeal and enthusiastic sense of mission? In this essay, I argue that psychiatry, and its handmaiden, clinical psychology, now constitutes an amorphous system of beliefs, behaviors and attitudes whose functions and doctrines are unsettlingly similar to those held by conventional religions. Are psychiatrists the new priests? Are clinics the new confessionals? Are pills the new prayer? Read on to learn that now may be the time to proudly add ‘psychiatry’ to the pantheon of world religions.
TL;DR: A small-scale study of health information-seeking among clients of community mental health services, descriptive in orientation and modest in scope, offers some fresh new perspectives for thinking about the domains of client information- seeking and subsequent decision-making.
Abstract: Tannebaum’s paper (2008) reports a small-scale study of health information-seeking among clients of community mental health services. In the tradition of well-conducted qualitative research, this paper is descriptive in orientation and modest in scope. Data are collected from only two locations, which certainly restricts external validity. The study raises as many questions as it answers. That said, it offers some fresh new perspectives for thinking about the domains of client information-seeking and subsequent decision-making. This is an area of increasing interest given wider shifts in medicine away from paternalism towards innovative models of shared decision-making (Adams and Drake 2006).