Showing papers in "Administration and Policy in Mental Health in 2015"
TL;DR: This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposefully sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
Abstract: Purposeful sampling is widely used in qualitative research for the identification and selection of information-rich cases related to the phenomenon of interest. Although there are several different purposeful sampling strategies, criterion sampling appears to be used most commonly in implementation research. However, combining sampling strategies may be more appropriate to the aims of implementation research and more consistent with recent developments in quantitative methods. This paper reviews the principles and practice of purposeful sampling in implementation research, summarizes types and categories of purposeful sampling strategies and provides a set of recommendations for use of single strategy or multistage strategy designs, particularly for state implementation research.
5,601 citations
TL;DR: Qualitative, quantitative, and hybrid approaches to mixed methods dissemination and implementation studies are reviewed, and methods for integrating multiple methods to increase depth of understanding while improving reliability and validity of findings are described.
Abstract: Limited translation of research into practice has prompted study of diffusion and implementation, and development of effective methods of encouraging adoption, dissemination and implementation. Mixed methods techniques offer approaches for assessing and addressing processes affecting implementation of evidence-based interventions. We describe common mixed methods approaches used in dissemination and implementation research, discuss strengths and limitations of mixed methods approaches to data collection, and suggest promising methods not yet widely used in implementation research. We review qualitative, quantitative, and hybrid approaches to mixed methods dissemination and implementation studies, and describe methods for integrating multiple methods to increase depth of understanding while improving reliability and validity of findings.
149 citations
TL;DR: The lessons this multi-institutional/multi-disciplinary team has learned conducting a range of mHealth projects using mobile phones with diverse clinical populations are summarized and recommendations for identifying and resolving barriers, or preventing their occurrence altogether are provided.
Abstract: The capacity of Mobile Health (mHealth) technologies to propel healthcare forward is directly linked to the quality of mobile interventions developed through careful mHealth research. mHealth research entails several unique characteristics, including collaboration with technologists at all phases of a project, reliance on regional telecommunication infrastructure and commercial mobile service providers, and deployment and evaluation of interventions “in the wild”, with participants using mobile tools in uncontrolled environments. In the current paper, we summarize the lessons our multi-institutional/multi-disciplinary team has learned conducting a range of mHealth projects using mobile phones with diverse clinical populations. First, we describe three ongoing projects that we draw from to illustrate throughout the paper. We then provide an example for multidisciplinary teamwork and conceptual mHealth intervention development that we found to be particularly useful. Finally, we discuss mHealth research challenges (i.e. evolving technology, mobile phone selection, user characteristics, the deployment environment, and mHealth system “bugs and glitches”), and provide recommendations for identifying and resolving barriers, or preventing their occurrence altogether.
133 citations
TL;DR: Burnout, particularly personal accomplishment, and to a lesser extent depersonalization, were predictive of overall self-rated Quality of Care, over and above background variables.
Abstract: Staff burnout is widely believed to be problematic in mental healthcare, but few studies have linked burnout directly with quality of care. The purpose of this study was to examine the relationship between burnout and a newly developed scale for quality of care in a sample of community mental health workers (N=113). The Self-Reported Quality of Care scale had three distinct factors (Client-Centered Care, General Work Conscientiousness, and Low Errors), with good internal consistency. Burnout, particularly personal accomplishment, and to a lesser extent depersonalization, were predictive of overall self-rated Quality of Care, over and above background variables.
93 citations
TL;DR: Co-responding police-mental health programs were found to have strong linkages with community services and reduce pressure on the justice system, but there is limited evidence on other impacts.
Abstract: Co-responding police-mental health programs are increasingly used to respond to ‘Emotionally Disturbed Persons’ in the community; however, there is limited understanding of program effectiveness and the mechanisms that promote program success. The academic and gray literature on co-responding police-mental health programs was reviewed. This review synthesized evidence of outcomes along seven dimensions, and the available evidence was further reviewed to identify potential mechanisms of program success. Co-responding police-mental health programs were found to have strong linkages with community services and reduce pressure on the justice system, but there is limited evidence on other impacts. The relevance of these findings for practitioners and the major challenges of this program model are discussed, and future research directions are identified.
93 citations
TL;DR: This mixed-methods study uses Maslow’s hierarchy as a theoretical lens to investigate the experiences of 63 newly enrolled clients of housing first and traditional programs for adults with serious mental illness who have experienced homelessness.
Abstract: This mixed-methods study uses Maslow’s hierarchy as a theoretical lens to investigate the experiences of 63 newly enrolled clients of housing first and traditional programs for adults with serious mental illness who have experienced homelessness. Quantitative findings suggests that identifying self-actualization goals is associated with not having one’s basic needs met rather than from the fulfillment of basic needs. Qualitative findings suggest a more complex relationship between basic needs, goal setting, and the meaning of self-actualization. Transforming mental health care into a recovery-oriented system will require further consideration of person-centered care planning as well as the impact of limited resources especially for those living in poverty.
93 citations
TL;DR: Testing the reliability and accuracy of two groups of community therapists who reported on their use of family therapy and motivational interviewing/cognitive-behavioral therapy interventions during routine treatment of inner-city adolescents with conduct and substance use problems offers support for the feasibility of using existing therapist-report methods to anchor quality assurance procedures for FT interventions in real-world settings.
Abstract: Developing therapist-report fidelity tools to support quality delivery of evidence-based practices in usual care is a top priority for implementation science. This study tested the reliability and accuracy of two groups of community therapists who reported on their use of family therapy (FT) and motivational interviewing/cognitive-behavioral therapy (MI/CBT) interventions during routine treatment of inner-city adolescents with conduct and substance use problems. Study cases (n = 45) were randomized into two conditions: (a) Routine Family Therapy (RFT), consisting of a single site that featured family therapy as its standard of care for behavioral treatment; or (b) Treatment As Usual (TAU), consisting of five sites that featured non-family approaches. Therapists and trained observational raters provided FT and MI/CBT adherence ratings on 157 sessions (104 RFT, 53 TAU). Overall therapist reliability was adequate for averaged FT ratings (ICC = .66) but almost non-existent for MI/CBT (ICC = .06); moreover, both RFT and TAU therapists were more reliable in reporting on FT than on MI/CBT. Both groups of therapists overestimated the extent to which they implemented FT and MI/CBT interventions. Results offer support for the feasibility of using existing therapist-report methods to anchor quality assurance procedures for FT interventions in real-world settings, though not for MI/CBT.
90 citations
TL;DR: Investigation of what staff say they do to support recovery and to identify what they perceive as barriers and facilitators associated with providing recovery-oriented support found a core category was Competing Priorities.
Abstract: Recovery has come to mean living a life beyond mental illness, and recovery orientation is policy in many countries. The aims of this study were to investigate what staff say they do to support recovery and to identify what they perceive as barriers and facilitators associated with providing recovery-oriented support. Data collection included ten focus groups with multidisciplinary clinicians (n = 34) and team leaders (n = 31), and individual interviews with clinicians (n = 18), team leaders (n = 6) and senior managers (n = 8). The identified core category was Competing Priorities, with staff identifying conflicting system priorities that influence how recovery-oriented practice is implemented. Three sub-categories were: Health Process Priorities, Business Priorities, and Staff Role Perception. Efforts to transform services towards a recovery orientation require a whole-systems approach.
88 citations
TL;DR: This review identifies 118 measures associated with the 27 adoption predictors in the synthesis of adoption theories, finding that more effective and integrated measurement can advance the adoption of complex innovations such as evidence-based practices.
Abstract: Building on a narrative synthesis of adoption theories by Wisdom et al. (2013), this review identifies 118 measures associated with the 27 adoption predictors in the synthesis. The distribution of measures is uneven across the predictors and predictors vary in modifiability. Multiple dimensions and definitions of predictors further complicate measurement efforts. For state policymakers and researchers, more effective and integrated measurement can advance the adoption of complex innovations such as evidence-based practices.
72 citations
TL;DR: It is demonstrated how optimal design methods with purposeful sampling can be used to assess the sensitivity of design decisions and balance competing needs when there are multiple study aims, a common situation in implementation research.
Abstract: Optimal design has been an under-utilized methodology. However, it has significant real-world applications, particularly in mixed methods implementation research. We review the concept and demonstrate how it can be used to assess the sensitivity of design decisions and balance competing needs. For observational studies, this methodology enables selection of the most informative study units. For experimental studies, it entails selecting and assigning study units to intervention conditions in the most informative manner. We blend optimal design methods with purposeful sampling to show how these two concepts balance competing needs when there are multiple study aims, a common situation in implementation research.
69 citations
TL;DR: Common elements across evidence-based prevention programs focused on the promotion of health-related outcomes in adolescents are identified, and problem-solving emerged as the most common practice element, followed by communication skills, and insight building.
Abstract: A growing number of evidence-based youth prevention programs are available, but challenges related to dissemination and implementation limit their reach and impact. The current review identifies common elements across evidence-based prevention programs focused on the promotion of health-related outcomes in adolescents. We reviewed and coded descriptions of the programs for common practice and instructional elements. Problem-solving emerged as the most common practice element, followed by communication skills, and insight building. Psychoeducation, modeling, and role play emerged as the most common instructional elements. In light of significant comorbidity in poor outcomes for youth, and corresponding overlap in their underlying skills deficits, we propose that synthesizing the prevention literature using a common elements approach has the potential to yield novel information and inform prevention programming to minimize burden and maximize reach and impact for youth.
TL;DR: Good practice across contexts in structural issues including recruitment and training is found, but differences in expectations of the peer worker role in different organisational cultures are found.
Abstract: A wide variety of peer worker roles is being introduced into mental health services internationally. Empirical insight into whether conditions supporting role introduction are common across organisational contexts is lacking. A qualitative, comparative case study compared the introduction of peer workers employed in the statutory sector, voluntary sector and in organisational partnerships. We found good practice across contexts in structural issues including recruitment and training, but differences in expectations of the peer worker role in different organisational cultures. Issues of professionalism and practice boundaries were important everywhere but could be understood very differently, sometimes eroding the distinctiveness of the role.
TL;DR: In multivariate analysis, military service variables and probable traumatic brain injury independently predicted VA use and VA users and nonusers differed in age and military background.
Abstract: We studied 1,292 Iraq and Afghanistan War veterans who participated in a clinical trial of expressive writing to estimate the prevalence of perceived reintegration difficulty and compare Veterans Affairs (VA) healthcare users to nonusers in terms of demographic and clinical characteristics. About half of participants perceived reintegration difficulty. VA users and nonusers differed in age and military background. Levels of mental and physical problems were higher in VA users. In multivariate analysis, military service variables and probable traumatic brain injury independently predicted VA use. Findings demonstrate the importance of research comparing VA users to nonusers to understand veteran healthcare needs.
TL;DR: The current study evaluated the impact of a statewide training and consultation program in a common elements approach to psychotherapy, indicating early increases in positive SA attitudes, with more gradual increases in self-reported SA skill and use.
Abstract: Despite increasing emphasis on the implementation of evidence-based treatments in community service settings, little attention has been paid to supporting the use of evidence-based assessment (EBA) methods and processes, a parallel component of evidence-based practice. Standardized assessment (SA) tools represent a key aspect of EBA and are central to data-driven clinical decision making. The current study evaluated the impact of a statewide training and consultation program in a common elements approach to psychotherapy. Practitioner attitudes toward, skill applying, and use of SA tools across four time points (pre-training, post-training, post-consultation, and follow-up) were assessed. Results indicated early increases in positive SA attitudes, with more gradual increases in self-reported SA skill and use. Implications for supporting the sustained use of SA tools are discussed, including the use of measurement feedback systems, reminders, and SA-supportive supervision practices.
TL;DR: Four interpersonal variables—team cohesion, team communication, team climate, and supervision—were correlated with the quantity of DBT elements implemented and Qualitative themes corroborated these findings.
Abstract: Guided by the Consolidated Framework for Implementation Research, this mixed method study explored the relationship between inner setting variables and dialectical behavior therapy (DBT) implementation. Intensively trained DBT clinicians completed an online quantitative survey (n = 79) and a subset were sequentially interviewed using qualitative methods (n = 20) to identify relationships between inner setting variables and DBT implementation. Four interpersonal variables—team cohesion, team communication, team climate, and supervision—were correlated with the quantity of DBT elements implemented. Qualitative themes corroborated these findings. Additional variables were connected to implementation by either quantitative or qualitative findings, but not both.
TL;DR: Results suggest that, for less-impaired youths with SED, less intensive options such as ICM may be equally effective to poor-quality wraparound delivered in the absence of wraparounds implementation supports and favorable system conditions.
Abstract: In this study, we compared service experiences and outcomes for youths with serious emotional disorder (SED) randomly assigned to care coordination via a defined wraparound process (n = 47) versus more traditional intensive case management (ICM; n = 46) The wraparound group received more mean hours of care management and services; however, there ultimately were no group differences in restrictiveness of residential placement, emotional and behavioral symptoms, or functioning. Wraparound implementation fidelity was found to be poor. Organizational culture and climate, and worker morale, were poorer for the wraparound providers than the ICM group. Results suggest that, for less-impaired youths with SED, less intensive options such as ICM may be equally effective to poor-quality wraparound delivered in the absence of wraparound implementation supports and favorable system conditions.
TL;DR: A multi-site effectiveness trial of CBT was conducted within the Texas public mental health system, and individuals receiving CBT showed greater improvements in depression symptoms than those in the comparison group.
Abstract: State mental health systems have been leaders in the implementation of evidence-based approaches to care for individuals with severe mental illness. Numerous case studies of the wide-scale implementation of research-supported models such as integrated dual diagnosis treatment and assertive community treatment are documented. However, relatively few dissemination efforts have focused on cognitive behavioral therapy (CBT) for individuals with major depression despite evidence indicating its efficacy with this population. A multi-site effectiveness trial of CBT was conducted within the Texas public mental health system. Eighty-three adults with major depression received CBT from community clinicians trained through a workshop and regular consultation with a master clinician. Outcomes were compared to a matched sample of individuals receiving pharmacotherapy. Outcome measures used included the quick inventory of depressive symptomatology and beck depression inventory. Individuals receiving CBT showed greater improvements in depression symptoms than those in the comparison group. Greater pre-treatment symptom severity predicted better treatment response, while the presence of comorbid personality disorders was associated with poorer outcomes.
TL;DR: It is proposed that high rates of mental health need and low service utilization among Latino immigrant families call for service models within non-specialty settings that build upon natural resources toward reducing risk factors and improving outcomes.
Abstract: By 2050, Latino school-aged youth are projected to outnumber their non-Latino white peers (Fry & Gonzales, 2008). One in every four youth below 18 has at least one foreign-born parent, with 37 % of 40 million foreign-born in the US of Latin American descent (Grieco et al., 2012). Despite the fact that immigrant mental health has been an urgent national priority for over a decade (Flores et al., 2002; Pumariega & Rothe, 2010), it appears clear that the community mental health system cannot address this alone (Bringewatt & Gershoff, 2010; Huang et al., 2005) and falls short of strengthening natural supports within communities (Alegrı́a et al., 2010). Barriers to medical care thwart specialty referrals (Flores et al., 2005; Beniflah et al., 2013), and a dearth of bilingual, culturally competent providers exacerbates slow dissemination of empirically supported treatments into community mental health settings (Stagman & Cooper, 2010). We propose that high rates of mental health need and low service utilization among Latino immigrant families (DeRose et al., 2007; Kataoka et al., 2002; RAND, 2001) call for service models within non-specialty settings that build upon natural resources toward reducing risk factors and improving outcomes. Mental Health Risk Factors for Immigrant Families
TL;DR: This randomized controlled implementation study compared the effectiveness of a standard versus enhanced version of the replicating effective programs (REP) implementation strategy to improve the uptake of the life goals-collaborative care model (LG-CC) for bipolar disorder.
Abstract: This randomized controlled implementation study compared the effectiveness of a standard versus enhanced version of the replicating effective programs (REP) implementation strategy to improve the uptake of the life goals-collaborative care model (LG-CC) for bipolar disorder. Seven community-based practices (384 patient participants) were randomized to standard (manual/training) or enhanced REP (customized manual/training/facilitation) to promote LG-CC implementation. Participants from enhanced REP sites had no significant changes in primary outcomes (improved quality of life, reduced functioning or mood symptoms) by 24 months. Further research is needed to determine whether implementation strategies can lead to sustained, improved participant outcomes in addition to program uptake.
TL;DR: Longer episode length predicted greater receipt of PDEB; older youth, males, and youth in out-of-home levels of care were more likely to receive PMES; and youth receiving an evidence-based treatment program were less likely to receiving PMES.
Abstract: Practice data from 74 therapists providing public mental health services to 519 youth ages 5–19 were examined. Multilevel modeling suggested child and therapist characteristics predicted use of practices derived from the evidence-base (PDEB) and use of practices with minimal evidence support (PMES). Longer episode length predicted greater receipt of PDEB; older youth, males, and youth in out-of-home levels of care were more likely to receive PMES; and youth receiving an evidence-based treatment program were less likely to receive PMES. Professional specialty and theoretical orientation significantly predicted PDEB whereas therapist characteristics did not predict PMES. Implementation implications are discussed.
TL;DR: Pleading evidence is provided that implementing the FCU in community mental health agencies has the potential to improve youth behavior outcomes and a pragmatic effectiveness–implementation hybrid trial of theFCU is conducted.
Abstract: This study reports the results of a pragmatic effectiveness–implementation hybrid trial of the Family Check-Up (FCU) conducted in three community mental health agencies with 40 participating therapists. Seventy-one families with children between 5 and 17 years of age participated. Intervention fidelity and level of adoption were acceptable; families reported high service satisfaction; and therapists reported high acceptability. Families in the FCU condition experienced significantly reduced youth conduct problems in comparison to usual care and completion of the FCU resulted in larger effects. This study provides promising evidence that implementing the FCU in community mental health agencies has the potential to improve youth behavior outcomes.
TL;DR: This study examines the implementation of two evidence-based psychotherapies, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), in the Department of Veterans Affairs residential Posttraumatic Stress Disorder treatment programs.
Abstract: This study examines the implementation of two evidence-based psychotherapies, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), in the Department of Veterans Affairs residential Posttraumatic Stress Disorder treatment programs. Two hundred and one providers from 38 programs completed an online survey concerning implementation of PE delivered on an individual basis and CPT delivered in individual and group formats. For PE, a supportive organizational context (dedicated time and resources, and incentives and mandates) and overall positive view of the treatment were related to its implementation. For both group and individual CPT, only the supportive organizational context was significantly associated with outcome. Implications for implementation efforts are discussed.
TL;DR: Findings revealed that providers tended to incorporate content from the EBT protocol in most treatment sessions, but that the sequencing of the sessions was often modified, suggesting that providers are amenable to evidence-based procedures, but not necessarily their prescribed arrangement.
Abstract: This study examined patterns of evidence-based treatment (EBT) implementation within community settings by evaluating integrity along separate dimensions of practice content (PC; a session included the prescribed procedure) and practice sequencing (a session occurred in the prescribed sequence) within a recent randomized effectiveness trial. We measured whether sessions showed integrity to PC and to flexible or linear practice sequences. Findings revealed that providers tended to incorporate content from the EBT protocol in most treatment sessions, but that the sequencing of the sessions was often modified, suggesting that providers are amenable to evidence-based procedures, but not necessarily their prescribed arrangement.
TL;DR: Improvements in social skills and reductions in problem behaviors lend support to after school programs as a space for mental health promotion.
Abstract: Leaders @ Play is a park after-school program for urban middle school youth designed to leverage recreational activities for social emotional learning. Mental health and park staff co-facilitated sports and games to teach and practice problem solving, emotion regulation, and effective communication. Additional practice occurred during multi-family groups and summer internships as junior camp counselors. We examined feasibility and promise via an open trial (n = 3 parks, 46 youth, 100 % African American, 100 % low-income, 59 % female, M = 13.09 years old). Improvements in social skills and reductions in problem behaviors lend support to after school programs as a space for mental health promotion.
TL;DR: Qualitative data was evaluated regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD) and leadership was associated with PE implementation and a lack of dedicated time and resources was viewed as a deterrent for both.
Abstract: This national investigation utilizes qualitative data to evaluate an implementation model regarding factors influencing provider use of two evidence-based treatments for posttraumatic stress disorder (PTSD). Semi-structured qualitative interviews with 198 mental health providers from 38 Department of Veterans Affairs’ (VA) residential treatment programs were used to explore these issues regarding prolonged exposure (PE) and cognitive processing therapy (CPT) in VA residential PTSD programs. Several unique and some overlapping predictors emerged. Leadership was viewed as an influence on implementation for both CPT and PE, while a lack of dedicated time and resources was viewed as a deterrent for both. Compatibility of CPT with providers’ existing practices and beliefs, the ability to observe noticeable patient improvement, a perceived relative advantage of CPT over alternative treatments, and the presence of a supportive peer network emerged as influential on CPT implementation. Leadership was associated with PE implementation. Implications for the design and improvement of training and implementation efforts are discussed.
TL;DR: The findings from this Gathering offer important lessons that can inform current work regarding strategies to achieve a balance of program fidelity and cultural-alignment and efforts to embed implementation within a consortium or learning community hold considerable promise as a strategy for sustainability.
Abstract: Implementation of Evidence-Based Practices (EBP) within American Indian and Alaskan Natives communities is currently an area of debate and contention. There is considerable concern about expanding EBP policy mandates to AI/AN communities as these mandates, either through funding restrictions or other de facto policies, recall past histories of clinical colonization and exploitation by the state and federal government. As a response, work is being done to evaluate indigenous programs and examine strategies for culturally-sensitive implementation. While the literature reflects the perspectives of AI/AN populations on EBP generally, no one has yet reported the perspectives of AI/AN communities on how to feasibly achieve widespread EBP implementation. We report the findings of a statewide Tribal Gathering focused on behavioral health interventions for youth. The Gathering participants included AI/AN individuals as well as staff working with AI/AN populations in tribal communities. Participants identified strengths and weaknesses of the five legislatively fundable programs for youth delinquency in Washington State and discussed strategies likely to be effective in promoting increased uptake within tribes. Analysis of these discussions resulted in many useful insights in program-specific and community-driven strategies for implementation. In addition, two major themes emerged regarding widespread uptake: the importance of a multi-phase engagement strategy and adopting a consortium/learning community model for implementation. The findings from this Gathering offer important lessons that can inform current work regarding strategies to achieve a balance of program fidelity and cultural-alignment. Attending to engagement practices at the governance, community and individual level are likely to be key components of tribal-focused implementation. Further, efforts to embed implementation within a consortium or learning community hold considerable promise as a strategy for sustainability.
TL;DR: Qualitative research is conducted to examine recent efforts in NM to establish a recovery-oriented behavioral healthcare system, focusing on comprehensive community support services, clinical homes, and core service agencies, and how sociopolitical factors can undermine implementation efforts and create crises within fragile behavioral healthcare systems.
Abstract: Since 1997, public-sector behavioral healthcare in New Mexico has remained under continual transition. We have conducted qualitative research to examine recent efforts in NM to establish a recovery-oriented behavioral healthcare system, focusing on comprehensive community support services, clinical homes, and core service agencies. We examine how decisions made in the outer context (e.g., the system level) shaped the implementation of each initiative within the inner context of service provision (e.g., provider agencies). We also clarify how sociopolitical factors, as exemplified in changes instituted by one gubernatorial administration and undone by its successor, can undermine implementation efforts and create crises within fragile behavioral healthcare systems. Finally, we discuss findings in relation to efforts to promote wraparound service planning and to establish medical home models under national healthcare reform.
TL;DR: “Over-placing” children in settings more restrictive than the algorithm recommended was associated with more severe baseline functioning but fewer significant results in rate of improvement than predicted by concordant decisions.
Abstract: After children enter the child welfare system, subsequent out-of-home placement decisions and their impact on children’s well-being are complex and under-researched. This study examined two placement decision-making models: a multidisciplinary team approach, and a decision support algorithm using a standardized assessment. Based on 3,911 placement records in the Illinois child welfare system over 4 years, concordant (agreement) and discordant (disagreement) decisions between the two models were compared. Concordant decisions consistently predicted improvement in children’s well-being regardless of placement type. Discordant decisions showed greater variability. In general, placing children in settings less restrictive than the algorithm suggested (“under-placing”) was associated with less severe baseline functioning but also less improvement over time than placing children according to the algorithm. “Over-placing” children in settings more restrictive than the algorithm recommended was associated with more severe baseline functioning but fewer significant results in rate of improvement than predicted by concordant decisions. The importance of placement decision-making on policy, restrictiveness of placement, and delivery of treatments and services in child welfare are discussed.
TL;DR: Grouping visits into episodes provides a clearer representation of how services are distributed over extended periods of time, facilitating research and enhancing accuracy in service planning.
Abstract: Criteria to define an episode of care in children’s mental health services are needed. Various criteria were applied to 5 years of visit data from children 4–11 years (N = 5,206) at their first visit to 1 of 3 children’s mental health agencies. A minimum of 3 visits with 180 days between episodes optimized agreement with other dates (e.g., telephone intake assessment) marking the start and end of an episode, and clinician-rated number of episodes. Grouping visits into episodes provides a clearer representation of how services are distributed over extended periods of time, facilitating research and enhancing accuracy in service planning.
TL;DR: While staff find the work emotionally demanding, they do not appear to be emotionally exhausted and report administrative rather than client issues as their primary concerns.
Abstract: Mental health work presents problems for staff over and above those encountered in other organisations, including other areas of healthcare. Healthcare workers, in particular mental health workers, have poorer job satisfaction and higher job burnout and turnover compared with established norms for other occupational groups. To make sense of why healthcare workers experience high levels of burnout, a strong body of literature points to the emotionally demanding nature of people-work. The negative effects of mental health work on employee health can be mitigated by the provision of appropriate job resources and wellbeing initiatives. As to develop initiatives that appropriately target staff sources of stress and needs, it is important to engage staff in this process. As such, Children and Young People’s Mental Health (CYPMH) and headspace Gosford, in Australia, New South Wales (NSW), developed a survey to identify how staff experience and manage the emotional demands of mental health work, what they identify as key stressors and which initiatives they would like to see implemented. Fifty-five staff (response rate of 73 %) completed the survey, and the results suggest that while staff find the work emotionally demanding, they do not appear to be emotionally exhausted and report administrative rather than client issues as their primary concerns. While a strong body of literature identifies the management of emotions in the workplace as a significant cause of stress, organisational stressors such as working in a bureaucratic environment are also important to understanding staff wellbeing.