Heard, known and safe in general practice? An interview study with patients with severe and persistent mental illness

BackgroundAlthough GPs provide care to many patients with severe and persistent mental illness, the role and skillset of the GP in this space are contested. Patients are less satisfied with GP care of mental health than physical health issues.AimTo explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice.Design & settingPatient participants were recruited from community mental health clinics in Brisbane, Australia.MethodIndividual semi-structured interviews were conducted with a convenience sample of patients. Interviews were audio-recorded and transcribed professionally. The authors conducted an inductive thematic analysis, attending to participant vulnerability and reflexivity.Results16 interviews were conducted by one author (RW), average duration 29 minutes. Three overarching themes were identified: being heard; being known; and being safe. Participants greatly valued ‘good GPs’ who were able to detect early signs of relapse, and with whom they came to feel heard, known and safe over time. Experiences of perfunctory, hurried care and avoidance of mental health issues were also reported. Many participants were uncertain whether GP training in mental health was sufficient to keep them safe. Patients may suspect negative attitudes to mental illness in GPs who actively engage predominantly with their physical health.ConclusionSome GPs play central roles in patients’ mental healthcare. Barriers for others need further exploration, and may include time, confidence and/or expertise. Findings challenge GPs to engage more actively and effectively with these patients in theirgeneral practice consultations.

Turnover and Retention Strategies Among Mental Health Workers

BackgroundThe purpose of this study was to explore retention strategies that healthcare administrators use to retain mental health workers in community mental health clinics. The study was guided by the question What strategies do HCAs use to retain their MHWs with more than 2 years of experience? MethodsA qualitative case study analysis was performed. Interviews were conducted with six healthcare administrators at Fort Worth area community mental health clinics. Interviews were coded using thematic analysis. To increase the study’s reliability and validity, the interview guide was field checked by experts and member checking performed on interview transcripts.ResultsThe healthcare administrators identified six strategies for retention: providing good benefits packages, promoting worker health and wellness, providing competitive salaries, giving workers flexible scheduling options, incentivizing workers with rewards and positive reinforcement, and maintaining open communication channels.ConclusionsThe results from this study have positive implications for mental health workers, patients, and community mental health clinics. The strategies identified in this study can be implemented to increase worker satisfaction and reduce turnover. In doing so, patients will receive higher quality care and organizations will be more attractive to prospective employees.

Turnover and Retention Strategies Among Mental Health Workers Debbie L. Youngdoctor of Business Administrationtrophy Club, Texas [email protected], (254) 421-4134orcid Id Https://orcid.org/0000-0001-6073-8160

PurposeThe purpose of this study was to explore retention strategies that healthcare administrators use to retain mental health workers in community mental health clinics. The study was guided by the question What strategies do HCAs use to retain their MHWs with more than 2 years of experience? MethodsA qualitative case study analysis was performed. Interviews were conducted with six healthcare administrators at Fort Worth area community mental health clinics. Interviews were coded using thematic analysis. To increase the study’s reliability and validity, the interview guide was field checked by experts and member checking performed on interview transcripts.ResultsThe healthcare administrators identified six strategies for retention: providing good benefits packages, promoting worker health and wellness, providing competitive salaries, giving workers flexible scheduling options, incentivizing workers with rewards and positive reinforcement, and maintaining open communication channels.ConclusionsThe results from this study have positive implications for mental health workers, patients, and community mental health clinics. The strategies identified in this study can be implemented to increase worker satisfaction and reduce turnover. In doing so, patients will receive higher quality care and organizations will be more attractive to prospective employees.

Agent-based modeling for implementation research: An application to tobacco smoking cessation for persons with serious mental illness

Background: Implementation researchers have sought ways to use simulations to support the core components of implementation, which typically include assessing the need for change, designing implementation strategies, executing the strategies, and evaluating outcomes. The goal of this article is to explain how agent-based modeling could fulfill this role. Methods: We describe agent-based modeling with respect to other simulation methods that have been used in implementation science, using non-technical language that is broadly accessible. We then provide a stepwise procedure for developing agent-based models of implementation processes. We use, as a case study to illustrate the procedure, the implementation of evidence-based smoking cessation practices for persons with serious mental illness (SMI) in community mental health clinics. Results: For our case study, we present descriptions of the motivating research questions, specific models used to answer these questions, and a summary of the insights that can be obtained from the models. In the first example, we use a simple form of agent-based modeling to simulate the observed smoking behaviors of persons with SMI in a recently completed trial (IDEAL, Comprehensive Cardiovascular Risk Reduction Trial in Persons with SMI). In the second example, we illustrate how a more complex agent-based approach that includes interactions between patients, providers, and site administrators can be used to provide guidance for an implementation intervention that includes training and organizational strategies. This example is based in part on an ongoing project focused on scaling up evidence-based tobacco smoking cessation practices in community mental health clinics in Maryland. Conclusion: In this article, we explain how agent-based models can be used to address implementation science research questions and provide a procedure for setting up simulation models. Through our examples, we show how what-if scenarios can be examined in the implementation process, which are particularly useful in implementation frameworks with adaptive components. Plain Language Summary: The goal of this paper is to explain how agent-based modeling could be used as a supplementary tool to support the components of complex implementation processes. Such models have not yet been widely used in implementation science, partly because they are not straightforward to develop. To promote the use of agent-based modeling we provide a stepwise procedure using non-technical language and emphasizing the relationships between the model and implementation processes. We used two detailed examples to demonstrate our proposed approach. In the first example, we simulate the observed smoking behaviors of persons with serious mental illness in a recently completed trial (IDEAL, Comprehensive Cardiovascular Risk Reduction Trial in Persons with Serious Mental Illness). In the second example, we illustrate how agent-based models that include interactions between patients, providers and site administrators can be used to provide guidance for an implementation intervention that includes training and organizational strategies. This example is based in part on an ongoing project focused on scaling up evidence-based tobacco smoking cessation practices in community mental health clinics in Maryland. For this example, we show how the visual user interface of an agent-based model can be in the form of a dashboard with levers for simulating what-if scenarios that can be used to guide implementation decisions. In summary, this paper shows how agent-based models can provide insights into the processes in complex interventions, and guide implementation decisions for improving delivery of evidence-based practices in community mental health clinics.

From Pandemic to Progression: An Educational Framework for the Implementation of Virtual Mental Healthcare for Children and Youth as a Response to COVID-19

COVID-19 restrictions have necessitated child/youth mental health providers to shift towards virtually delivering services to patients’ homes rather than hospitals and community mental health clinics. There is scant guidance available for clinicians on how to address unique considerations for the virtual mental healthcare of children and youth as clinicians rapidly shift their practices away from in-person care in the context of the COVID-19 pandemic. Therefore, we bridge this gap by discussing a six-pillar framework developed at Hospital for Sick Children (SickKids) in Toronto, Ontario, Canada, for delivering direct to patient virtual mental healthcare to children, youth and their families. We also offer a discussion of the advantages, disadvantages, and future implications of such services.

Efficacy of Attachment-Based Family Therapy compared to Treatment as Usual for Depressed Adolescents in Community Mental Health Clinics

Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship. Objective: To study the efficacy of ABFT compared with Treatment as Usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD. Method: Sixty adolescents, aged 13-18 years, with MDD referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were clinician-rated (Hamilton Depression Scale, HAMD) and self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms assessed at baseline and post-treatment by blinded evaluators for HAMD and at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks for BDI-II. Analyses were performed according to intent-to-treat principles. Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups ( X 2 [2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority of adolescents were still in the clinical range after 16 weeks of treatment. Conclusion: In this sample of adolescents treated for MDD in community mental health clinics, ABFT was not associated with more favorable outcomes than TAU in terms of remission rates on clinician rated and self-reported depressive symptoms. Remission and response rates were low in both groups, suggesting a need for continued improvement of the treatment methods. Trial Registration: Clinicaltrials.gov identifier: NCT01830088 https://clinicaltrials.gov/ct2/show/NCT01830088?term=Villab%C3%B8&draw=2&rank=1 Date of registration: April 12, 2013 Keywords: Depression, Adolescents, Attachment Based Family Therapy, Efficacy trial

Efficacy of Attachment-Based Family Therapy compared to Treatment as Usual for Depressed Adolescents in Community Mental Health Clinics

Background: Major Depressive Disorder (MDD) is a disabling mood disorder, profoundly affecting a large number of adolescent’s quality of life. To date, no obvious treatment of choice for MDD in adolescents is available and progress in the treatment of depressed adolescents will have important public health implications. Attachment-Based Family Therapy (ABFT), as the only empirically supported family therapy model designed to treat adolescent depression, aims to repair interpersonal ruptures and rebuild an emotionally protective parent-child relationship.Objective: To study the efficacy of ABFT compared with Treatment as Usual (TAU) delivered within child- and adolescent mental health services (CAMHS) to adolescents with MDD.Method: Sixty adolescents, aged 13-18 years, with MDD referred to two CAMHS were randomized to receive 16 weeks of ABFT or TAU. ABFT consisted of weekly therapy sessions (family/individual or both) according to the treatment manual. TAU was not monitored. Primary outcomes were clinician-rated (Hamilton Depression Scale, HAMD) and self-reported (Beck Depression Inventory-II, BDI-II) depressive symptoms assessed at baseline and post-treatment by blinded evaluators for HAMD and at baseline, and after 4, 6, 8, 10,12, 14, and 16 weeks for BDI-II. Analyses were performed according to intent-to-treat principles.Results: At post-treatment, clinician-rated remission rates on the HAMD (5 % in ABFT and 3.33% in TAU, p =1, OR=1.54, Fisher’s exact test) and self-reported symptoms of depression on the BDI-II did not differ significantly between groups (X2[2, N = 60] =0.06 , p = 0.97). In both treatment groups participants reported significantly reduced depressive symptoms, but the majority of adolescents were still in the clinical range after 16 weeks of treatment.Conclusion: In this sample of adolescents treated for MDD in community mental health clinics, ABFT was not associated with more favorable outcomes than TAU in terms of remission rates on clinician rated and self-reported depressive symptoms. Remission and response rates were low in both groups, suggesting a need for continued improvement of the treatment methods.