A Psychological Service Dedicated to Work-Related Stress: the Experience at Perugia General Hospital.

INTRODUCTION: The characteristics of the working environment significantly influence the mental well-being of workers, and the presence of unfavorable conditions in the workplace can have a negative impact on mental health. Healthcare professionals are particularly exposed to the risk of burnout and the development of psychiatric, and particularly affective, symptoms. This paper aims to describe the activity of a psychological support service dedicated to work-related stress at the General Hospital of Perugia, Italy. SUBJECTS AND METHODS: In June 2022, a free and anonymous psychological service dedicated to healthcare professionals was established at the Perugia General Hospital. The main objectives of the service were to promote overall well-being of workers, to provide psychological support, and to address professionals towards specific pathways to care. RESULTS: The activity of the service consisted of clinical consultations with psychiatrists and psychologists who also administered psychometric tools to better characterize the overall clinical picture. After the clinical evaluation process, healthcare professionals who accessed the service were addressed to specific pathways of care, when needed. The data collection carried out from June 2022 to April 2024 showed a total number of 139 accesses to the Service, with a majority of requests from women (80%) and mainly belonging to nursing staff (53%). CONCLUSIONS: Preliminary data from the psychological service dedicated to healthcare professionals confirms the high prevalence of work-related stress, especially in specific settings. In the near future, psychological support services are expected to identify work-related stress situations as soon possible, possibly contributing to the reduction of stigma and to the built of healthier working environments.

Improving the efficiency and person-centredness of occupational therapy input into care-plans in a forensic mental health and rehabilitation service.

Care-planning is vital to the delivery of timely, person-centred, safe and effective care. Despite the understanding of the benefits of person-centred care-plan in both services, occupational therapists (OTs) within our forensic and rehabilitation services had difficulties in inputting into patient care-plan an efficient and person-centred manner.The OT team developed a Quality Improvement (QI) project to improve the efficiency of the OT process to create more time for care-planning and improve person-centredness of OT input into care-plans to 82% in the forensic services and rehabilitation services by December 2023.The results indicated an increase in the person-centredness of care-plans from 63.64% to 84.34% within the rehabilitation service and an increase from 65.15% to 95.45% in the forensic service. This project used feedback from patients to develop our input into care-plans. The project also increased the efficiency of the admission process and released time to be spent on care-planning and treatment.We improved the quality of our input to care-plans in a sustainable way by using the Royal Academy of Improvement sustainability measure and taking actions which included training our band 6 and 7 OTs to complete their monthly audit and reporting this as part of the head of nursing report for assurance in our monthly Clinical and Operational Assurance Team meetings. These actions ensured that our project fitted with the organisation's strategic aims and values. We also used low carbon alternatives by holding most of our improvement meetings online and eliminating the use of paper.Lastly, we improved the generalisability of this project by using the Goal Directed Care Plan audit tool, which is a well-researched, evidence-based tool created by service-users, carers and members of staff. This was used to train members of staff and develop an example of a person-centred input into care-plans to improve their practice.

Current policy and practice for the identification, management, and treatment of postpartum anxiety in the United Kingdom: a focus group study.

BACKGROUND: Postpartum Anxiety [PPA] is a prevalent problem in society, posing a significant burden to women, infant health, and the National Health Service [NHS]. Despite this, it is poorly detected by current maternal mental health practices. Due to the current lack of appropriate psychometric measures, insufficiency in training of healthcare professionals, fragmentation of maternal mental healthcare policy and practice, and the magnitude of the effects of PPA on women and their infants, PPA is a critical research priority. This research aims to develop a clear understanding from key stakeholders, of the current landscape of maternal mental health and gain consensus of the needs associated with clinically identifying, measuring, and targeting intervention for women with PPA, in the NHS. METHODS: Four focus groups were conducted with a total of 21 participants, via Zoom. Data were analysed using Template Analysis. RESULTS: Analysis rendered four main themes: (1) Defining Postpartum Anxiety; (2) Postpartum Anxiety in Relation to other Mental Health Disorders; (3) Challenges to Measurement and Identification of Maternal Mental Health; and (4) An Ideal Measure of Postpartum Anxiety. CONCLUSIONS: Findings can begin to inform maternal mental healthcare policy as to how to better identify and measure PPA, through the implementation of a postpartum-specific measure within practice, better training and resources for staff, and improved interprofessional communication.

Measuring fidelity to manualised peer support for people with severe mental health conditions: development and psychometric evaluation of the UPSIDES fidelity scale.

BACKGROUND: Peer support workers provide support for people experiencing mental health conditions based on their own lived experience of mental health problems. Assessing fidelity to core ingredients of peer support is vital for successful implementation and intervention delivery. Modifications to its implementation are needed when scaling up to different socio-economic settings, raising further uncertainty about fidelity. As part of a large multi-centre study on peer support called Using Peer Support In Developing Empowering Mental Health Services (UPSIDES), we developed and evaluated the psychometric properties of the UPSIDES Fidelity Scale. METHODS: We constructed the fidelity scale based on an initial item pool developed through international expert consultation and iterative feedback. Scale refinement involved site-level expert consultation and translation, resulting in a service user-rated 28-item version and a peer support worker-rated 21-item version assessing receipt, engagement, enactment, competence, communication and peer support-specific components. Both versions are available in six languages: English, German, Luganda, Kiswahili, Hebrew and Gujarati. The scale was then evaluated at six study sites across five countries, with peer support workers and their clients completing their respective ratings four and eight months after initial peer support worker contact. Psychometric evaluation included analysis of internal consistency, construct validity and criterion validity. RESULTS: For the 315 participants, item statistics showed a skewed distribution of fidelity values but no restriction of range. Internal consistency was adequate (range α = 0.675 to 0.969) for total scores and all subscales in both versions. Confirmatory factor analysis indicated acceptable fit of the proposed factor structure for the service user version (χ2/df = 2.746; RMSEA = 0.084) and moderate fit for the peer support worker version (χ2/df = 3.087; RMSEA = 0.093). Both versions showed significant correlations with external criteria: number of peer support sessions; perceived recovery orientation of the intervention; and severity of illness. CONCLUSIONS: The scale demonstrates good reliability, construct and criterion validity, making it a pragmatic and psychometrically acceptable measure for assessing fidelity to a manualised peer support worker intervention. Recommendations for use, along with research and practical implications, are addressed. As validated, multi-lingual tool that adapts to diverse settings this scale is uniquely positioned for global application. TRIAL REGISTRATION: ISRCTN, ISRCTN26008944. Registered on 30 October 2019.

Integrating the Attachment, Regulation, and Competency Trauma-Informed Framework in Inpatient, Day Treatment, Partial Hospitalization,and Residential Treatment Settings.

Pediatric mental health needs are currently on the rise across all levels of care. The COVID-19 pandemic accentuated concerns within our mental health system, not only for those requiring care, but also for care providers. One particular area of concern is access to care for those that require acute care or crisis stabilization (eg, emergency department visits or stays on crisis stabilization units). The Attachment, Regulation, and Competency (ARC) approach, a flexible trauma-informed treatment framework, provides equitable and effective treatments for youth as well as systems to support health care professionals caring for these youth. Trauma-informed care, particularly that which incorporates restorative practices, increases equity for racially and ethnically minoritized youth and informs the creation of upstream, midstream, and downstream policy interventions.

The Role of the Medical Director and Psychiatric Medical Director in Child Welfare Serving Agencies.

Collaboration between the child welfare system and health care practitioners has become increasingly necessary in order to meet the often-significant health needs of system-involved youth. Child welfare medical directors and psychiatric medical directors have been implemented as a means to address this need in several state child welfare systems. Building on the core principles of the National Guidelines for Child and Youth Behavioral Health Crisis Care, medical and psychiatric medical directors can help ensure youth receive the least-restrictive, most appropriate level of behavioral health care; prioritizing care involvement with caregivers in community-based settings.

Patients' perception of the quality of psychiatric inpatient care in the Faroe Islands.

PURPOSE: Evaluating the quality of psychiatric care from the patient's perspective is crucial to measure the effectiveness of the provided care. This study aimed to translate the original Swedish Quality in Psychiatric Care - Inpatient (QPC-IP) instrument into Faroese, adapting it to the specific context of psychiatric inpatient care in the Faroe Islands, conducting a detailed evaluation of its psychometric properties, and to describe patients' perception of quality of psychiatric care. MATERIALS AND METHODS: Following a thorough translation and back-translation, the content validity of the Faroese QPC-IP was confirmed by a group of Faroese patients. Subsequently, the instrument was completed by 61 psychiatric inpatients. RESULTS: Item total correlations revealed that most items strongly correlated with their intended dimensions, mirroring the original Swedish version. However, a noteworthy exception was found in the discharge dimension, leading to the exclusion of an item related to helping find an occupation; this task was not performed by the ward. While the internal consistency of the overall scale was excellent, specific dimensions exhibited lower consistency. CONCLUSIONS: The translation and cultural adaptation of the Faroese QPC-IP proved satisfactory. The psychometric evaluation affirmed a shared understanding of the quality of psychiatric care in both Faroese and Swedish cultural contexts. As a result, the Faroese QPC-IP emerges as a valuable instrument for assessing the quality of psychiatric care in the Faroe Islands. Its utility extends to quality assurance initiatives and contributes to cross-cultural research examining the quality of psychiatric care from the patient's perspective.

Protocols for transitioning to adult mental health services for adolescents with ADHD.

BACKGROUND: For Attention Deficit/Hyperactivity Disorder (ADHD) youth transitioning from child to adult services, protocols that guide the transition process are essential. While some guidelines are available, they do not always consider the effective workload and scarce resources. In Italy, very few guidelines are currently available, and they do not adhere to common standards, possibly leading to non-uniform use. METHODS: The present study analyzes 6 protocols collected from the 21 Italian services for ADHD patients that took part in the TransiDEA (Transitioning in Diabetes, Epilepsy, and ADHD patients) Project. The protocols' content is described, and a comparison with the National Institute for Clinical Health and Excellence (NICE) guidelines is carried out to determine whether the eight NICE fundamental dimensions were present. RESULTS: In line with the NICE guidelines, the dimensions addresses in the 6 analyzed documents are: early transition planning (although with variability in age criteria) (6/6), individualized planning (5/6), and the evaluation of transfer needs (5/6). All protocols also foresee joint meetings between child and adult services. The need to include the families is considered by 4 out of 6 protocols, while monitoring (2/6), and training programs (1/6) are less encompassed. In general, a highly heterogeneous picture emerges in terms of quality and quantity of regulations provided. CONCLUSIONS: While some solid points and core elements are in common with international guidelines, the content's variability highlights the need to standardize practices. Finally, future protocols should adhere more to the patients' needs and the resources available to clinicians.

Gender identity services for children and young people: navigating uncertainty through communication, collaboration and care.

This editorial describes the Cass Review findings and the extraordinary challenge we all face in managing uncertainty amid a toxic and highly polarised debate. Children and young people will only get the best care if patients and professionals join forces to seek answers collaboratively and respectfully.

Nurses' perceptions of involving family members in the care of mental health care users.

BACKGROUND:  Family involvement in mental health care is a therapeutic intervention in the management of mental illness. The global concern in long-term mental health is that families find it difficult to accept mental illness when their loved ones are admitted to receive care, treatment and rehabilitation. OBJECTIVES:  To describe nurses' perceptions of involving family members in the care of mental health care users in long-term institutions. METHOD:  A quantitative descriptive design was used. The population comprised nurses working at three mental health institutions (MHIs). Probability simple random sampling was used to select 360 respondents. Data were collected using self-administered questionnaires. RESULTS:  The findings revealed that most (86.9%) of the nurses acknowledged that challenges affect families' involvement in mental health care. A total of 91.4% of nurses complained that family members' involvement was insufficient and (80.6%) indicated that poor family contact affects the provision of quality mental health care. Therefore, the respondents believed that the families' involvement has an impact on the management of mental illness. CONCLUSION:  Engaging family members in mental health care helps both health professionals and families to participate in patient-centred care and mental health care services. However, MHCUs benefit when their families are involved.Contribution: The study contributed to mental health nursing as its results can be used to measure the quality of health services improvements, by involving the family members during hospitalisation of their loved ones for mental health care.

International declaration on rural mental health research: 10 guiding principles and standards.

Rural communities have unique mental health needs and challenges which are often related to the uniqueness of the community itself. On a per-capita basis, the investment in rural mental health research is far less than that in urban communities. Added to this, rural communities are often at risk of researchers, based in large urban universities, visiting, conducting the research with minimal engagement with local stakeholders and limited understanding of the community's social-service-environmental context. Often this research leaves no visible benefit to the community with respect to increased knowledge, resources or community capacity. This commentary is based on the insights of a panel of authors from 9 countries, each with extensive experience of rural mental health research and work. And it seeks to stimulate the discourse on responsible rural mental health practice. The aim of this commentary is to provide a reference on research practice for novice and experienced researchers on rural mental health research and practice, to assist policymakers, government and funding bodies to establish appropriate standards and guidelines for rural mental health research, and support rural communities to advocate for equity of funding and sustainable research as they engage with researchers, funders and governments. The 10 standards in this declaration will help guide researchers toward research that is beneficial to rural communities and also help develop the local community's research capability, which ultimately will serve to enhance the mental health and well-being of rural communities.

Development and implementation determinants of competency frameworks for mental health clinicians and service providers working with youth: a scoping review protocol.

INTRODUCTION: Despite high prevalence, access to mental healthcare for Canadian youth is limited, with less than 20% receiving adequate treatment. Marginalised and at-risk youth face particular challenges, including cultural misunderstandings, long wait times and negative care experiences. A competency framework for mental health clinicians working with youth can be a tool to increase the capacity of the health workforce to deliver culturally responsive care. This scoping review aims to comprehensively summarise the existing literature on competency frameworks for mental health clinicians and youth service providers, assessing how these frameworks align with culturally responsive care and examining their development, evaluation and implementation methods. METHODS AND ANALYSIS: This review protocol is guided by the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines and registered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/EY7NF). The search strategy, developed with an Information Specialist, comprises a three-step process: preliminary searches in two databases, expansion of the search across Medline, CINAHL, EMBASE, PsycInfo, CENTRAL and dissertations and theses databases and examination of reference lists and hand-searching for additional sources. The search strategy was reviewed using the Peer Review of Electronic Search Strategies checklist. Eligible English language articles will be selected through title and abstract screening (level 1) and full-text review (level 2). The search dates are 18 July and 21 August 2023, as well as 19 January 2024. Data from eligible articles will be extracted in duplicate and independently using a data extraction form. The data will then be summarised descriptively and qualitatively using content analysis mapped to the four evidence-based conceptual frameworks and presented in a table. ETHICS AND DISSEMINATION: As the scoping review involves gathering and describing existing literature, it is exempt from ethical approval requirements. The findings of this scoping review will be presented at relevant local and international conferences and published in a peer-reviewed journal. The findings will also be disseminated and shared with professional organisations to enhance healthcare workforce capacity and drive systemic change. Furthermore, the findings will be used to inform doctoral work and future mental health and health education research related to underserved youth.

Multidimensional Approaches to Quality Measurement and Performance Improvement in the Ideal Crisis System.

This work expands on the National Council for Mental Wellbeing whitepaper Quality Measurement in Crisis Services. The authors present 2 approaches to measure development: The first maps flow through the crisis continuum and defines metrics for each step of the process. The second uses the mnemonic ACCESS TO HELP to define system values, from the perspective of various stakeholders, with corresponding metrics. The article also includes case examples and discusses how metrics can align multiple components of a crisis system toward common goals, strategies for using metrics to drive quality improvement initiatives, and the complexities of measuring and interpreting data.

Mapping review of 'proof-of-concept' in mental health implementation research using the TRL framework: a need for a better focus and conceptual clarification.

BACKGROUND: Proof-of-concept (PoC) development is a key step in implementation sciences. However, there is a dearth of studies in this area and the use of this term in health and social sciences is ambiguous. OBJECTIVE: The objective was to remove the ambiguity surrounding the PoC and pilot study stage in the research development process using a standard system to rate the development of projects and applications provided by the Technology Readiness Levels (TRL) framework. DESIGN: Mapping review and critical analysis using TRL as the standard measure. SEARCH STRATEGY AND CHARTING METHOD: PubMed and PsycInfo databases were searched for papers that reported PoC studies of mental health interventions up to August 2023. Data were extracted, described and tabulated. ELIGIBILITY CRITERIA: Included were PoC studies in mental health implementation research. Exclusion criteria were research relating to biomedical (drugs) development, neurocognitive tools, neuropsychology, medical devices, literature reviews or discussion papers or that did not include the term 'proof-of-concept' in the title, abstract or text. RESULTS: From the 83 citations generated from the database search, 22 studies were included in this mapping review. Based on the study title, abstract and text, studies were categorised by research development stage according to the TRL framework. This review showed 95% of the studies used PoC incorrectly to describe the development stage of their research but which were not at this specific level of project development. CONCLUSIONS: The TRL was a useful reference framework to improve terminological clarity around the term 'proof-of-concept' in implementation research. To extend the use of TRL in implementation sciences, this framework has now been adapted and validated to a health and social science-related research context accompanied by a health-related glossary of research process terms and definitions to promote a common vocabulary and shared understanding in implementation sciences.

Validating a Pragmatic Measure of Evidence-Based Practice (EBP) Delivery: Therapist Reports of EBP Strategy Delivery and Associations with Child Outcome Trajectories.

Pragmatic measures of evidence-based practice (EBP) implementation can support and evaluate implementation efforts. We examined the predictive validity of therapist reports of EBP strategy delivery for children's mental health outcomes. Data were obtained from 1,380 sessions with 248 children delivered by 76 therapists in two county systems. Children (Mage=11.8 years, SD = 3.7) presented with internalizing (52%), externalizing (27%), trauma (16%), and other (5%) concerns. Therapists reported their delivery of EBP strategies on a revised version of the EBP Concordant Care Assessment (ECCA; Brookman-Frazee, et al., Administration and Policy in Mental Health and Mental Health Services Research, 48, 155-170, 2021) that included 25 content (e.g., parenting, cognitive behavioral) and 12 technique strategies (e.g., modeling, practice/role-play). On average, 5.6 ECCA session reports (SD = 2.3) were obtained for each client, and caregivers reported symptoms on the Brief Problem Checklist (Chorpita, et al., Journal of Consulting and Clinical Psychology, 78(4), 526-536, 2010) at baseline, weekly over two months, and again at four months. Multilevel models examined whether the mean extensiveness of each EBP strategy predicted trajectories of child outcomes. More individual technique (6 of 12) than content strategies (1 of 25) were associated with outcome trajectories. For techniques, more extensive use of Performance Feedback and Live Coaching and less extensive use of Addressing Barriers were associated with greater declines in total symptoms, and more extensive use of Establishing/Reviewing Goals, Tracking/Reviewing Progress, and Assigning/Reviewing Homework was associated with declines in externalizing symptoms. For content, more extensive use of Cognitive Restructuring was associated with declines in total symptoms. In addition, higher average extensiveness ratings of the top content strategy across sessions was associated with greater declines in total and externalizing symptoms. Therapist-reported delivery of some EBP strategies showed evidence of predictive validity and may hold utility in indexing quality of care.

Assessment of Navy Provider Knowledge of Women's Mental Health Services, Treatment Practices, and Training.

INTRODUCTION: As female active duty populations increase in all military environments, it is critical that women's health be addressed in a comprehensive manner. The study's results will be utilized to assist Navy health care leaders in addressing female force readiness policies, treatment gaps, and training specific to women's mental health. MATERIALS AND METHODS: In total, 212 active duty participants were recruited from the Navy's mental health specialties. The survey was hosted on the U.S. Government's MAX.gov survey website and received Institutional Review Board and Survey Review Board approval per Navy and Defense Health Agency requirements. Participants recorded their experiences with various patient presentations using Likert scale assessments, indicated their comfort in prescribing medication to patients with 11 distinct presenting concerns, and responded to six questions regarding their training and clinical experience in the field of women's mental health. RESULTS: Differences were noted for provider gender, treatment setting, patient sex, provider rank, and years of independent practice. Female providers were more likely than males to report that their female patients presented with 15 of the 21 measured issues. Providers located at MTFs were significantly more likely than providers in operational billets to report female patients presenting with certain conditions and reported being more comfortable prescribing medication. Eighty percent of respondents authorized to prescribe medicine rated themselves as very or extremely comfortable prescribing medications to their patients for all specified conditions except two: women who are breastfeeding and women who are pregnant. Senior officers reported the most comfort prescribing medication to women who are planning to become pregnant and women who have experienced perinatal loss. Only a minority of providers (20%, female; 33%, males) reported receiving women's mental health education during their training. Of those who did receive training, it was limited to post-partum and pregnancy. Most participants (93%) agreed that women's mental health should be incorporated into training programs for military providers. CONCLUSIONS: This exploratory study highlights that provider variables impact assessment and treatment of and for patients. The study highlights the interplay of gender, treatment setting, experiences, and level of comfort are associated with provider assessment of presenting concerns. The authors hope this study will help in prioritizing women's mental health practices, mental health training, and research, and in informing policy and decision-making.