Plano de Ação Regional da Rede de Atenção Psicossocial: Tocantins - Macrorregião Norte / Regional Action Plan of the Psychosocial Care Network: Tocantins - North Macroregion

Trata de um documento que aborda a ampliação do acesso à atenção psicossocial da população da Macrorregião de Saúde Norte no Estado do Tocantins. Tem os objetivos de dimensionar os vazios assistenciais; propor novos pontos da Rede de Atenção Psicossocial; Definir e organizar a Rede de Atenção Psicossocial. Alcança as metas de: Implantar 13 novos serviços dos componentes da Rede de Atenção Psicossocial na Macrorregião Norte nos próximos dois anos e de qualificar trabalhadores da Rede de Atenção Psicossocial.

It deals with a document that addresses the expansion of access to psychosocial care for the population of the Northern Health Macroregion in the State of Tocantins. It has the objectives of dimensioning the gaps in care; propose new points of the Psychosocial Care Network; Define and organize the Psychosocial Care Network. It achieves the goals of: Implementing 13 new services from the components of the Psychosocial Care Network in the North Macro-region over the next two years and qualifying workers in the Psychosocial Care Network.

Se trata de un documento que aborda la ampliación del acceso a la atención psicosocial de la población de la Macrorregión de Salud Norte del Estado de Tocantins. Tiene los objetivos de dimensionar las brechas en la atención; proponer nuevos puntos de la Red de Atención Psicosocial; Definir y organizar la Red de Atención Psicosocial. Logra las metas de: Implementar 13 nuevos servicios de los componentes de la Red de Atención Psicosocial en la Macrorregión Norte en los próximos dos años y calificar a los trabajadores de la Red de Atención Psicosocial.

Increasing Psychiatric Rehabilitation Knowledge in a Supported Housing Setting: Pre- and Posttest Analysis.

The current study investigated the effectiveness of a state-wide Community Support Services training grounded in work-based learning to improve knowledge about psychiatric rehabilitation principles and skills. Supervisory staff and direct care staff in supported housing settings completed a 17-item, multiple choice, preand posttest after attending a 48-hour training series. Results indicated that participants gained psychiatric rehabilitation knowledge. These findings support the effectiveness of the training series grounded in work-based learning. [Journal of Psychosocial Nursing and Mental Health Services, 57(6), 39-44.].

Behavioral health workforce development challenges in the digital health era.

TOPIC: This column describes challenges for hiring, training, and supervising psychiatric rehabilitation service providers for positions that involve the use of digital health technology. PURPOSE: Adoption and implementation of any new technology or technique requires workforce development. This article outlines considerations for policymakers, funders, and service agency administrators as digital health technologies become more widespread. SOURCES USED: The article discusses issues based on professional experience of the authors and available literature. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The literature on adoption of innovations in general, and the adoption of psychiatric evidence-based practices in particular, indicates that funding and adoption of new techniques and technologies are not adequate to ensure full and sustained implementation. The use of any new treatment or technology requires training and other supports to ensure that users have the competencies needed to make it work and that the workplace supports its use. As new digital health technologies become available, considerations of their cost and effectiveness need to include an examination of the required competencies of the service providers who will use them and the added cost of developing, enhancing, and maintaining those competencies. Specific attitudes, knowledge, and skills will be relevant to hiring decisions. Relevant preservice and on-the-job training opportunities, technical assistance, and supervision will be needed. Implementation needs to be monitored, not assumed, and the rights of the people who use technology-supported services must be fully protected. (PsycINFO Database Record

The long road from policy to practice.

TOPIC: As behavioral health care policies evolve, based on shifting paradigms and a developing base of evidence, day-to-day practices at the direct service level must change. Workforce development initiatives are a critical component to effect such change yet may be overlooked, underfunded, or implemented in ways that are ineffective. PURPOSE: This article highlights considerations for training focused on policy, for training issues relevant across recent policy initiatives, and components of effective workforce development initiatives. SOURCES USED: Sources include the personal experience of the authors and the available literature on education, training, and workforce development, as well as select references related to policy initiatives in psychiatric rehabilitation and behavioral health care. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Until policy initiatives include the necessary funding for and guidance on evidence-based workforce development, they are unlikely to achieve their full promise. (PsycINFO Database Record

A multidisciplinary learning experience contributing to mental health rehabilitation.

Purpose People who access health services often have a range of needs that require the involvement of members from a multidisciplinary team. Teaching future health professionals about the importance of a multidisciplinary approach can be challenging. The aim of this paper is to describe a project called Recovery Camp that enhanced multidisciplinary health education through experiential and immersive engagement with people experiencing mental illness. Method Future health professionals and people with a lived experience of mental illness took part in Recovery Camp - an innovative five-day therapeutic recreation initiative in the Australian bush. Results are presented in a case study format and provide the reflective quotes of participants. The quotes were analyzed using a content analysis to identify core concepts. Results Analyses identified a common appreciation of multidisciplinary learning. The interactions among students and between students and consumers, promoted inter-professional practice and a holistic understanding of mental health care. Conclusions An immersive multidisciplinary approach, embedded within a recovery-based programme, enhances students' understanding of the significance of multidisciplinary mental health care and treatment. Implications for Rehabilitation People with a lived experience of mental illness have a range of complex needs that require involvement of members from a multidisciplinary rehabilitation team. This study suggested a multidisciplinary, experiential, immersive health education experience - drawing on the principles of therapeutic recreation - can promote inter-professional rehabilitative practice and an appreciation for holistic mental health care.

Rapid realist review of the evidence: achieving lasting change when mental health rehabilitation staff undertake recovery-oriented training.

AIM: The aim of this study was to identify the factors contributing to lasting change in practice following a recovery-based training intervention for inpatient mental health rehabilitation staff. BACKGROUND: Staff training may help nurses and other staff groups in inpatient mental health rehabilitative settings to increase their recovery-oriented practice. There are no published reviews on the effectiveness of such training and few long-term evaluations. This review informed a realist evaluation of a specific intervention (GetREAL). DESIGN: Rapid realist review methodology was used to generate and prioritize programme theories. DATA SOURCES: ASSIA, CINAHL, Cochrane Library, Medline, PsycINFO, Scopus, Web of Science and grey literature searches were performed in September 2014-March 2015 with no date restrictions. Stakeholders suggested further documents. GetREAL project documentation was consulted. REVIEW METHODS: Programme theory development took place iteratively with literature identification. Stakeholders validated and prioritized emerging programme theories and the prioritized theories were refined using literature case studies. RESULTS: Fifty-one relevant documents fed into 49 programme theories articulating seven mechanisms for lasting change. Prioritized mechanisms were: staff receptiveness to change; and staff feeling encouraged, motivated and supported by colleagues and management to change. Seven programme theories were prioritized and refined using data from four case studies. CONCLUSION: Lasting change can be facilitated by collaborative action planning, regular collaborative meetings, appointing a change agent, explicit management endorsement and prioritization and modifying organizational structures. Conversely, a challenging organizational climate, or a prevalence of 'change fatigue', may block change. Pre-intervention exploration may help identify any potential barriers to embedding recovery in the organizational culture.

Recovery-based staff training intervention within mental health rehabilitation units: a two-stage analysis using realistic evaluation principles and framework approach.

BACKGROUND: Long-term change in recovery-based practice in mental health rehabilitation is a research priority. METHODS: We used a qualitative case study analysis using a blend of traditional 'framework' analysis and 'realist' approaches to carry out an evaluation of a recovery-focused staff training intervention within three purposively selected mental health rehabilitation units. We maximised the validity of the data by triangulating multiple data sources. RESULTS: We found that organisational culture and embedding of a change management programme in routine practice were reported as key influences in sustaining change in practice. The qualitative study generated 10 recommendations on how to achieve long-term change in practice including addressing pre-existing organisational issues and synergising concurrent change programmes. CONCLUSIONS: We propose that a recovery-focused staff training intervention requires clear leadership and integration with any existing change management programmes to facilitate sustained improvements in routine practice.

Knowledge and attitudes of Irish Mental Health Professionals to the concept of recovery from mental illness - five years later.

WHAT IS KNOWN ABOUT THE SUBJECT?: The Advancing Recovery in Ireland (ARI) project (Health Service Executive, 2012) promotes recovery-orientated services. A previous study of Irish mental health practitioners (Cleary & Dowling ) identified the need to improve knowledge and attitudes towards recovery. To facilitate implementation of ARI and monitor progress, this study provided a 'benchmark' of current knowledge and attitudes to recovery. WHAT THIS STUDY ADDS TO EXISTING KNOWLEDGE?: The study provides important baseline information on recovery knowledge and attitudes which can be used to assess the impact of the ARI Project. It also provides valuable information that can be compared to recovery approaches employed in other countries. Despite the increased emphasis on recovery in Ireland, knowledge and attitudes of health care practitioners towards recovery remain relatively unchanged between 2007 and 2013. Working in dual settings, being a non-nurse, and training was associated with better RKI scores. Training appears to be the strongest factor in predicting better recovery knowledge. The findings suggest that knowledge levels and attitude changes following education may not be sustained over time and ongoing training may be required. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is considerable scope to improve recovery knowledge. Key recommendations include the need for more recovery training, evaluate whether training translates into clinical practice, using 'Recovery Champions', introducing peer support workers and developing local policies and protocols to support recovery practice. ABSTRACT: Introduction A study of Irish mental health practitioners (Cleary & Dowling ) identified the need to improve knowledge and attitudes towards recovery. This led to the Advancing Recovery in Ireland Project (ARI) which promoted recovery-orientated services and a need to 'benchmark' progress. There is little evidence regarding the types of educational interventions that maintain positive recovery knowledge and attitudes in providers. Aim The study assessed current knowledge and attitudes to recovery. Methods The methodology of Cleary & Dowling () was replicated. A survey was administered to practitioners (n = 337) using the adapted Recovery Knowledge Inventory (RKI) (Cleary & Dowling ). Results No significant differences were found in recovery scores compared to Cleary & Dowling () or by level of experience. Working in dual settings, being a non-nurse, and training was associated with better recovery scores. Significantly more respondents had received training in recovery (40% versus 23%) compared to Cleary & Dowling (). Training appears to be the strongest factor predicting better recovery knowledge. Conclusions There is considerable scope to improve recovery knowledge. Key recommendations include the need for more recovery training, using 'Recovery Champions', introducing peer support workers and developing local policies and protocols to support recovery working.

Feasibility and effectiveness of a combined individual and psychoeducational group intervention in psychiatric residential facilities: A controlled, non-randomized study.

This controlled, non-randomized study explored the feasibility of introducing a Combined Individual and Group Intervention (CIGI) for users with mental disorders in residential facilities, and tested whether users who received the CIGI had better functioning than users who received the Treatment-As-Usual (TAU), at two-year follow up. In the CIGI, a structured cognitivebehavioral approach called VADO (in English, Skills Assessment and Definition of Goals) was used to set specific goals with each user, while Falloon's psychoeducational treatment was applied with the users as a group. Thirty-one professionals attended a training course in CIGI, open to users' voluntary participation, and applied it for two years with all users living in 8 residential facilities of the Mental Health Department of Modena, Italy. In the same department, 5 other residential facilities providing TAU were used as controls. ANOVA for repeated measures showed a significant interaction effect between users' functioning at baseline and follow up assessments, and the intervention. In particular, change in global functioning was higher in the 55 CIGI users than in the 44 TAU users. These results suggest that CIGI can be successfully introduced in residential facilities and may be useful to improve functioning in users with severe mental disorders.

Using incentives for training participation.

TOPIC: This column describes how public partners can help incentivize participation in training. Specifically, a state mental health agency and its implementation center applied financial and nonfinancial incentives to encourage participation in training and implementation supports. PURPOSE: Although training is not sufficient to change practice, it is a necessary first step in implementing evidence-based treatments. Finding ways to incentivize participation, particularly strategies with minimal resource involvement, is important for the psychiatric rehabilitation workforce and cash-strapped public systems. SOURCES USED: This description draws from published material and experiences from New York State. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Engaging public partners to incentivize training can significantly increase participation in training. Incentive programs exist that do not require additional funding-an important consideration, given the fiscal climate for most public payers.

Capacity, commitment, and culture: The 3 Cs of staff development in a learning organization.

TOPIC: If an agency desires changes in practice and a consistent approach to services, psychiatric rehabilitation staff development requires more than a single session of training. PURPOSE: This column describes one agency's approach to a comprehensive staff training and development program, designed to enhance the 3 Cs of capacity, commitment, and culture. SOURCES USED: The program described has been in place, with frequent adjustments, for over 20 years, and the experiences of the authors and their colleagues form the primary source for the paper. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Staff development requires an ongoing investment--competency-based training, supervision congruent with the service vision and mission, accountability through performance evaluation, and opportunities for growth. We have a firm belief that our employees learn to treat others, in part, from how they are treated by our agency leadership.

Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial.

BACKGROUND: We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training intervention to improve patient engagement in activities in inpatient mental health rehabilitation units. Concurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units and the contextual issues that may have influenced the effectiveness of the intervention. METHOD: We conducted focus groups with staff working in the inpatient units that received the intervention, sampled using a maximum variation strategy. RESULTS: The intervention was accepted by staff. However, the skills gained, and changes to the unit's processes and structures that were agreed with the intervention team were not sustained after they left. The main reasons for this were a) external factors (economic recession, resource limitations); b) organisation level factors (lack of senior staff support; competing priorities); c) limitations of the intervention itself (length of intensive training period; reinforcement of skills). CONCLUSION: This study illustrates some of the inter-related factors which operate at different levels within and outside of NHS organisations that may impact on the success of complex interventions. These factors need to be considered when designing interventions to ensure adequate buy-in from senior staff. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25898179 (Registered 23 April 2010).

Using distance technologies to facilitate a learning collaborative to implement stagewise treatment.

OBJECTIVE: This report describes experiences and outcomes of an online learning collaborative focused on implementation of stagewise treatment. METHODS: Eleven participating programs convened online monthly for a year. Between meetings, program staff created an implementation plan and programs collected performance indicator data, including assessment of staff knowledge of integrated treatment for people with co-occurring disorders, whether a person's current stage of treatment was documented in his or her chart, and whether the treatments were appropriate for the stage of treatment. Descriptive statistics were used to characterize performance indicators and feedback. Wilcoxon matched-pairs signed-rank tests examined changes in performance indicators over time. RESULTS: Program staff generally demonstrated significant improvements in performance indicators over time and rated the distance learning collaborative favorably. CONCLUSIONS: Distance learning collaboratives can be structured to provide opportunities for program staff to interact and learn from one another and to implement and sustain changes.

Serviços substitutos na perspectiva da reabilitação psicossocial: relato de experiência / Substitute services from the perspective of psychosocial rehabilitation: an experience report / Servicios sustitutivos en la perspectiva de la rehabilitación psicosocial: un relato de experiencia

No Brasil, uma longa tradição contribuiu para institucionalizar o estigma e o isolamento social do indivíduo em sofrimento psíquico, mas a partir do processo de reforma psiquiátrica, estabelecendo a modalidade de atenção psicossocial por meio de uma rede de serviços substitutivos que inclui os centros de atenção psicossocial (CAPS). Assim, a partir da vivência acadêmica extracurricular em serviços substitutivos prestados pelo Programa de Educação Tutorial em saúde mental (PET) saúde mental, crack e outras drogas, este estudo tem como objetivo relatar a experiência de estágio em um Centro de Atenção Psicossocial II da cidade de Pelotas. Esses estágios acontecem uma vez por semana e são supervisionados por profissionais da área. Durante a prática foi seguida a rotina do local, incluindo oficinas terapêuticas, visitas de enfermagem, grupos de familiares e outras atividades. Com base nas necessidades e interesses dos usuários e profissionais, foram desenvolvidas estratégias de suporte à equipe. Esta experiência permite-nos conhecer o funcionamento de serviços substitutivos e certificar que o atendimento qualificado deve ser com liberdade. Além disso, temos a oportunidade de contribuir com a equipe, de estabelecer uma relação positiva com os usuários e familiares e de formular procedimentos para melhorar a qualidade de vida dos envolvidos.

In Brazil, a long tradition contributed to institutionalizing the stigma and social isolation of the individual in psychological distress, but from the process of psychiatric reform, establishing the mode of psychosocial care through a network of substitute services including the psychosocial care centers (CAPS). Thus, from academic extracurricular experience in substitute services provided by mental health Tutorial Educational Program (PET) mental health, crack and other drugs, this study aims at reporting the internship experience in a Psychosocial Care Center II of the city of Pelotas. These internships take place once a week and they are supervised by professional workers. During the practice the routine of the place was followed, including therapeutic workshops, Nursing visitation, family groups and other activities. Based on the needs and interests of users and professionals strategies to support the team were developed. This experience allows us to know the functioning of substitute services and to certify that qualified care should be with freedom. In addition, we have the opportunity to contribute to the team, to establish a positive relationship with users and families and to formulate procedures to improve the quality of life of those involved.

En Brasil, por mucho tiempo una tradición institucionalizante contribuyó para el estigma y aislamiento social del sujeto en sufrimiento psíquico, pero a partir del proceso de reforma psiquiátrica, se instituyó el modo de atención psicosocial a través de una red de servicios sustitutivos, entre ellos, los Centros de Atención Psicosocial (CAPS). Así, este estudio tiene el objetivo de relatar la experiencia de prácticas en un Centro de Atención Psicosocial II del municipio de Pelotas , a partir de la experiencia académica extracurricular en los servicios sustitutivos proporcionada por el Programa de Educación Tutorial (PET) salud mental, crack y otras drogas. Las prácticas suceden una vez por semana y son supervisadas por profesionales del servicio. Durante la práctica acompañamos la rutina del local, incluyendo oficinas terapéuticas, consultas de enfermería, grupo de familiares entre otras actividades del servicio y a partir de las necesidades e intereses de los profesionales y usuarios elaboramos estrategias de apoyo al equipo. Esa experiencia nos permite conocer el funcionamiento de los servicios sustitutivos y certificarnos de que el cuidado calificado debe ser en libertad. Además, nos da la oportunidad de contribuir con el equipo, establecer un vínculo positivo con los usuarios y familiares y formular estrategias de actuación que mejore la calidad de vida de los actores involucrados.

Visita domiciliar no atendimento a usuários de um centro de atenção psicossocial: relato de experiência / Home visit in the care of users in a psychosocial care center: an experience report / Visita domiciliaria en el cuidado a usuarios en un centro de atención psicosocial: relato de experiencia

Este artigo tem como objetivo relatar a experiência acadêmica do curso de enfermagem de um Centro de Atenção Psicossocial (CAPS) por meio de visita domiciliar. O CAPS é um serviço de base comunitária que atende pessoas com transtorno mental e seus familiares, em que a inclusão social e a reabilitação são os eixos que norteiam o cuidado dos profissionais. Um dos principais dispositivos utilizados para monitorar a rede social é a visita domiciliar, pois a partir dela podemos ter o diagnóstico da realidade do indivíduo e de sua família. Podemos ver a visita domiciliar como uma forma de compartilhar mais a sintonia entre a comunidade e os alunos que desenvolvem a doença. Através da troca de conhecimentos podemos intervir de forma positiva, melhorando a qualidade de vida da comunidade através da educação e promoção da saúde.

This article aims to report the academic experience of the nursing program at a Center for Psychosocial Care (CAPS) through home visits. CAPS is a community-based service that provides care for people with mental illness and their families, in which social inclusion and rehabilitation are the axes that guide the care of professionals. One of the main devices used to monitor the social network is the home visit, because from it we can have the diagnosis of the reality of the individual and his family. We can see the home visit as a way to share more in line between the community and students who develop the disease. Through the exchange of knowledge we can intervene in a positive way, improving the quality of life of the community through education and health promotion. during home visits can strengthen ties with families in order to involve all actors in the process of care before it is possible to create or strengthen ties to the professional providing greater autonomy in interdisciplinary effectiveness of their actions.

Este artículo tiene como objetivo relatar la experiencia de académicas del curso de enfermería en un Centro de Atención Psicosocial (CAPS) a través de visitas domiciliarias. El CAPS es un servicio de base comunitaria que presta cuidados a persona con enfermedad mental y a su familia, en el que la inclusión social y la rehabilitación son los ejes que guían a los profesionales de estos cuidados. Uno de los principales dispositivos utilizados para acompañar esa red social es la visita domiciliaria, pues es a partir de ella que podemos tener el diagnóstico de la realidad del individuo y de su familia. Podemos observar la visita domiciliaria como un espacio de cambio más próximo entre la comunidad y los alumnos que la desarrollan. Mediante el intercambio de conocimientos podemos intervenir de una manera positiva, mejorando la calidad de vida de esta comunidad a través de la educación y promoción de la salud. Durante la visita domiciliaria es posible estrechar los lazos con las familias para que participen todos los actores del proceso de la atención, delante de esto es posible crear o fortalecer los vínculos, proporcionando al profesional una mayor autonomía en la efectividad de sus acciones interdisciplinarias.