Evaluation of an occupation-based, mental-health program: Meeting being, belonging and becoming needs.

INTRODUCTION: Being, belonging and becoming are important theoretical constructs for occupational scientists and therapists, and for members of Northern Initiative for Social Action (NISA), located in northern Ontario, Canada. Collaborative research with service users guided the development of NISA and its evaluation tool: the 3B~S Scale. The aim of this paper is to share the results of the 2018 program evaluation. METHODS: 113 participants completed a questionnaire consisting of the 3B~S Scale, demographic and program satisfaction questions, and open-ended questions. Quantitative analysis used descriptive statistics followed by ordinal logistic regression to determine the intersectional effects of gender, race and age on becoming and system impact outcomes. Open-ended responses were analysed thematically and triangulated with quantitative findings. RESULTS: Participants agreed-to-strongly agreed that the program met their 3B needs (x = 4.20, SD = 0.24). Participants indicated strong satisfaction with the program (x = 4.38, SD = 0.66), and agreement that participating in the program reduced their reliance on other system-based services (x = 3.96, SD = 0.24). The regression revealed no significant differences in gender, race or age in predicting six of 10 outcomes examined; race was not significant for any outcome. Younger females were more likely to agree that the work they do is part of a larger community charitable purpose, the program is helping them to achieve their goals, and is increasing their involvement in community. Younger participants were more likely to agree that participation facilitated a return to school or employment than older participants. CONCLUSIONS: Occupation-based, mental health programs that address participants' being, belonging and becoming needs can contribute to improvements in perceived mental health and well-being, as well as to improved community and system usage outcomes. The NISA model provides a framework for clinically operationalising the 3B's and may provide a unique contribution to ongoing theoretical discussions of these constructs within occupational therapy and science.

Are we prepared? The development of performance indicators for public health emergency preparedness using a modified Delphi approach.

BACKGROUND: Disasters and emergencies from infectious diseases, extreme weather and anthropogenic events are increasingly common. While risks vary for different communities, disaster and emergency preparedness is recognized as essential for all nation-states. Evidence to inform measurement of preparedness is lacking. The objective of this study was to identify and define a set of public health emergency preparedness (PHEP) indicators to advance performance measurement for local/regional public health agencies. METHODS: A three-round modified Delphi technique was employed to develop indicators for PHEP. The study was conducted in Canada with a national panel of 33 experts and completed in 2018. A list of indicators was derived from the literature. Indicators were rated by importance and actionability until achieving consensus. RESULTS: The scoping review resulted in 62 indicators being included for rating by the panel. Panel feedback provided refinements to indicators and suggestions for new indicators. In total, 76 indicators were proposed for rating across all three rounds; of these, 67 were considered to be important and actionable PHEP indicators. CONCLUSIONS: This study developed an indicator set of 67 PHEP indicators, aligned with a PHEP framework for resilience. The 67 indicators represent important and actionable dimensions of PHEP practice in Canada that can be used by local/regional public health agencies and validated in other jurisdictions to assess readiness and measure improvement in their critical role of protecting community health.

Being, belonging and becoming: Development of the 3B Scale.

BACKGROUND: The aim of the current study was to assess the construct validity and internal consistency of a measure used by an occupation-based, mental health program. The measure was formulated according to the 3B theory of being, belong and becoming and system impacts. METHODS: The scale was administered to a sample of 122 current members of Northern Initiative for Social Action. Confirmatory factor analysis (CFA) was carried out to examine the model fit of the 3B Scale. Internal reliability was assessed using Cronbach's alpha measure of internal consistency. RESULTS: The CFA confirmed the four hypothesised underlying constructs of the 3B theory. The results of the CFA reported adequate model fit. Each factor had good to excellent internal reliability with Cronbach's alpha ranging from 0.81 to 0.91. CONCLUSION: The 3B Scale is a valid and reliable tool for measuring Being, Belonging and Becoming needs in an occupation-based mental health program. The 3B Scale is an example of an outcome measure created specifically to quantify program outcomes and demonstrates that instruments suited to unique programs can be individually configured and assist occupational therapists in their efforts to measure client perspectives. These are the essential first steps to client-centred practice and the development of practice-based evidence. The 3B Scale may be useful to similar peer-led programs, as well as community-based occupational programs that foster participation. Further research is needed to determine whether the 3B Scale can detect change over time.

Authentic peer support work: challenges and opportunities for an evolving occupation.

BACKGROUND: The peer support worker (PSW) belongs to the fastest growing occupation in the mental health sector, yet it is often under-valued and poorly understood. Despite an emerging evidence base, and strong support from mental health service users, the PSW remains on the periphery of mainstream services in northeastern Ontario. AIMS: To examine the role of the PSW, along with the challenges and benefits, and to understand why the PSW is not more integrated within mainstream services. METHODS: A sequential, exploratory, mixed-methods design was used to collect data on 52 survey and 33 focus group participants. Qualitative data were analyzed thematically. RESULTS: Peer support work was described by participants as being authentic when PSWs can draw upon lived experience, engage in mutually beneficial discussions, and be a role model. Authentic peer support was noted to be important to the recovery of mental health service users; yet, participants revealed that many positions continue to reflect more generic duties. Challenges to further integration include acceptance, training and credentialing, self-care, and voluntarism. CONCLUSIONS: Future development and mainstream integration of peer support work must reconcile current tensions between standardization and loss of authenticity. Training in communicating the lived experience, setting boundaries and self-care are important steps forward.

Urban washout: how strong is the rural-background effect?

OBJECTIVE: To test predictors of practice location of fully qualified Monash University Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates. DESIGN: Cohort survey, 2011. SETTING: Australia. PARTICIPANTS: Rural (n = 67/129) and urban (n = 86/191) background doctors starting at Monash University 1992-1999. Approximately 60% female, 77% married/partnered, 79% Australian-born, mean age 34 years, 31% general practitioners, 72% fully qualified and 80% training/practising in major cities. MAIN OUTCOME MEASURES: First and current practice location once fully qualified. Intended practice location in 5-10 years. RESULTS: Logistic regression found that rural versus urban background was a significant predictor of rural (outside major city) first practice location (odds ratio (OR) 5.0, 95% confidence interval (CI) 1.3-19.2) and rural current practice location (OR 5.6, 95% CI 1.5-21.2) for fully qualified doctors. General practitioner versus other medical specialists significantly predicted first (OR 7.2, 95% CI 2.1-25.2) or current (OR 3.6, 95% CI 1.1-11.9) rural practice location. Preference for a rural practice location in 5-10 years was predicted by rural background (OR 4.4, 95% CI 1.6-11.8) and positive intention towards rural practice upon completing MBBS (OR 4.6, 95% CI 1.7-12.6). Surveyed in 2011, 28% of those who also responded to the 2006 survey shifted their preferred future practice location from rural to urban communities versus 13% shifting from urban to rural (McNemar-Bowker test, P = 0.02). CONCLUSION: The majority of fully qualified Monash MBBS graduates practicing in rural communities have rural backgrounds. The rural-background effect diminished over time and may need continued support during training and full practice.