Improving access to cancer information and supportive care services: A systematic review of mechanisms applied to link people with cancer to psychosocial supportive care services.

OBJECTIVE: Previous research has described the low uptake of psychosocial support services in people living with cancer. While characteristics of individuals using services have been examined, mechanisms applied to link individuals to support services are less frequently considered. This review aims to identify the mechanisms used to link people with cancer to support services and assess their impact. METHODS: Systematic searches of Pubmed, CINAHL, EMBASE and PsycINFO were conducted up to May 2020. Studies reporting service use associated with mechanisms to link adults with cancer to support services targeting emotional, informational, practical or social support needs were eligible. Eligible study designs included controlled trials, pre-post designs and observational studies. Study quality was assessed and a narrative synthesis of findings undertaken. RESULTS: A total of 10 papers (from 8,037 unique titles) were eligible. Testing the feasibility of the linkage mechanism was the primary aim in five (50%) studies. Three linkage mechanisms were identified: (a) outreach from the support service; (b) clinician recommendation/referral; (c) mailed invitation. Outreach was the most successful in connecting people with cancer to services (52%-90% use); clinician recommendation/referral was least successful (3%-28%). The impact of different linkage mechanisms for different demographic groups was not assessed. CONCLUSIONS: Outreach from services shows the most potential for increasing access to support services. However, the limited number of studies and limitations in the types of support services people with cancer were linked to, demonstrated the need for further work in this area. Identifying mechanisms that are effective for underserved, high-needs patient groups is also needed.

Can targeting information on cancer-related psychosocial services by male gender and rurality improve attitude to service use in this difficult-to-engage population?

OBJECTIVE: Rural men affected by cancer are difficult to engage in psychosocial support services. This exploratory study tested whether exposure to printed brochures describing services, distinguished by a focus on rural men affected by cancer, resulted in more positive help-seeking attitudes than exposure to material focused on rural location only or generic cancer support material. METHODS: Targeted versions of a South Australian Cancer Council service brochure were developed to enhance cultural appropriateness, consistent with the Elaboration Likelihood Model. Rural men affected by cancer were recruited via supportive accommodation and randomized to receive one of the three brochures. The primary outcome was positive attitude to help-seeking at post-test (between 1 and 2 days). Negative attitudes to help-seeking, intention to seek help, perceived isolation, and service use were secondary outcomes; perceived information relevance at immediate post-test was also measured. RESULTS: Analysis (N = 114) indicated no detectable group differences (rurality/male gender, n = 33; rurality, n = 41; control, n = 40) on primary or secondary outcome measures (p > 0.05). Participants' existing service use was high, due to the recruitment methods. Support service information was primarily sourced from other people (e.g., friends/family, 22.22%; medical professionals, 27.27%). CONCLUSIONS: Existing service use rates suggest that ceiling effects obscured any potential benefit from demographic targeting of materials. Further research should consider building understanding about the acceptability of targeting techniques in this population, replication with materials designed with greater consumer input, and employ samples recruited outside a support service.

Quality of life, recovery and decision-making: a mixed methods study of mental health recovery in social care.

PURPOSE: Mental health care is a complex system that includes social care organisations providing support for people with continuing needs. The relationship over time between decisional conflict, social support, quality of life and recovery outcomes across two time periods for people experiencing mental health problems in receipt of social care was investigated. METHODS: This is a mixed methods study comprised of a quantitative survey at two time points using measures of decisional conflict, social support, recovery and quality of life in a random sample (n = 122) using social care services in Wales, UK. In addition, 16 qualitative case studies were developed from data collected from individuals, a supportive other and a care worker (n = 41) to investigate trajectories of care. Survey responses were statistically analysed using SPSS and case study data were thematically analysed. RESULTS: Participants reported increasing decisional conflict and decreasing social support, recovery and quality of life over the two time points. Linear regression indicated that higher recovery scores predict better quality of life ratings and as ratings for social support decline this is associated with lower quality of life. Correlational analysis indicated that lower decisional conflict is associated with higher quality of life. Thematic analysis indicated that 'connectedness and recovery' is a product of 'navigating the system of care' and the experience of 'choice and involvement' achieved by individuals seeking help. CONCLUSIONS: These results indicate that quality of life for people experiencing mental health difficulties is positively associated with social support and recovery and negatively associated with decisional delay.

[Psychosocial Emergency Care After the Death of a Parent: Guidelines for Dealing with Affected Children]. / Psychosoziale Notfallversorgung nach dem Tod eines Elternteils: Leitlinien für den Umgang mit betroffenen Kindern.

Psychosocial Emergency Care After the Death of a Parent: Guidelines for Dealing with Affected Children Does psychosocial emergency care after parental death affect children's mental health? Or do affected children consider psychosocial emergency care useful at all? And what do children really want in this situation? Against the background of these questions, data were collected both qualitatively and quantitatively from a sample of 35 affected children and adolescents. The results show no mental health differences between groups (children with PSNV, n = 11 and children without PSNV, n = 24). Nevertheless, affected children appear to evaluate psychosocial emergency care after parental death positively. The derived guidelines therefore represent a further step towards psychosocial emergency care adapted to the needs of children and can therefore serve as orientation for practice.

Bio-psycho-social-spiritual needs of adolescents and young adults with life-threatening illnesses: Implications for social work practice.

This paper explores the biopsychosocial and spiritual needs of adolescents and young adults (AYA) with life-threatening or terminal illnesses. AYA are situated between childhood and adulthood (ages 15-25) and have distinct biopsychosocial and spiritual needs unique to their developmental stage. Having a life-threatening or terminal illness directly challenges normal AYA developmental tasks and identity formation. AYA experience more troubling physical symptoms during the dying process compared to other age groups, which leads to significant psychological distress and an increased need for pharmacological treatments. In general, AYA desire to be fully informed and involved in the health care decision-making process, leading to ethical dilemmas when the AYA is a minor and their wishes differ from the wishes of their legal guardian(s). Social workers are especially well-equipped to serve this population due to aligning professional standards and ability to advocate for holistic care within interdisciplinary teams. Additional research is needed to tailor holistic interventions to meet the needs of this population.

Factors associated with the use of social workers for assistance with lifetime and 12-month behavioral health disorders.

This study examined the use of social workers for assistance with a behavioral health disorder. Data were from the Collaborative Psychiatric Epidemiology Surveys. The analytic sample included respondents who reported using professional services for assistance with a behavioral health disorder during their lifetime (n = 5,585). Logistic regression was used to examine the use of a social worker during the respondent's lifetime or 12 months prior to the interview. Ten percent of respondents visited a social worker for help with a behavioral health disorder during their lifetime and 3% did so in the 12 months prior to the interview. Women were less likely than men to report using a social worker. Those who visited a social worker tended to also use other professionals for a behavioral health disorder although overall respondents reported visiting social workers less frequently for this reason than other types of professionals.

Effects of stepped psychooncological care on referral to psychosocial services and emotional well-being in cancer patients: A cluster-randomized phase III trial.

OBJECTIVE: Emotional distress in cancer patients often goes unnoticed in daily routine; therefore, distress screening is now recommended in many national guidelines. However, screening alone does not necessarily translate into better well-being. We examined whether stepped psychooncological care improves referral to consultation-liaison (CL) services and improves well-being. METHODS: In a cluster-randomized trial, wards were randomly allocated to stepped versus standard care. Stepped care comprised screening for distress, consultation between doctor and patient about the patient's need for CL services, and provision of CL service. Primary outcomes were referral to psychosocial services and emotional well-being half a year after baseline, measured with the Hospital Anxiety and Depression Scale. A secondary endpoint was uptake of outpatient health care. Analysis employed mixed-effects multivariate regression modeling. RESULTS: Thirteen wards were randomized; 1012 patients participated. With stepped care (N = 570; 7 wards), 22% of the patients were referred to CL services and 3% with standard care (N = 442; 6 wards; odds ratio [OR] 10.0; P < .001). Well-being 6 months after baseline was 9.5 after stepped care (N = 341) and 9.4 after standard care (N = 234, ß -0.3; P = .71). After stepped care, patients with psychiatric comorbidity went more often to psychotherapists (OR 4.0, P = .05) and to psychiatrists (OR 2.3, P = .12), whereas patients without comorbidity used psychiatrists less often (OR 0.4, P = .04) than in standard care. CONCLUSIONS: Stepped care resulted in better referral to CL services. The patients' emotional well-being was not improved, but uptake of outpatient psychiatric help was increased in patients with psychiatric comorbidity and decreased in patients without.

Strategies to destigmatize mental illness in South Africa: Social work perspective.

Stigma is a contributing factor to non-help-seeking behavior and social isolation of mental health-care users. The study examined social workers' perspective regarding strategies that can be implemented to destigmatize mental illness in South Africa. A qualitative study method was adopted. Data were sourced through focus group discussions with social work students and telephone interviews with social workers working in hospitals. Data were analyzed using a thematic approach. Active involvement, education, and awareness campaigns, creating opportunities for improved well-being and constant support, were identified as relevant strategies. Given that stigma is multidimensional, various strategies are important if mental illness is to be destigmatized.

[Structure and characteristics of technical support that psychiatric social workers of prefectural governments provide for municipalities].

Objectives　The support to municipalities by prefectural governments has become necessary in the fields of mental health and welfare. Therefore, psychiatric social workers (PSW) ordered from the prefectural governor has been providing technical support (TS) that promote community activities of the municipality and improve staff support for persons with mental disabilities. The purpose of this study was to identify empirical structure and characteristics of TS that PSW provide for municipality staff.Method　Semi-structured interviews were conducted with seven certified PSW randomly selected from the membership list of the National Psychiatric Social Worker Organization. Inclusion criteria required participants to have more than 10 years of experience at the prefectural government and experience providing TS in the last five years. Interviews focused on two situations: a casework and a project related to mental health. Interview data were analyzed using a qualitative content method, setting a framework for the consultation process.Results　The analysis included five categories < > and 15 subcategories [ ], which consisted of 37 concepts. In category with municipalities consisted of [complementary relationship] and [partnership]. The category included two subcategories, [analyze/judgment from the conditions spread in front of] and [analyze/judgment be the accumulated skills and knowledge in person]. In category , six policies were considered as important, including [problem solving and promoting action], [fostering person centered care perspective], [promoting the understanding of residents], [provide psychological support to the staff], [clarify responsibility as the municipal officials], and [coordinate to improve the environment]. Category consisted of both [support indirectly] and [support cooperatively]. The last category, included three subcategories, [lead to the maintenance and improvement of the system], [have the staff pleasure/contribute to the community], and [consider whether it can be applied to other regions]. The results showed that the characteristics of TS had a consultation function, and the support function utilized complementarity and collaboration between prefecture and municipality providing services to residents.Conclusion　This study has clarified the characteristics of TS, which have not been clarified in previous research. We should accumulate the knowledge and establish a method for spreading through various regions.

Psychosocial staffing at National Comprehensive Cancer Network member institutions: data from leading cancer centers.

OBJECTIVE: The National Comprehensive Cancer Network (NCCN) is comprised of 25 National Cancer Institute-designated cancer centers and arguably could thus set the standard for optimal psychosocial staffing for cancer centers; therefore, information was sought from NCCN Member Institutions about their current staffing for psychosocial services. These findings are put into perspective given the limited existing literature and consensus reports. METHODS: The NCCN Best Practices Committee surveyed member institutions about their staffing for psychosocial services. The survey was administered electronically in the winter of 2012. RESULTS: The survey was completed by 20 cancer centers. Across institutions, case managers and mental health therapists, typically social workers, were utilized most frequently to provide psychosocial services (67% of full-time-equivalents (FTEs)), with other psychosocial professionals also represented but less consistently. Most psychosocial services are institutionally funded (ranging from 64 to 100%), although additional sources of support include fee for service and grant funding. Training of psychosocial providers is unevenly distributed across responding sites, ranging from 92% of institutions having training programs for psychiatrists to 36% having training programs for mental health therapists. CONCLUSIONS: There was variability among the institutions in terms of patient volume, psychosocial services provided, and psychosocial staff employed. As accreditation standards are implemented that provide impetus for psychosocial services in oncology, it is hoped that greater clarity will develop concerning staffing for psychosocial services and uptake of these services by patients with cancer.

Barriers and Facilitators in Providing Community Mental Health Care to Returning Veterans with a History of Traumatic Brain Injury and Co-occurring Mental Health Symptoms.

As Veterans from recent conflicts return from deployments, increasing numbers are seeking care for physical (e.g., history of traumatic brain injury) and mental health (e.g., depression, anxiety) symptoms. Data suggest that only about half of recent Veterans are seeking care within the Veterans Health Administration. As such, providers within the community are likely to require additional training to meet the unique needs of these Veterans and their families. Towards this end, meetings were held with administrators and clinicians at Colorado Community Mental Health Centers (CMHCs) to identify current barriers and facilitators, as they relate to working with Veterans with a history of TBI and co-occurring mental health conditions. On-whole, CMHC employees had limited experience with providing care to the cohort of interest. Additional training will assist with increasing capacity and a web-based toolkit was developed to facilitate the transfer of knowledge ( www.mirecc.va.gov/visn19/tbi_toolkit ).

Becoming an Approved Mental Health Professional: an analysis of the factors that influence individuals to become Approved Mental Health Professionals.

BACKGROUND: In England and Wales, the Approved Mental Health Professional (AMHP) has final responsibility for applying under the Mental Health Act 1983 to admit an individual compulsorily and convey them to psychiatric hospital. The AMHP role is challenging and legally accountable and unique to the UK context. AIMS: To analyse the motivation of individuals to become AMHPs, and identify factors which may affect motivation. METHOD: Semi-structured interviews were conducted with 12 AMHPs from local authorities across Southern England. Ten participants were social workers, one was qualified as both a nurse and social worker, and one was a mental health nurse. RESULTS: Participants identify career progression and professional development as significant as well as the status and independence of the role and enhanced job security. Social work participants value the Mental Health Act assessment as a contained piece of work, with a high degree of professional discretion. CONCLUSIONS: AMHPs are motivated by an increase in professional status and job security, but also exercising independent judgment and authority in a time-limited intervention is emotionally and professionally rewarding.

Commercial sexual exploitation of children and the emergence of safe harbor legislation: implications for policy and practice.

Commercial sexual exploitation of children is an enduring social problem that has recently become the focus of numerous legislative initiatives. In particular, recent federal- and state-level legislation have sought to reclassify youth involved in commercial sexual exploitation as victims rather than as offenders. So-called Safe Harbor laws have been developed and centered on decriminalization of "juvenile prostitution." In addition to or instead of decriminalization, Safe Harbor policies also include diversion, law enforcement training, and increased penalties for adults seeking sexual contact with minors. The purpose of this paper is to review the underlying rationale of Safe Harbor laws, examine specific policy responses currently enacted by the states, and consider the effects of policy variations. Directions for future research and policy are addressed.

Training in the implementation of prolonged exposure therapy: provider correlates of treatment outcome.

The authors examined the degree to which provider characteristics, such as profession, treatment orientation, prior experience in treating posttraumatic stress disorder (PTSD), prior experience with prolonged exposure (PE) therapy, and attitudes about PE, were related to the clinical outcomes of veterans receiving care from clinicians participating in the national Department of Veterans Affairs (VA) PE Training Program. Positive patient outcomes were achieved by providers of every profession, theoretical orientation, level of clinical experience treating PTSD, and prior PE training experience. With 1,105 providers and 32 predictors (13 provider variables), power was at least 90% power to detect an effect of ß = .15. Profession was the only provider characteristic significantly related to outcomes, but the mean effect (a 2 point difference on the PTSD Checklist) was too small to be clinically meaningful. The results support the intensive training model used in the VA PE training program and demonstrate that clinicians of varying backgrounds can be trained using interactive training workshops followed by case consultation to deliver PE effectively.

Psychoeducation for schizophrenia in the Czech Republic: curriculum modification based on opinions of service users and providers.

OBJECTIVE: The authors examined current knowledge about psychoeducation for schizophrenia in Czech Republic. METHODS: The authors sent a screening survey to 550 mental health-care facilities and administered a detailed questionnaire to 113 providers of mental health and social services and to 200 service users. The authors also carried out 14 focus groups and 16 individual interviews. RESULTS: Forty-six departments provided some type of psychoeducation for schizophrenia; of these, 16 provided family psychoeducation for patients and relatives and 1 provided psychoeducation only for relatives. Service users who received psychoeducation performed significantly better in the test of knowledge than did service users who did not receive psychoeducation. CONCLUSION: The authors propose a service user-driven curriculum based on information delivery followed by skills training. Psychiatrists should learn to explain schizophrenia relapse neurobiology to laypeople and to address relatives' frustrations.

Integrity of evidence-based practice: are providers modifying practice content or practice sequencing?

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.

[Gene-environment-interaction of ODD and Conduct Disorder Versus "Anethic Psychopathy"]. / Eine frühe Gen-Umwelt-Theorie der Störungen des Sozialverhaltens versus "Anethischer Psychopathie".

Gene-environment-interaction of ODD and Conduct Disorder Versus ¼Anethic Psychopathy«. In 1934, Kramer and von der Leyen demonstrated in a sophisticated longitudinal study with eleven conduct disordered and neglected children labelled as ¼anethic psychopaths« that ¼anethic traits« subsided in a favourable educational setting. Sound prognoses, due to the diversity of environmental factors, were found to be impossible. On the contrary they stated that negative labelling led to an affirmation of a negative prognosis. In theory, they supposed a genetic predisposition resulting in a heightened sensitivity to the environment. This early theory of epigenetics radically contradicted the Nazi dogma of hereditability and ostracism and the selection procedures in mainstream psychiatry at that time. The debate ended with von der Leyen's suicide and the prohibition of medical work and publication towards Kramer. Even after the end of the Nazi policy of ¼eradication of the socially debased«, this early theory was not taken on again, nor dignified.

[Self-neglect as a sign of decompensation]. / L'incurie comme un signe de décompensation.

A lack of hygiene to which the patient appears indifferent, self-neglect can be a sign of the decompensation of a mental pathology. This article presents the case of a patient who, after several months of stabilisation and a return home to a relatively clean environment, reactivates a delusion of persecution.

[Nursing support in a housing association apartment]. / Accompagnement infirmier en appartement associatif.

A transferable lease project jointly run by the municipal authorities, the departmental council, the local mental health council and the hospital, has been set up for the benefit of patients in the process of reintegration. In this context, the work of the nurse is based around the individual support of the patient, integration within networks and the establishment of the project within the community.