Predictors of outcomes of assertive outreach teams: a 3-year follow-up study in North East England.

INTRODUCTION: Assertive outreach (AO) is a required component of services for people with severe mental illness in England. However, the claims to its effectiveness have been contested and the relationships between team organisation, including model fidelity, the use of mental health interventions and outcomes for service users remain unclear. METHOD: Three-year follow up of 33 AO teams was conducted using standardised measures of model fidelity and mental health interventions, and of current location and a range of outcomes for service users (n = 628). Predictors of the number of hospital admissions, mental health and social functioning at T2, and discharge from the team as 'improved' were modelled using multivariate regression analyses. RESULTS: Teams had moderate mean ratings of fidelity to the AO model. All rated highly on the core intervention modalities of engagement, assessment and care co-ordination, but ratings for psychosocial interventions were comparatively low. Two-thirds (462) of service users were still in AO and data were returned on 400 (87%). There was evidence of small improvements in mental health and social functioning and a reduction in the mean number of hospital admissions in the previous 2 years (from 2.09 to 1.39). Poor outcomes were predicted variously by service users' characteristics, previous psychiatric history, poor collaboration with services, homelessness and dual diagnosis. Fidelity to the AO model did not emerge as a predictor of outcome, but the team working for extended hours was associated with more frequent in-patient admissions and less likelihood of discharge from AO. Supportive interventions in daily living, together with the team's use of family and psychological interventions were also associated with poorer outcomes. Possible explanations for these unexpected findings are considered. CONCLUSION: AO appears to have been quite successful in keeping users engaged over a substantial period and to have an impact in supporting many people to live in the community and to avoid the necessity of psychiatric hospital admission. However, teams should focus on those with a history of hospital admissions, who do not engage well with services and for whom outcomes are less good. Psychosocial interventions should be applied. The relationship between model fidelity, team organisation, mental health interventions and outcomes is not straightforward and deserves further study.

Effects of the Omagh bombing on medical staff working in the local NHS trust: a longitudinal survey.

This article investigates post-traumatic stress disorder (PTSD) symptoms reported by doctors working in the aftermath of the Omagh bombing. Doctors responding to surveys 4 and 17 months after the incident reported the lowest symptom levels compared with other health service staff, with only 12% (2) above PTSD threshold at 17 months. Junior doctors had higher mean PTSD scores than seniors, although numbers are too small to test significance. Possible explanations are discussed and recommendations made.

Reframing risk management in dementia care through collaborative learning.

Risk management is a complex aspect of practice which can lead to an emphasis on maintaining physical safety, which impacts on the well-being of people with dementia. Education for practitioners in risk management is particularly challenging because of its conceptual nature and diverse perceptions of risk between and within professional groups. The practice development research reported here formed one part of a multisite study and contributed to developing a risk assessment and management framework for use by practitioners in partnership with people with dementia and their families. Practice development research uses learning theories in the process of the research, and in so doing its intent is to not only create new knowledge but to view the research process as also a process of learning for those involved. Twenty practitioners from varying professions participated in five Collaborative Learning Groups, each of at least 2 hours duration, which were held over a 7-month period. Data analysis highlighted contradictions in the care system and in the professional's intention to practice in a person-centred way. These were expressed through the themes of: Seeking Certainty; Making Judgements; Team Working; Managing Complexity; Gathering and Using Information.

Risk management dilemmas in dementia care: an organizational survey in three UK countries.

Aims and objectives. The overall project aimed to understand the variability of the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. This paper focuses on the objective of identifying the understandings of risk by practitioners. Background. Risk management can result in a 'safety first' approach to care practices, but this may be disempowering for people with dementia. Design. This paper describes the results of the first stage of the study: a survey to service managers or equivalent in health, social and voluntary sector care organizations in three countries of the UK. Methods. Data from this stage was collection by postal questionnaire (n = 46). Results. Risk was portrayed as a multidimensional concept and clustered around three themes: (1) Risk and Independence, (2) Risk and Resource, and (3) Organizational Risk Management. Conclusions. Very wide understandings of risk are identifiable, ranging from avoidance of physical harm through to managed risk taking to improve quality of life, and to an appreciation of the impact of organizational and professional patterns of behaviour resulting in harm to the person with dementia. Relevance to clinical practice. Obtaining information about the perspectives of others may help to illuminate some of the dilemmas experienced by staff in this study, and the development of risk assessment frameworks may assist staff to resolve some of these.

After the Omagh bomb: posttraumatic stress disorder in health service staff.

In this postal survey of 1064 health service staff working closest to the Omagh bombing in Northern Ireland, approximately half reported having professional orcivilian involvement. Types of involvement and posttraumatic stress disorder (PTSD) levels varied between staff groups. Staff involved both professionally and as a civilian, particularly those who witnessed the trauma, or those who had experienced previous emotional problems and trauma, had the highest levels of symptomatology. Although staff with higher PTSD symptoms were more likely to seek professional help, only a minority contacted professionals for support.

What might encourage later retirement among general practitioners?

More GPs are needed, but there are concerns about retaining the existing workforce quite apart from recruiting new doctors. This survey of GP principals in the Northern deanery aged over 45, identified factors potentially encouraging them to take early retirement (before 60) or to work on beyond 60. Over a third of those with retirement plans intended to retire early. Perceived undesirable changes in the NHS and workload were the main factors influencing intentions to retire. Reducing hours and administrative duties, and improving managerial support were factors that may encourage later retirement. Financial incentives in the form of increased pensions were most attractive to those already planning later retirement. A total of 35 per cent scored above threshold for significant psychological distress, and the higher psychological distress the earlier GPs wanted to retire. Interventions encouraging later retirement should be targeted at reducing workload and administration. Interventions to reduce stress could also encourage later retirement.