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1.
Australas Psychiatry ; 21(3): 249-53, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23616378

RESUMO

OBJECTIVE: The aim of this study was to identify promising elements of best practice relevant to mainstream mental health service (MHS) delivery of early psychosis intervention (EPI) to Indigenous communities. In a companion paper, a comprehensive literature review identified a promising service model with potential for delivering EPI: an Indigenous sub-team embedded within a mainstream health service. METHOD: This paper describes a consultation process with Indigenous Mental Health Workers (IMHWs) in south eastern Queensland. A case study of the Sunshine Coast Cultural Healing Program (CHP-SC) was carried out during the consultation process. RESULTS: IMHWs agreed that the Australian clinical guidelines for early psychosis were relevant to improving outcomes for Indigenous patients. IMHWs unanimously identified the CHP-SC as a best practice mainstream MHS for delivering EPI. The CHP-SC, which represented an Indigenous sub-team model, was found to be associated with substantially improved engagement of Indigenous young people. CONCLUSIONS: We provisionally conclude that specialist EPI could be delivered by specialist Indigenous sub-teams (rather than specialist EPI teams) embedded in mainstream MHSs that incorporate culturally safe practice and are fully integrated with Indigenous primary care services, and recommend that the model be formally evaluated.


Assuntos
Agentes Comunitários de Saúde , Intervenção Médica Precoce/métodos , Serviços de Saúde do Indígena/organização & administração , Havaiano Nativo ou Outro Ilhéu do Pacífico/psicologia , Guias de Prática Clínica como Assunto , Transtornos Psicóticos/etnologia , Serviços Comunitários de Saúde Mental/métodos , Grupos Focais , Pesquisa sobre Serviços de Saúde , Humanos , Avaliação de Programas e Projetos de Saúde , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Queensland/epidemiologia , Inquéritos e Questionários
2.
Aust N Z J Psychiatry ; 45(1): 63-75, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20977312

RESUMO

AIM: Clinical practice improvement carried out in a quality assurance framework relies on routinely collected data using clinical indicators. Herein we describe the development, minimum training requirements, and inter-rater agreement of indicators that were used in an Australian multi-site evaluation of the effectiveness of early psychosis (EP) teams. METHODS: Surveys of clinician opinion and face-to-face consensus-building meetings were used to select and conceptually define indicators. Operationalization of definitions was achieved by iterative refinement until clinicians could be quickly trained to code indicators reliably. Calculation of percentage agreement with expert consensus coding was based on ratings of paper-based clinical vignettes embedded in a 2-h clinician training package. RESULTS: Consensually agreed upon conceptual definitions for seven clinical indicators judged most relevant to evaluating EP teams were operationalized for ease-of-training. Brief training enabled typical clinicians to code indicators with acceptable percentage agreement (60% to 86%). For indicators of suicide risk, psychosocial function, and family functioning this level of agreement was only possible with less precise 'broad range' expert consensus scores. Estimated kappa values indicated fair to good inter-rater reliability (kappa > 0.65). Inspection of contingency tables (coding category by health service) and modal scores across services suggested consistent, unbiased coding across services. CONCLUSIONS: Clinicians are able to agree upon what information is essential to routinely evaluate clinical practice. Simple indicators of this information can be designed and coding rules can be reliably applied to written vignettes after brief training. The real world feasibility of the indicators remains to be tested in field trials.


Assuntos
Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/terapia , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Diagnóstico Precoce , Humanos , Garantia da Qualidade dos Cuidados de Saúde
3.
Aust N Z J Psychiatry ; 44(3): 195-219, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20180724

RESUMO

The literature that is relevant to evaluation of treatment effectiveness is large, scattered and difficult to assemble for appraisal. This scoping review first develops a conceptual framework to help organize the field, and second, uses the framework to appraise early psychosis intervention (EPI) studies. Literature searches were used to identify representative study designs, which were then sorted according to evaluation approach. The groupings provided a conceptual framework upon which a map of the field could be drawn. Key words were cross-checked against definitions in dictionaries of scientific terms and the National Library of Medicine Medical Subject Headings (MeSH) browser. Using the final list of key words as search terms, the EPI evaluation literature was appraised. Experimental studies could be grouped into two classes: efficacy and effectiveness randomized controlled trials. Non-experimental studies could be subgrouped into at least four overlapping categories: clinical epidemiological; health service evaluations; quality assurance studies; and, quasi-experimental assessments of treatment effects. Applying this framework to appraise EPI studies indicated promising evidence for the effectiveness of EPI irrespective of study design type, and a clearer picture of where future evaluation efforts should be focused. Reliance on clinical trials alone will restrict the type of information that can inform clinical practice. There is convergent evidence for the benefits of specialized EPI service functions across a range of study designs. Greater investment in health services research and quality assurance approaches in evaluating EPI effectiveness should be made, which will involve scaling up of study sizes and development of an EPI programme fidelity rating template. The degree of complexity of the evaluation field suggests that greater focus on research methodology in the training of Australasian psychiatrists is urgently needed.


Assuntos
Pesquisa sobre Serviços de Saúde , Transtornos Psicóticos/terapia , Terminologia como Assunto , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
4.
Behav Sci Law ; 27(6): 862-77, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19937919

RESUMO

This article reports a test of multisystemic predictors of therapeutic engagement (TE) with adolescent sexual offenders (ASOs), and an evaluation of clinical efforts to improve TE with this client group. First, clinicians rated their TE with 105 Australian court-referred male ASOs (M = 15.53 years; SD = 1.30 years), who participated in treatment between 2001 and 2005. For this cohort, correlation analysis showed impulsivity/antisociality, negative peer relationships, and indigenous race to be associated with poorer TE. Multiple regression analysis identified impulsivity/antisociality and indigenous race as significant unique predictors. Clinical efforts subsequently focused on improving TE, particularly with higher-antisocial youth and with indigenous youth and their families. Clinicians then rated TE with a second, independent cohort of 54 court-referred male ASOs (M = 15.44 years; SD = 1.22 years), who participated in the modified treatment between 2006 and 2009. A two-way ANCOVA, controlling for impulsivity/antisociality, indicated significant improvements in TE for both indigenous and non-indigenous ASOs. Despite these general improvements, indigenous ASOs remained comparatively less engaged than their non-indigenous counterparts.


Assuntos
Comportamento do Adolescente/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Psicoterapia/métodos , Delitos Sexuais/psicologia , Adolescente , Criança , Feminino , Humanos , Masculino , Queensland , Inquéritos e Questionários
5.
Int J Offender Ther Comp Criminol ; 61(5): 582-603, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26246370

RESUMO

Internationally, best practice for prison health care recommends transferring health service provision from corrections to health authorities. Although it is expected that this change will result in improved health care, there is little evidence of evaluation. This article used qualitative interviews with health service providers to gain insight into the health needs of women's prisons in Queensland, Australia, both prior to and after the transition in health care service provision. We found that service providers identified that problems persisted regardless of service provider and that improvement required increased resources and more fundamental structural changes within prison environments.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Prisioneiros , Serviços de Saúde da Mulher , Feminino , Humanos , Prisões , Queensland , Saúde da Mulher
6.
Early Interv Psychiatry ; 4(1): 25-30, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20199477

RESUMO

AIM: Expert opinion holds that the rate of implementation of specialist services for first presentation psychosis in Australia is much too slow. We aimed to collect evidence regarding this view from the first national survey of adult public mental health services about their self-reported efforts to implement specialist early psychosis intervention (EPI). METHODS: Using a purpose-designed Census form for assessing EPI implementation, adult public mental health service directors throughout Australia were asked about EPI-relevant local service activities. RESULTS: Sixty Census forms were returned (response rate = 61%), representing a total catchment population of 12.5 million people. A minority of services reported high levels of EPI implementation, which varied widely between area services and across state and territory jurisdictions. Rural and remote services were overrepresented in the lowest levels of reported EPI implementation. Only one service characteristic, the value of identifiable funding committed specifically to EPI, was predictive of level of reported EPI implementation. CONCLUSIONS: The disturbingly high levels of variability in EPI implementation across jurisdictions suggest a pressing need for a set of nationally agreed uniform EPI implementation standards. Additional specific strategies for rural and remote mental health services may be needed for these services to implement EPI.


Assuntos
Pesquisas sobre Atenção à Saúde/métodos , Implementação de Plano de Saúde/estatística & dados numéricos , Política de Saúde , Transtornos Psicóticos/terapia , Austrália , Administradores de Instituições de Saúde , Humanos , Serviços de Saúde Mental , Transtornos Psicóticos/diagnóstico
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