Organizational response to the COVID-19 pandemic and its association with moral distress in community mental health teams in the UK: A qualitative study.

In March 2020, Coronavirus-19 (COVID-19) rapidly spread across the globe impacting the mental health of the population and putting an overwhelming pressure on health services. Much has been written about the impact of the pandemic on health-care workers working in hospital settings but less attention has been paid to its effect on community mental health teams (CMHTs). This study is based on 21 remote interviews with community mental health professionals during the first wave of the COVID-19 pandemic. Interviews were transcribed and analysed using a thematic analysis whereby codes of similar meaning were grouped into main themes. Analysis identified three major contributors to moral distress; changes in the nature of contact with service users, changes to the place of work, and difficulties of balancing risks to the families of CMHT staff and service users. This study demonstrates that necessary organizational changes instituted to minimize the spread of COVID-19, required different ways of working which were not perceived to be in the best interests of service users or the families of CMHT staff. In order to comply with Government directives, CMHT staff were forced to behave in a way which did not match their moral values causing them to experience moral distress.

Making It Work: The Experiences of Delivering a Community Mental Health Service during the COVID-19 Pandemic.

The COVID-19 pandemic forced rapid innovative change to healthcare delivery. Understanding the unique challenges faced by staff may contribute to different approaches when managing future pandemics. Qualitative interviews were conducted with 21 staff from a Community Mental Health Team in the North West of England, UK, three months after the first wave of the pandemic. Thematic analysis was used to examine data reporting the challenges arising when working to deliver a service during the pandemic. Data is discussed under four headings; "senior trust managers trying to make it work", "individuals making it work", "making it work as a team", and "making it work through working at home". Clear communication was essential to ensure adherence to guidelines while providing safe care delivery. The initial response to the pandemic involved the imposition of boundaries on staff by senior leadership to ensure that vulnerable service users received a service while maintaining staff safety. The data raises questions about how boundaries were determined, the communication methods employed, and whether the same outcome could have been achieved through involving staff more in decision-making processes. Findings could be used to design interventions to support mental health staff working to deliver community services during future crises.

Formative Evaluation of Open Goals: A UK Community-Based Multi-Sport Family Programme.

Community parks provide opportunities for physical activity (PA) and facilitate social interactions. This formative evaluation assesses the implementation of 'Open Goals' (OG), a novel multi-sport programme aiming to increase family PA and community cohesion, delivered weekly by Liverpool Football Club's charitable foundation to local parks in Liverpool, North West England. Three Open Goals parks were chosen for the evaluation settings. Formative evaluation measures included: System for Observing Play and Recreation in Communities (SOPARC) observations (n = 10), direct session observations (n = 8), semi-structured interviews with Open Goals coaching staff (n = 3), and informal feedback from families (n = 5) about their experiences of Open Goals. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Within the three evaluation parks, Open Goals reached 107 participants from May-July 2019, through 423 session attendances. Fidelity of the programme was high (M = 69% of session content delivered as intended). Overall park use when OG was offered compared to when it was not offered was not statistically significant (p = 0.051), however, target area use was significantly increased (p = 0.001). Overall physical activity levels in parks were significantly (p = 0.002) higher when Open Goals was being offered, compared to when it was not. Coaches reported that engagement in OG positively affected family co-participation and children's behavioural development. Contextual issues included environmental and social barriers to programme engagement, including the co-participation element of the programme and criticism of the marketing of OG. It is evident that community-based multi-sport PA programmes endorsed by professional football clubs are well positioned to connect with local communities in deprived areas and to encourage PA and community engagement. This study suggests that such programmes may have the ability to improve park usage in specific areas, along with improving physical activity levels among families, although further research is required. Effective marketing strategies are needed for promotional purposes. Upskilling of coaches in the encouragement of family co-participation may support regular family engagement in PA in local parks.

ADOPTing a new method of partner management for genital chlamydia in New South Wales: findings from a pilot implementation program of patient-delivered partner therapy.

Background Patient-delivered partner therapy (PDPT) for chlamydia is an effective and safe additional partner management strategy. Some Australian regulatory changes have been made to support PDPT, but implementation guidance is lacking. This paper describes a pilot implementation program of PDPT in New South Wales (NSW), the Australian Development and Operationalisation of Partner Therapy (ADOPT). METHODS: ADOPT involved: (1) clarification of the NSW PDPT legal and policy framework; (2) development and implementation of PDPT service models, resources and data collection tools for select publicly funded sexual health services (PFSHS) and Family Planning (FP) NSW clinics; and (3) evaluation of PDPT uptake. RESULTS: PDPT can be undertaken in NSW if accompanied by adequate provider, patient and partner information. Regulatory amendments enabled medication prescribing. The pilot implementation took place in four PFSHS and five FPNSW clinics from January to December 2016. In PFSHS, 30% of eligible patients were offered PDPT and 89% accepted the offer. In FPNSW clinics, 42% of eligible patients were offered PDPT and 63% accepted the offer. Most partners for whom PDPT was accepted were regular partners. CONCLUSIONS: A close collaboration of researchers, policy makers and clinicians allowed successful implementation of a PDPT model for chlamydia in heterosexual patients at select PFSHS and FPNSW clinics, providing guidance on its use as standard of care. However, for the full public health benefits of PDPT to be realised, it must be implemented in general practice, where most chlamydia is diagnosed. Further work is recommended to explore feasibility, develop guidelines and promote the integration of PDPT into general practice.

The C-project: use of self-collection kits to screen for Chlamydia trachomatis in young people in a community-based health promotion project.

BACKGROUND: The present study aimed to ascertain the acceptability to at-risk young people of self-collected urine samples as a means of testing for Chlamydia trachomatis (chlamydia); to determine the effectiveness of drop-off and outreach collection methods as a means of detecting and treating chlamydia; and to determine the rate of positive chlamydia tests in a sample of the target group. METHODS: Participants requested postal testing kits from the project website, the NSW Sexual Health Infoline or at an outreach event and either returned urine samples at selected drop-off locations or directly to the researchers during active outreach events. RESULTS: A total of 413 kits were requested - 196 (47.5%) via email, 204 (49.4%) during outreach events and nine (2.2%) via the NSW Sexual Health Infoline. A total of 195 samples (47.2% of ordered kits) were returned. Participants were less likely to return samples if they had been requested by email (odds ratio = 9.6; 95% confidence interval: 6.0-15.0) or via telephone (odds ratio = 22.0; 95% confidence interval: 2.7-181.0) compared with directly obtaining a kit at an outreach event. The number of specimens positive for chlamydia in the targeted age range was 4, giving a 3.1% positive rate (95% confidence interval: 1.0-8.0). CONCLUSIONS: This study identified that free testing kits and online communication worked well as a means of engaging young people and raising awareness of sexual health. However, the requirement to drop-off urine samples at selected locations was not well accepted.