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1.
BMC Res Notes ; 14(1): 320, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419155

RESUMO

OBJECTIVES: Peer support is rapidly being introduced into mental health services internationally, yet peer support interventions are often poorly described, limiting the usefulness of research in informing policy and practice. This paper reports the development of a peer support intervention that aims to improve outcomes of discharge from inpatient to community mental health care. People with experiential knowledge of using mental health services-peer workers and service user researchers-were involved in all stages of developing the intervention: generating intervention components; producing the intervention handbook; piloting the intervention. RESULTS: Systematic review and expert panels, including our Lived Experience Advisory Panel, identified 66 candidate intervention components in five domains: Recruitment and Role Description of Peer Workers; Training for Peer Workers; Delivery of Peer Support; Supervision and Support for Peer Workers; Organisation and Team. A series of Local Advisory Groups were used to prioritise components and explore implementation issues using consensus methods, refining an intervention blueprint. A peer support handbook and peer worker training programme were produced by the study team and piloted in two study sites. Feedback workshops were held with peer workers and their supervisors to produce a final handbook and training programme. The ENRICH trial is registered with the ISRCTN clinical trial register, number ISRCTN 10043328, and was overseen by an independent steering committee and a data monitoring committee.


Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Aconselhamento , Humanos , Pacientes Internados , Transtornos Mentais/terapia , Saúde Mental , Revisões Sistemáticas como Assunto
2.
BJPsych Bull ; : 1-6, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33583477

RESUMO

AIMS AND METHOD: To explore whether people from Black, Asian and minority ethnic (BAME) communities experience equality of access and outcome in individual placement and support (IPS) employment services. Cross-sectional data were analysed of all people with severe mental health problems who accessed two mature high-fidelity IPS services in London in 2019 (n = 779 people). RESULTS: There were no significant differences between the proportions of people who gained employment. The data strongly suggest that people from BAME communities are not differentially disadvantaged in relation to either access to or outcomes of IPS employment services. CLINICAL IMPLICATIONS: The challenge for mental health professionals is not to decide who can and who cannot work but, how to support people on their case-loads to access IPS and move forward with life beyond their illness.

3.
Medicine (Baltimore) ; 99(10): e19192, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150057

RESUMO

INTRODUCTION: In the period shortly after discharge from inpatient to community mental health care, people are at increased risk of self-harm, suicide, and readmission to hospital. Discharge interventions including peer support have shown potential, and there is some evidence that community-based peer support reduces readmissions. However, systematic reviews of peer support in mental health services indicate poor trial quality and a lack of reporting of how peer support is distinctive from other mental health support. This study is designed to establish the clinical and cost effectiveness of a peer worker intervention to support discharge from inpatient to community mental health care, and to address issues of trial quality and clarity of reporting of peer support interventions. METHODS: This protocol describes an individually randomized controlled superiority trial, hypothesizing that people offered a peer worker discharge intervention in addition to usual follow-up care in the community are less likely to be readmitted in the 12 months post discharge than people receiving usual care alone. A total of 590 people will be recruited shortly before discharge from hospital and randomly allocated to care as usual plus the peer worker intervention or care as usual alone. Manualized peer support provided by trained peer workers begins in hospital and continues for 4 months in the community post discharge. Secondary psychosocial outcomes are assessed at 4 months post discharge, and service use and cost outcomes at 12 months post discharge, alongside a mixed methods process evaluation. DISCUSSION: Clearly specified procedures for sequencing participant allocation and for blinding assessors to allocation, plus full reporting of outcomes, should reduce risk of bias in trial findings and contribute to improved quality in the peer support evidence base. The involvement of members of the study team with direct experience of peer support, mental distress, and using mental health services, in coproducing the intervention and designing the trial, ensures that we theorize and clearly describe the peer worker intervention, and evaluate how peer support is related to any change in outcome. This is an important methodological contribution to the evidence base. TRIAL REGISTRATION: This study was prospectively registered as ISRCTN 10043328 on November 28, 2016.


Assuntos
Transtornos Mentais/terapia , Alta do Paciente , Transferência de Pacientes/economia , Grupo Associado , Serviços Comunitários de Saúde Mental , Análise Custo-Benefício , Humanos , Transtornos Mentais/psicologia , Qualidade de Vida , Fatores de Risco , Medicina Estatal , Reino Unido
4.
JBI Evid Synth ; 18(1): 170-177, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31503087

RESUMO

OBJECTIVE: The objective of this review is to identify and map existing knowledge on the methods and approaches used to implement Individual Placement and Support at scale in the health and welfare sectors, as well as the frameworks and methodological approaches used in implementation studies, and to identify knowledge gaps that are important for further research. INTRODUCTION: Individual Placement and Support is an evidence-based, standardized approach designed to support people with mental health conditions to gain and maintain competitive jobs in the labor market. Translating scientific knowledge into mainstream practice is challenging, and there is insufficient knowledge of the approaches used to implement Individual Placement and Support at scale in the health and welfare sectors. INCLUSION CRITERIA: This review will include studies reporting on the implementation of Individual Placement and Support for people with mental health conditions within a health and welfare context, from 1993 to the present. Studies that have abstracts in English, German or Scandinavian languages will be considered. Randomized controlled trials will be excluded. METHODS: The review will be conducted in accordance with the JBI methodology for scoping reviews. We will follow a three-step search strategy to trace published studies. Search strategies are developed to fit with the databases MEDLINE, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, Base, OpenGrey and CINAHL. Data will be extracted from papers included in the review using data extraction tables developed by the reviewers. A qualitative content analysis will be used to facilitate the mapping of the results.


Assuntos
Literatura de Revisão como Assunto , Humanos
5.
Work ; 64(4): 777-785, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31815717

RESUMO

BACKGROUND: Pedometer-based worksite interventions have been found to be successful in increasing physical activity (PA) but adherence is challenging. OBJECTIVE: To examine the use of Implementation Intentions (II), a self-regulatory skill, with self-monitoring with a pedometer to initiate behavior change as well as post-intervention adherence in a worksite wellness intervention. METHODS: University employees (N = 54) participated in an 8-week pedometer-based intervention. A 2-arm randomized trial was used to compare the effectiveness of 1) only pedometers (PED) (n = 28) and 2) pedometers and II (PED+II) (n = 26) on PA. RESULTS: Significant differences were observed between time points (p < .0001) but not between groups. Post-hoc pairwise comparisons between the time points revealed difference between Baseline and Week 4 (mean difference: 2446.9 steps/ day; p < 0.001), Week 4 and 12 (mean difference: 2956.3 steps/ day; p < 0.001), and Week 8 and 12 (mean difference: 2228.8 steps/ day; p = 0.005). CONCLUSION: The PED+II group had higher step increases during the intervention indicating that the behavioral strategy was effective. However, participants in both groups had a significant decrease in steps from the end of the intervention to the delayed-post assessment highlighting the challenge to maintain behavioral changes post-intervention.


Assuntos
Actigrafia/métodos , Exercício Físico/fisiologia , Intenção , Local de Trabalho , Adulto , Feminino , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Autocontrole , Universidades , Caminhada
6.
Work ; 55(3): 703-713, 2016 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-27792028

RESUMO

BACKGROUND: Physical inactivity is a leading cause of morbidity and mortality. Worksites provide an ideal environment for physical activity (PA) interventions. Colleges and universities are a unique work venue, with institutions of higher education of varying scope within every state of the United States and worldwide. OBJECTIVE: To explore the institutional influences on worksite PA across multiple universities. PARTICIPANTS: Employees from two large, universities (Midwestern and Southern) and a mid-size, university (Midwestern) participated in exploratory research in March/April 2010 and 2013. METHODS: The Nominal Group Technique (NGT) methodology and the Health Belief Model (HBM) were used to assess perceived influences on employees' engagement in worksite PA. RESULTS: The findings demonstrate that university employees experienced similar factors that influence PA as employees across the different institutions. Specifically, there was an interesting relationship between opportunities for PA and lack of a supportive work culture to promote it. CONCLUSIONS: Emphasis on immediate perceived threats to PA inactivity may improve the utility of the HBM for interventions within this context. Further, campus worksite interventions for employees should address barriers such as cost of campus recreation centers and administrative support for engaging in worksite PA as possible cues to action.


Assuntos
Exercício Físico , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Cultura Organizacional , Universidades/economia , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Universidades/organização & administração , Local de Trabalho/organização & administração
7.
J Health Commun ; 20(10): 1214-23, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26161726

RESUMO

Teens and young people are at risk for contracting sexually transmitted infections. Understanding how relationship context may moderate the effectiveness of safer sex communication strategies among this demographic is important information for practitioners striving to promote safer sex behaviors. In this study, focus groups (N = 9) with college students were conducted and analyzed to examine the relation between 6 principles of influence (authority, consistency, liking, reciprocity, scarcity, and social proof) and safer sex communication during committed and casual sexual encounters. Results revealed that with the exceptions of social proof and consistency, the principles of influence were endorsed more frequently for casual than committed sexual encounters. For casual sexual encounters, the principles of authority, reciprocity, and scarcity arose as influential principles. For committed sexual encounters, the principles of consistency, liking, and reciprocity arose as influential principles. These results are discussed with an emphasis on the theoretical and practical implications.


Assuntos
Comunicação , Relações Interpessoais , Infuência dos Pares , Sexo Seguro/psicologia , Parceiros Sexuais/psicologia , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Meio-Oeste dos Estados Unidos , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Universidades , Adulto Jovem
8.
Nord J Psychiatry ; 69(1): 57-66, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24983382

RESUMO

BACKGROUND: Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. AIMS: To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. METHODS: A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. RESULTS: One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. CONCLUSIONS: IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.


Assuntos
Readaptação ao Emprego/métodos , Transtornos Mentais/reabilitação , Adulto , Integração Comunitária/estatística & dados numéricos , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Psicometria , Reabilitação Vocacional/métodos , Método Simples-Cego , Fatores Socioeconômicos , Suécia , Adulto Jovem
9.
Adm Policy Ment Health ; 42(6): 682-94, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25331447

RESUMO

A wide variety of peer worker roles is being introduced into mental health services internationally. Empirical insight into whether conditions supporting role introduction are common across organisational contexts is lacking. A qualitative, comparative case study compared the introduction of peer workers employed in the statutory sector, voluntary sector and in organisational partnerships. We found good practice across contexts in structural issues including recruitment and training, but differences in expectations of the peer worker role in different organisational cultures. Issues of professionalism and practice boundaries were important everywhere but could be understood very differently, sometimes eroding the distinctiveness of the role.


Assuntos
Unidades Hospitalares/organização & administração , Serviços de Saúde Mental/organização & administração , Grupo Associado , Profissionalismo , Papel (figurativo) , Adolescente , Adulto , Idoso , Serviços Comunitários de Saúde Mental/organização & administração , Inglaterra , Feminino , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Cultura Organizacional , Unidade Hospitalar de Psiquiatria/organização & administração , Pesquisa Qualitativa , Recursos Humanos , Adulto Jovem
10.
Br J Psychiatry ; 205(2): 145-50, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24855129

RESUMO

BACKGROUND: Individual placement and support (IPS) is effective in helping patients return to work but is poorly implemented because of clinical ambivalence and fears of relapse. AIMS: To assess whether a motivational intervention (motivational interviewing) directed at clinical staff to address ambivalence about employment improved patients' occupational outcomes. METHOD: Two of four early intervention teams that already provided IPS were randomised to receive motivational interviewing training for clinicians, focused on attitudinal barriers to employment. The trial was registered with the International Standard Randomised Controlled Trial Register (ISRCTN71943786). RESULTS: Of 300 eligible participants, 159 consented to the research. Occupational outcomes were obtained for 134 patients (85%) at 12-month follow-up. More patients in the intervention teams than in the IPS-only teams achieved employment by 12 months (29/68 v. 12/66). A random effects logistic regression accounting for clustering by care coordinator, and adjusted for participants' gender, ethnicity, educational and employment history and clinical status scores, confirmed superiority of the intervention (odds ratio = 4.3, 95% CI 1.5-16.6). CONCLUSIONS: Employment outcomes were enhanced by addressing clinicians' ambivalence about their patients returning to work.


Assuntos
Atitude do Pessoal de Saúde , Motivação , Transtornos Psicóticos/reabilitação , Reabilitação Vocacional , Adolescente , Adulto , Inglaterra , Feminino , Humanos , Modelos Logísticos , Masculino , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
11.
Health Commun ; 29(6): 531-41, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24093876

RESUMO

Cialdini's (1984) principles of influence were employed to inform the decision-making process with respect to using condoms during casual sex. In the current study, focus groups (n = 9) were conducted to understand the relationship between the six principles of influence (authority, consistency, liking, reciprocity, scarcity, and social proof) and condom use in casual sex relationships. Results revealed that authority, consistency, and social proof were endorsed often as influencing condom use. Gender differences in the endorsement of the principles were also observed. The results speak to how these principles of influence aide the condom decision-making process during these often spontaneous sexual encounters and are discussed with an emphasis on the theoretical and practical implications for using these principles in future health campaigns.


Assuntos
Preservativos/estatística & dados numéricos , Tomada de Decisões , Comportamento Sexual/psicologia , Adolescente , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Fatores Sexuais , Parceiros Sexuais/psicologia , Adulto Jovem
12.
Br J Psychiatry ; 203(3): 247-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24085736

RESUMO

People with severe mental health problems have low rates of open employment. Despite good evidence for the effectiveness of Individual Placement and Support (IPS), these schemes are not widely implemented. Their implementation is hampered by clinician and societal attitudes and the effect of organisational context on implementing IPS schemes with sufficient fidelity.


Assuntos
Emprego/estatística & dados numéricos , Esquizofrenia/epidemiologia , Feminino , Humanos , Masculino
13.
J Ment Health ; 19(6): 483-91, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21121821

RESUMO

BACKGROUND: The onset of schizophrenia is associated with a pronounced decline in employment and educational attainment. AIMS: The aim of this study was to evaluate the impact of implementing the Individual Placement and Support approach (supported employment) adapted to include supported education within an Early Intervention Team for young people with a first episode of psychosis in the UK. METHOD: Demographic, clinical and vocational data were collected between November 2001 and July 2006 to evaluate the impact on service user vocational outcomes at 6, 12, 18 and 24 months. Individual vocational pathways are reported for the follow-up periods and fidelity to the implementation of the Individual Placement and Support (IPS) approach. RESULTS: By 6 months, 69% of people were supported in open employment and mainstream education/training and this rose to 81% at 18 months. The open employment rate increased significantly from 13% at baseline to 48% at 18 months and this was maintained through to 24 months. CONCLUSION: This study suggests that the IPS approach combined with supported education was effective at enabling a significant proportion of young people with a first episode of psychosis in a UK Early Intervention Service to gain/retain open employment and mainstream education.


Assuntos
Readaptação ao Emprego/métodos , Transtornos Psicóticos/reabilitação , Adolescente , Adulto , Escolha da Profissão , Serviços Comunitários de Saúde Mental/métodos , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Masculino , Reabilitação Vocacional/métodos , Reino Unido , Adulto Jovem
14.
Int Rev Psychiatry ; 22(2): 148-62, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20504055

RESUMO

Despite considerable growth in treatments, interventions, services and research of young people with a first episode of psychosis, little attention has been given to the priorities of these young people, in particular, gaining employment. A literature review was undertaken with the aim of investigating: 1) whether young people with a first episode of psychosis want to work, 2) what challenges they experience regarding work, 3) what is understood about employment outcomes, 4) what the most effective interventions to enable them to gain employment may be, and 5) what the associated costs may be. The review found that these young people appear to want to work yet face a range of psychological and social challenges to achieving this. Typically by the time they first come into contact with mental health services a proportion are already falling out of education and employment, and this decline continues with contact with services. However, there are specific interventions that can support them to gain employment. The Individual Placement and Support approach, adapted to include support to fulfil educational goals, has demonstrated that a mean of 69% of young people with a first episode of psychosis can gain education and employment compared to 35% of controls.


Assuntos
Terapia Cognitivo-Comportamental/economia , Terapia Cognitivo-Comportamental/métodos , Emprego , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Humanos , Transtornos Psicóticos/economia , Apoio Social , Estereotipagem
15.
Int Rev Psychiatry ; 22(2): 163-72, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20504056

RESUMO

Despite the overwhelming evidence of the effectiveness of the individual placement and support (IPS) approach to vocational rehabilitation for people with mental health conditions, there is very limited evidence of implementation in the UK. Both government policy and national clinical guidelines have set out a need for the availability of this effective approach in favour of other approaches, yet implementation appears to be an exception rather than a rule. This paper sets out four key challenges to implementing the IPS approach within mental health services in England: fear on the part of professionals, individuals and their families; a culture of low expectations; a failure to provide the support that we know works, and the global 'credit crunch' recession. Using a framework from implementation science, this review identifies the key features of implementing IPS within routine clinical practice from the experience of two large mental health NHS trusts in England.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Apoio Social , Emprego , Inglaterra , Humanos
16.
Health Soc Care Community ; 17(2): 151-8, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18800980

RESUMO

In the context of UK policy to promote employment for people with disability as a means to greater social inclusion, this study investigated how people with severe mental health problems fare in existing supported employment agencies. The aim of the study was to identify factors associated with successful placement in work and to test the impact of working on psychological well-being in this group. One hundred and fifty-five users of six English agencies were followed up for 1 year (2005-2006). Information was collected about their employment status, job-seeking behaviour, perceived obstacles to work, self-esteem and hope, and the employment support received. Eighty-two per cent of those working at baseline were still in work a year later. The support agencies helped 25% of unemployed clients into work, a statistically significant increase in the proportion of clients in employment. Gaining employment was associated with improvements in financial satisfaction and self-esteem. There was a trend towards working half time. People who had been out of work longer were less likely to secure employment. No significant associations were found between getting a job and personal characteristics, the quantity of employment support given, nor the recipient's rating of the support offered. The odds of moving into work were nearly four times higher for those people who visited a job centre prior to the start of the study. Clients of specialist agencies rated their provision more highly than clients of pan-disability agencies. These results demonstrate the benefits of working for this group and support the development of employment services with an individualised, rapid placement approach, linked to job centre advice and expert mental health service input. This is consistent with the Individual Placement and Support model, and highlights in addition the importance of job centres for its implementation in England.


Assuntos
Emprego/estatística & dados numéricos , Transtornos Mentais/reabilitação , Serviços de Saúde Mental , Saúde Mental , Saúde do Trabalhador , Apoio Social , Estudos Transversais , Coleta de Dados , Grupos Étnicos , Pesquisa sobre Serviços de Saúde , Humanos , Psicometria , Autoimagem , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento
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