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1.
Artigo em Inglês | MEDLINE | ID: mdl-32030595

RESUMO

The paper describes the Antipsychotic Medication Management Fidelity Scale and its psychometric properties, including interrater reliability, frequency distribution, sensitivity to change and feasibility. Fidelity assessors conducted fidelity reviews four times over 18 months at eight sites receiving implementation support for evidence-based antipsychotic medication management. Data analyses shows good to fair interrater reliability, adequate sensitivity to change over time and good feasibility. At 18 months, item ratings varied from poor to full fidelity on most items. Use of the scale can assess fidelity to evidence-based guidelines for antipsychotic medication management and guide efforts to improve practice. Further research should improve and better calibrate some items, and improve the procedures for access to information.Trial registration: ClinicalTrials.gov Identifier: NCT03271242.

2.
Artigo em Inglês | MEDLINE | ID: mdl-32036479

RESUMO

Mental health programs need an instrument to monitor adherence to evidence-based physical health care for people with serious mental illness. The paper describes the Physical Health Care Fidelity Scale and study interrater reliability, frequency distribution, sensitivity to change and feasibility. Four fidelity assessments were conducted over 18 months at 13 sites randomized to implementation support for evidence-based physical health care. We found good to excellent interrater reliability, adequate sensitivity for change, good feasibility and wide variability in fidelity across sites after 18 months of implementation. Programs were more successful in establishing Policies stating physical health care standards than in implementing these Policies. The Physical Health Care Fidelity Scale measures and guides implementation of evidence-based physical health care reliably.Trial registration: ClinicalTrials.gov Identifier: NCT03271242.

3.
Medicine (Baltimore) ; 99(1): e18635, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895824

RESUMO

This cross sectional study examined patients' perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records.Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.The MedSupport inventory was suitable for assessing the patients' perceived support from health care service regarding their medication. Awareness of differences in patients' perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.


Assuntos
Transtornos Mentais/tratamento farmacológico , Serviços de Saúde Mental , Psicotrópicos/uso terapêutico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
4.
BMC Health Serv Res ; 19(1): 879, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752958

RESUMO

BACKGROUND: Seclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion. METHODS: This study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis. RESULTS: The main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff's sincere desire to provide good treatment and the patients' behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice. CONCLUSION: Ethical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff.

5.
BMC Health Serv Res ; 19(1): 793, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31684933

RESUMO

BACKGROUND: Health professionals in Norway are required by law to help safeguard information and follow-up with children of parents with mental or physical illness, or who have substance abuse problems, to reduce their higher risk of psychosocial problems. Knowledge is lacking regarding whether organisation and/or worker-related factors can explain the differences in health professionals' ability to support the families when patients are parents. METHODS: Employing a translated, generic version of the Family Focused Mental Health Practice Questionnaire (FFPQ), this cross-sectional study examines family focused practice (FFP) differences in relation to health professionals' background and role (N = 280) along with exploring predictors of parent, child, and family support. RESULTS: While most health professions had begun to have conversations with parents on children's needs, under one-third have had conversations with children. There were significant differences between nurses, social workers, psychologists, physicians, and others on seven of the FFP subscales, with physicians scoring lowest on five subscales and psychologists providing the least family support. Controlling for confounders, there were significant differences between child responsible personnel (CRP) and other clinicians (C), with CRP scoring significantly higher on knowledge and skills, confidence, and referrals. Predictors of FFP varied between less complex practices (talking with parents) and more complex practices (family support and referrals). CONCLUSION: The type of profession was a key predictor of delivering family support, suggesting that social workers have more undergraduate training to support families, followed by nurses; alternately, the results could suggest that that social workers and nurses have been more willing or able than physicians and psychologists to follow the new legal requirements. The findings highlight the importance of multidisciplinary teams and of tailoring training strategies to health professionals' needs in order to strengthen their ability to better support children and families when a parent is ill.


Assuntos
Filho de Pais Incapacitados , Medicina de Família e Comunidade/organização & administração , Pessoal de Saúde/estatística & dados numéricos , Transtornos Mentais , Papel Profissional , Adolescente , Adulto , Criança , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Pessoal de Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Noruega
6.
Artigo em Inglês | MEDLINE | ID: mdl-31701294

RESUMO

This study examined the psychometric properties and feasibility of the Illness Management and Recovery (IMR) Fidelity scale. Despite widespread use of the scale, the psychometric properties have received limited attention. Trained fidelity assessors conducted assessments four times over 18 months at 11 sites implementing IMR. The IMR Fidelity scale showed excellent interrater reliability (.99), interrater item agreement (94%), internal consistency (.91-.95 at three time points), and sensitivity to change. Frequency distributions generally showed that item ratings included the entire range. The IMR Fidelity scale has excellent psychometric properties and should be used to evaluate and guide the implementation of IMR.Trial registration: ClinicalTrials.gov Identifier: NCT03271242.

7.
Int J Ment Health Syst ; 13: 65, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31636700

RESUMO

Background: Assertive community treatment (ACT) is an evidence-based treatment for people with severe mental illness, and this model is used widely throughout the world. Given the various adaptations in different contexts, we were interested in studying the implementation and adaptation of the ACT model in Norway. The first 12 Norwegian ACT teams were established between 2009 and 2011, and this study investigated the teams' model fidelity and the team members' experiences of working with ACT. Methods: To investigate implementation of the ACT model, fidelity assessments were performed 12 and 30 months after the teams started their work using the Tool for Measurement of Assertive Community Treatment (TMACT). Means and standard deviations were used to describe the ACT teams' fidelity scores. Cohen's effect size d was used to assess the changes in TMACT scores from the first to second assessment. Qualitative focus group interviews were conducted in the 12 teams after 30 months to investigate the team members' experiences of working with the ACT model. Results: The fidelity assessments of the Norwegian teams showed high implementation of the structural and organizational parts of the ACT model. The newer parts of the model, the recovery and evidence-based practices, were less implemented. Four of the six subscales in TMACT improved from the first to the second assessment. The team members experienced the ACT model to be a good service model for the target population: people with severe mental illness, significant functional impairment, and continuous high service needs. Team members perceived some parts of the model difficult to implement and that it was challenging to find effective ways to collaborate with existing health and social services. Conclusion: The first 12 Norwegian ACT teams implemented the ACT model to a moderate degree. The ACT model could be implemented in Norway without extensive adaptations. Although the team members were satisfied with the ACT model, especially the results for their service users, inclusion of the ACT team to the existing service system was perceived as challenging.

8.
Community Ment Health J ; 55(8): 1344-1353, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31190179

RESUMO

Evidence-based practices that are implemented in mental health services are often challenging to sustain. In this focus-group study, 26 mental health practitioners with high fidelity scores were interviewed regarding their experiences with implementing the illness management and recovery, an evidence-based practice for people with severe mental disorders, in their services and how this could influence further use. Findings indicate that high fidelity is not equivalent to successful implementation. Rather, to sustain the practice in services, the practitioners emphasized the importance of their leaders being positive and engaged in the intervention, and hold clear goals and visions for the intervention in the clinic. In addition, the practitioners' understanding of outcome monitoring as a resource for practice improvement must be improved to avoid random patient experiences becoming the decisive factor in determining further use.Trial registration: ClinicalTrials.gov NCT02077829. Registered 25 February 2014.

9.
BMC Psychiatry ; 19(1): 174, 2019 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182058

RESUMO

BACKGROUND: Service providers throughout Europe have identified the need to define how high-quality community-based mental health care looks to organize their own services and to inform governments, commissioners and funders. In 2016, representatives of mental health care service providers, networks, umbrella organizations and knowledge institutes in Europe came together to establish the European Community Mental Health Services Provider (EUCOMS) Network. This network developed a shared vision on the principles and key elements of community mental health care in different contexts. The result is a comprehensive consensus paper, of which this position paper is an outline. With this paper the network wants to contribute to the discussion on how to improve structures in mental healthcare, and to narrow the gap between evidence, policy and practice in Europe. MAIN TEXT: The development of the consensus paper started with an expert workshop in April 2016. An assigned writing group representing the workshop participants built upon the outcomes of this meeting and developed the consensus paper with the input from 100 European counterparts through two additional work groups, and two structured feedback rounds via email. High quality community-based mental health care: 1) protects human rights; 2) has a public health focus; 3) supports service users in their recovery journey; 4) makes use of effective interventions based on evidence and client goals; 5) promotes a wide network of support in the community and; 6) makes use of peer expertise in service design and delivery. Each principle is illustrated with good practices from European service providers that are members of the EUCOMS Network. CONCLUSIONS: Discussion among EUCOMS network members resulted in a blueprint for a regional model of integrated mental health care based upon six principles.

10.
Front Psychiatry ; 10: 163, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31001149

RESUMO

Background: A strong connection exists between parental mental illness and lifetime mental health risk for their children. Thus, it is important to determine, when parents attend for treatment for their illness, the prevalence and characteristics of parents with a mental illness and identify referral actions for their children. Previous studies indicate that 12-45% of adult mental health service patients are parents with minor children. There is a need for studies with larger sample sizes that investigate the prevalence and characteristics of parents, and factors associated with referral actions for their children. Method: Data on 23,167 outpatients was drawn from a national census study across 107 Norwegian adult mental health outpatient clinics during 2 weeks in April 2013. Clinicians identified various socio-demographic characteristics of patients who were parents and referral actions for their children. Results: Eight thousand thirty-five (36%) of outpatients had children under 18 years. Thirty-one percent were provided with referrals for their children and 58% were reported to have children with no need for referral. Three percent were reported to have children with unmet needs who were not referred. There were missing data on children's needs and referral actions for 8% of parents. Patients who care for minor children were more likely to be refugees, and less likely to be single, male, not own a house/apartment, and have a schizophrenia spectrum illness or substance use disorder. Children were more likely to be referred when their parent was single, with no income from paid work, low education, not owning house/apartment, poor family network, long outpatient treatment, and an individual care plan; and less likely for men with a moderate or less severe mental illness. Children were referred to child protection agencies, child and adolescent mental health services and school psychological/pedagogic services. Discussion: The prevalence of outpatients with children is similar to other studies. Referrals were made for children of one third of outpatients with minor children. Needs and referrals of children was unknown for one in ten outpatients. Mental health outpatient clinics must improve procedures to identify parenting status and ascertain and act on children's needs.

11.
PLoS One ; 14(4): e0215354, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31017935

RESUMO

INTRODUCTION: Long-term sick leave and disabilities due to common mental disorders are challenging for society, employers, and individuals. Hence, we wanted to investigate whether psychosocial work environments experienced by employees undergoing treatment for such disorders was associated with return to work. METHODS: At the start of treatment, 164 patients responded to questionnaires concerning their psychosocial work environment (the Job Demand-Control-Support model and the Effort-Reward Imbalance model), symptoms (The Clinical Outcomes in Routine Evaluation Outcome Measure) and ability to work (Work Ability Index). In addition, the respondents reported whether they were working or on sick leave at the start and end of their courses of treatment. Their therapists provided information about diagnoses. RESULTS: Return to work was associated with control of decisions, support from colleagues, esteem, and job promotion opportunities as measured at the start of treatment. In multivariate analyses, control over decisions and job promotion opportunities continued to predict return to work when adjusted for symptoms, current work ability, and expected future work ability. DISCUSSION: The working conditions that predicted return to work are considered to facilitate work performance and to be sources of motivation, job satisfaction, and job commitment. Consequently, it is important to examine whether this patient group has a favorable working environment and consider changes in the workplace if the environment is not favorable.


Assuntos
Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Retorno ao Trabalho/psicologia , Local de Trabalho/psicologia , Adolescente , Adulto , Feminino , Humanos , Satisfação no Emprego , Masculino , Saúde Mental , Pessoa de Meia-Idade , Estresse Ocupacional/psicologia , Estudos Prospectivos , Licença Médica , Meio Social , Inquéritos e Questionários , Adulto Jovem
13.
Qual Life Res ; 28(4): 1063-1073, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30478598

RESUMO

PURPOSE: Health-related quality of life (HRQoL) may be helpful in identifying children at risk of developing adjustment problems. Few studies have focused on HRQoL among children of ill or substance abusing parents despite their considerable risk status. In the present study, we used the KIDSCREEN-27 to assess self-reported HRQoL in children and adolescents living in families with parental illness, or substance dependence. First, we tested whether the factor structure of the KIDSCREEN-27 was replicated in this population of children. Next, we examined differences in HRQoL according to age, gender, and type of parental illness. Finally, we compared levels of HRQoL in our sample to a normative reference population. METHOD: Two hundred and forty-six children and adolescents aged 8-17 years and their ill parents participated. The construct validity of the KIDSCREEN-27 questionnaire was examined by confirmatory factor analysis (CFA). T-tests and ANOVA were used to test differences in HRQoL levels according to age, gender, and parental patient groups, and for comparisons with reference population. RESULTS: The KIDSCREEN-27 fit the theoretical five-factor model of HRQoL reasonably well. Boys and younger children reported significantly greater well-being on physical well-being, psychological well-being, and peers and social support, compared to girls and older children. Younger children also reported significantly greater well-being at school than did older children. There were no significant differences in HRQoL between groups of children living with different type of parental illness. The children in our sample reported their physical well-being significantly lower than the reference population. CONCLUSION: The KIDSCREEN-27 questionnaire appears to work satisfactorily among children of ill or substance abusing parents.


Assuntos
Qualidade de Vida/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Criança , Feminino , Humanos , Masculino , Pais
14.
Scand J Pain ; 19(2): 337-343, 2019 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-30422805

RESUMO

Background and aims Posttraumatic stress disorder (PTSD) is related to more severe pain among chronic pain patients. PTSD is also related to dysfunctions or biases in several cognitive processes, including autobiographical memory. The autobiographical memories are our memories of specific personal events taking place over a limited amount of time on a specific occasion. We investigated how two biases in autobiographical memory, overgeneral memory style and negative emotional bias were related to pain, PTSD and trauma exposure in chronic pain patients. Methods Forty-three patients with diverse chronic pain conditions were recruited from a specialist pain clinic. The patients were evaluated for psychiatric diagnosis, with a diagnostic interview Mini-International Neuropsychiatric Interview (M.I.N.I) and for exposure to the most common types of traumatic events with the Life Event Checklist (LEC). The patients were tested with the 15-cue-words version of the Autobiographical Memory Test (AMT). In this test the participants are presented verbally to five positive, five neutral and five negative cue words and asked to respond with a personal, episodic memory associated with the cue word. The participant's responses were coded according to level of specificity and emotional valence. Pain intensity was assessed on a Visual Analogy Scale (VAS) and extent of pain by marking affected body parts on a pre-drawn body figure. Comparisons on autobiographical memory were made between PTSD and non-PTSD groups, and correlations were computed between pain intensity and extent of pain, trauma exposure and autobiographical memory. Results PTSD and extent of pain were significantly related to more negatively emotionally valenced memory responses to positive and negative cue words. There were no significant difference in response to neutral cue words. PTSD status and pain intensity were unrelated to overgeneral autobiographical memory style. Conclusions A memory bias towards negatively emotionally valenced memories is associated with PTSD and extent of pain. This bias may sustain negative mood and thereby intensify pain perception, or pain may also cause this memory bias. Contrary to our expectations, pain, trauma exposure and PTSD were not significantly related to an overgeneral memory style. Implications Cognitive therapies that have an ingredient focusing on amending memory biases in persons with comorbid pain and PTSD might be helpful for this patient population. Further investigations of negative personal memories and techniques to improve the control over these memories could potentially be useful for chronic pain treatment.

15.
Qual Life Res ; 28(3): 713-724, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30392098

RESUMO

PURPOSE: Our study investigated quality of life (QoL) in patients with severe or non-severe mental illness diagnoses (SMI and non-SMI) and the association between QoL and service satisfaction measured as patients' perception of continuity of care (CoC), therapeutic relationship, and unmet service needs. METHODS: We conducted a national cross-sectional survey among 3836 mental health outpatients, of whom 1327 (34.6%) responded. We assessed QoL with the Manchester Short Assessment of Quality of Life (MANSA), CoC with the CONTINUUM, the therapeutic relationship with the Therapeutic Relationship in Community Mental Health Care (STAR-P) and developed a simple scale to measure unmet service needs. RESULTS: Outpatients with SMI (n = 155) reported significantly better QoL than those with non-SMI (n = 835) (p = 0.003). In both groups, QoL was positively associated with cohabitation (p = 0.007 for non-SMI and p = 0.022 for SMI), good contact with family and friends (p < 0.001 for both) and positive ratings of CoC (p < 0.001 for non-SMI and p = 0.008 for SMI). A positive association between QoL and therapeutic relationship (p = 0.001) and a negative association between QoL and unmet needs for treatment (p = 0.009) and activity (p = 0.005) was only found in the non-SMI group. CONCLUSION: Our study highlights the important differences between those with SMI and those with non-SMI in their reported QoL and in the relationship between QoL and service satisfaction, with only non-SMI patients' QoL influenced by the therapeutic relationship and unmet needs for treatment and activity. It also shows the importance of continuity of care and social factors for good QoL for both groups.


Assuntos
Assistência Ambulatorial/métodos , Transtornos Mentais/psicologia , Satisfação Pessoal , Qualidade de Vida/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pacientes Ambulatoriais , Adulto Jovem
16.
Int J Ment Health Syst ; 12: 77, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30574174

RESUMO

Background: Changes in Norwegian law and health policy require all health professionals to help safeguard the provision of information and follow-up for the children of parents with mental or physical illness, or substance abuse problems, to decrease their risk of psychosocial problems. There is a lack of knowledge on how the national changes have been received by hospital-based health professionals, and if they have led to an increase in family focused practice. Methods: This cross-sectional study examined the adherence of health professionals' (N = 280) in five hospitals to new guidelines for family focused practice, using a translated and generic version of Family Focused Mental Health Practice Questionnaire. Results: Overall, health professionals scored high on knowledge and skills, and were confident in working with families and children, but reported moderate levels of family support and referrals. Comparison of the five hospitals showed significant differences in terms of workplace support, knowledge and skills and family support. The smallest hospital had less workplace support and less knowledge and skills but scored medium on family support. The two largest hospitals scored highest on family support, but with significant differences on parents refusing to have conversations with children. Conclusions: Differences in implementation of family focused practice highlight the need to tailor improvement strategies to specific barriers at the different hospitals. The use of implementation theories and improvement strategies could promote full implementation, where all families and children in need were identified and had access to family support.Trial registration The study is approved by the Regional Committee on Medical and Health Research Ethics South-East Q5 37 (reg. no. 2012/1176) and by the Privacy Ombudsman.

17.
Health Qual Life Outcomes ; 16(1): 219, 2018 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-30453992

RESUMO

OBJECTIVE: To examine the existing body of knowledge on quality of life (QoL) in partners of people with substance use problems (PP-SUPs) to provide a synthesized summary of the evidence and identify gaps in our knowledge on the QoL of PP-SUPs. METHODS: A systematic scoping review was performed. Publications indexed in EMBASE, Medline, PsycINFO, CINAHL, SocINDEX, and CENTRAL were searched for original, empirical, peer-reviewed, full-length research papers that examined QoL in PP-SUPs. Research papers identified through a manual search of key references and known references by co-authors were also included. A total of 3070 abstracts were screened, 41 full-text papers examined, and nine were found to meet the inclusion criteria. Eligibility was determined in two steps by four and two independent researchers, respectively. The main findings were explored by content analysis. RESULTS: Eight of the nine included studies had quantitative designs, one had a mixed methods design, and no qualitative studies were found. Three studies were conducted exclusively among PP-SUPs, whereas the others included various subgroups. A majority of participants were women, and no study was conducted exclusively among men. Nearly half of the studies reported on whether there were minor children in the PP-SUPs' household. The studies used established and generic QoL instruments based on different conceptual and theoretical perspectives on QoL. A majority of the studies found lower QoL in PP-SUPs than in general population, with substance use by the person with a SUP having the most impact on QoL of all evaluated factors. Two studies reported that gender was associated with QoL, with poor QoL being associated with being a male partner and vice versa for female partners. CONCLUSIONS: Further research is needed to examine QoL in PP-SUPs exclusively. A variety of QoL instruments covering various, but limited, dimensions of the concept have been used in previous studies of PP-SUPs. Thus, obtaining a comprehensive understanding of PP-SUPs' QoL is challenging. Both qualitative and large-scale quantitative designs should be used in research on QoL in PP-SUPs, particularly among those with a parenting role.


Assuntos
Qualidade de Vida/psicologia , Cônjuges/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Criança , Feminino , Humanos , Masculino , Pesquisa Qualitativa
18.
BMC Health Serv Res ; 18(1): 609, 2018 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-30081882

RESUMO

BACKGROUND: Norway is one of the first countries to require all health professionals to play a part in prevention for children of parents with all kinds of illnesses (mental illness, drug addiction, or severe physical illness or injury) in order to mitigate their increased risk of psychosocial problems. Hospitals are required to have child responsible personnel (CRP) to promote and coordinate support given by health professionals to patients who are parents and to their children. METHODS: This study examined the extent to which the new law had been implemented as intended in Norwegian hospitals, using Fixsen's Active Implementation Framework. A stratified random sample of managers and child responsible personnel (n = 167) from five Hospitals filled in an adapted version of the Implementation Components Questionnaire (ICQ) about the implementation of policy changes. Additional information was collected from 21 hospital coordinators (H-CRP) from 16 other hospitals. RESULTS: Significant differences were found between the five hospitals, with lowest score from the smallest hopitals. Additional analysis, comparing the 21 hospitals, as reported by the H-CRP, suggests a clear pattern of smaller hospitals having less innovative resources to implement the policy changes. Leadership, resources and system intervention (strategies to work with other systems) were key predictors of a more successful implementation process. CONCLUSIONS: Legal changes are helpful, but quality improvements are needed to secure equal chances of protection and support for children of ill parents. TRIAL REGISTRATION: The study is approved by the Regional Committee on Medical and Health Research Etics South-East (reg.no. 2012/1176 ) and by the Privacy Ombudsmann.


Assuntos
Bem-Estar da Criança/legislação & jurisprudência , Filho de Pais Incapacitados/legislação & jurisprudência , Administração Hospitalar , Administradores Hospitalares , Pais , Criança , Estudos Transversais , Humanos , Liderança , Transtornos Mentais , Noruega , Política Organizacional , Melhoria de Qualidade , Inquéritos e Questionários
19.
BMC Health Serv Res ; 18(1): 389, 2018 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-29848338

RESUMO

BACKGROUND: Involuntary care and coercive measures are frequently present in mental healthcare for adolescents. The purpose of this study was to examine to what extent adolescents perceive or experience coercion during inpatient mental health care, and to examine predictors of experienced coercion. METHODS: A cross-sectional sample of 96 adolescent inpatients from 10 Norwegian acute and combined (acute and sub-acute) psychiatric wards reported their experienced coercion on Coercion Ladder and the Experienced Coercion Scale in questionnaires. Staff reported use of formal coercion, diagnoses, and psychosocial functioning. We used two tailed t-tests and mixed effects models to analyze the impact from demographics, alliance with parents, use of formal coercion, diagnostic condition, and global psychosocial functioning. RESULTS: High experienced coercion was reported by a third of all patients. In a mixed effects model, being under formal coercion (involuntary admission and / or coercive measures); a worse relationship between patient and parent; and lower psychosocial functioning, significantly predicted higher experienced coercion. Twenty-eight percent of the total sample of patients reported a lack of confidence and trust both in parents and staff. CONCLUSIONS: Roughly one third of patients in the sample reported high experienced coercion. Being under formal coercion was the strongest predictor. The average scores of experienced coercion in subgroups are comparable with adult scores in similar care situations. There was one exception: Adolescents with psychosis reported low experienced coercion and almost all of them were under voluntary care.


Assuntos
Coerção , Transtornos Mentais/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Pacientes Internados/psicologia , Tempo de Internação , Masculino , Saúde Mental , Noruega , Percepção , Unidade Hospitalar de Psiquiatria , Transtornos Psicóticos/psicologia , Inquéritos e Questionários
20.
World J Biol Psychiatry ; : 1-18, 2018 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29722600

RESUMO

OBJECTIVE: Previous guidelines and planning documents have identified the key role primary care providers play in delivering mental health care, including the recommendation from the WHO that meeting the mental health needs of the population in many low and middle income countries will only be achieved through greater integration of mental health services within general medical settings. This position paper aims to build upon this work and present a global framework for enhancing mental health care delivered within primary care. METHODS: This paper synthesizes previous guidelines, empirical data from the literature and experiences of the authors in varied clinical settings to identify core principles and the key elements of successful collaboration, and organizes these into practical guidelines that can be adapted to any setting. RESULTS: The paper proposes a three-step approach. The first is mental health services that any primary care provider can deliver with or without the presence of a mental health professional. Second is practical ways that effective collaboration can enhance this care. The third looks at wider system changes required to support these new roles and how better collaboration can lead to new responses to respond to challenges facing all mental health systems. CONCLUSIONS: This simple framework can be applied in any jurisdiction or country to enhance the detection, treatment, and prevention of mental health problems, reinforcing the role of the primary care provider in delivering care and showing how collaborative care can lead to better outcomes for people with mental health and addiction problems.

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