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1.
Epidemiol Psychiatr Sci ; 29: e109, 2020 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-32157987

RESUMO

AIMS: Community care units (CCUs) are a model of residential psychiatric rehabilitation aiming to improve the independence and community functioning of people with severe and persistent mental illness. This study examined factors predicting improvement in outcomes among CCU consumers. METHODS: Hierarchical regression using data from a retrospective cohort (N = 501) of all consumers admitted to five CCUs in Queensland, Australia between 2005 and 2014. The primary outcome was changed in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes were disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Potential predictors covered service, consumer, and treatment characteristics. Group-level and individualised change were assessed between the year pre-admission and post-discharge. Where relevant and available, the reliable and clinically significant (RCS) change was assessed by comparison with a normative sample. RESULTS: Group-level analyses showed statistically significant improvements in mental health and social functioning, and reductions in psychiatry-related bed-days, emergency department (ED) presentations and involuntary treatment. There were no significant changes in disability or accommodation instability. A total of 54.7% of consumers demonstrated reliable improvement in mental health and social functioning, and 43.0% showed RCS improvement. The majority (60.6%) showed a reliable improvement in psychiatry-related bed-use; a minority demonstrated reliable improvement in ED presentations (12.5%). Significant predictors of improvement included variables related to the CCU care (e.g. episode duration), consumer characteristics (e.g. primary diagnosis) and treatment variables (e.g. psychiatry-related bed-days pre-admission). Higher baseline impairment in mental health and social functioning (ß = 1.12) and longer episodes of CCU care (ß = 1.03) increased the likelihood of RCS improvement in mental health and social functioning. CONCLUSIONS: CCU care was followed by reliable improvements in relevant outcomes for many consumers. Consumers with poorer mental health and social functioning, and a longer episode of CCU care were more likely to make RCS improvements in mental health and social functioning.


Assuntos
Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Transtornos Mentais/reabilitação , Transtornos Mentais/terapia , Reabilitação Psiquiátrica/organização & administração , Centros Comunitários de Saúde Mental , Humanos , Transtornos Mentais/psicologia , Tratamento Domiciliar , Estudos Retrospectivos
2.
Ghana Med J ; 53(2): 92-99, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31481804

RESUMO

Background: Over the past few decades, there has been an emphasis on the de-institutionalisation of psychiatric care with a focus on community care. With Quality of Life (QoL) as an outcome measure, this study compared the QoL of patients with schizophrenia attending a psychiatric hospital and a community psychiatric centre. Design: This was a cross-sectional study in two psychiatric facilities. Methods: Data were obtained through a socio-demographic and clinical questionnaire; the QoL was assessed with the WHOQOL-BREF and patient satisfaction with care with CPOSS. Total and domain scores of WHOQOL-BREF for each group were calculated and compared with each other and other group characteristics. Diagnosis of schizophrenia was based on ICD-10. Results: Participants from the two centres did not differ significantly on any of the socio-demographic characteristics measured. Similarly, there was no significant difference in their overall mean WHOQOL-BREF scores as well as the mean WHOQOL-BREF of domain scores. However, the married and females from both centres significantly had higher mean WHOQOL-BREF scores than their male counterparts. Patients in remission for more than two years or those on a single type of medication (either oral or depot preparation) from both centres significantly had higher mean WHOQOL-BREF score compared with those who had less than two years of remission or on both oral and depot preparations. Conclusion: Overall QoL of patients managed at the two centres was comparable, with similar socio-demographic as well as clinical variables influencing QoL. This suggests that patients with schizophrenia can be well managed at community psychiatric centres. Funding: None declared.


Assuntos
Centros Comunitários de Saúde Mental , Hospitais Psiquiátricos , Qualidade de Vida , Esquizofrenia , Adulto , Assistência Ambulatorial , Desinstitucionalização , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Adulto Jovem
3.
Psychiatriki ; 30(2): 97-107, 2019.
Artigo em Grego Moderno | MEDLINE | ID: mdl-31425138

RESUMO

During previous financial crises as well as the recent global financial crisis, a strong impact of the crisis on the population mental health in many countries has been observed. Similarly, in Greece, a series of epidemiological studies pointed out the consequences of the economic crisis on the population mental health. However, there is limited data available, both in Greece and worldwide, regarding the impact of the economic crisis from the perspective of mental health services. The goal of the present study was to examine possible changes on the community mental health during the first years of the Greek financial crisis, as they are reflected on the operation of a community mental health unit with a specific catchment area within Athens (Byron and Kessariani). The demographic, social and clinical characteristics of adult users who were admitted for the first time at ByronKessariani Mental Health Community Center during the years 2008-2013 were analysed. The impact of the financial crisis on the workload of the center was also assessed during the same period. The sample of the study consisted of 1865 adult users and the data was collected with the use of an ad hoc structured questionnaire as well as from the users' case files. No significant differentiation on the number of clients admitted to the center per year after the beginning of the financial crisis was found. However, it is possible that an upper limit has been reached on the center's capacity to admit new clients, i.e. a ceiling effect, as it is shown from the increased number of provided sessions per year as well as from the increase in the mean waiting time for the intake of new patients during the same period. A constant increase in the number of women among the new clients of ByronKessariani Mental Health Community Center was found, but no significant differentiations were detected during the study period. Moreover, the study showed an upward trend in aggressive behavior as a reason for admission, a significant and continuous increase in the rate of unemployed individuals among the new clients, as well as a statistically significant increase in the number of referrals for psychotherapy during the study period. There was also an increase in the number of patients who had psychiatric history, even though they were admitted to Byron-Kessariani Mental Health Community Center for the first time. No significant differentiations were found in the remaining users' demographic and clinical characteristics assessed. Our study showed that during the crisis community mental health services are under pressure due to the increased needs of patients, especially the needs for psychotherapeutic intervention and psychological support. The increased unemployment rates affect the influx of new patients as well as the therapeutic management of many users. Reinforcement of the community mental health service network is an important strategy against the consequences of the crisis on the population mental health.


Assuntos
Centros Comunitários de Saúde Mental/estatística & dados numéricos , Recessão Econômica/estatística & dados numéricos , Adulto , Agressão , Centros Comunitários de Saúde Mental/organização & administração , Serviços Comunitários de Saúde Mental , Feminino , Grécia/epidemiologia , Humanos , Masculino , Transtornos Mentais/economia , Transtornos Mentais/psicologia , Saúde Mental , Pessoa de Meia-Idade , Psicoterapia/estatística & dados numéricos , Fatores Socioeconômicos , Desemprego/psicologia , Desemprego/estatística & dados numéricos
4.
Psychiatriki ; 30(2): 108-119, 2019.
Artigo em Grego Moderno | MEDLINE | ID: mdl-31425139

RESUMO

Psychosocial rehabilitation for people with chronic-severe mental illness mainly aims to social integration by restoring independent functioning in the community, improving quality of life, and addressing risk factors that lead to social disability. Support groups (SG) are usually part of this multilevel mental health process. Given that non-adherence to treatment is a common phenomenon in people with chronic- severe mental illness, the aim of the current study was to identify which factors influence members' attendance in a support group in a vocational training Program of the Psychosocial Rehabilitation Unit of Byron-Kaissariani Community Mental Health Centre. The SG sessions were weekly, with 45-minute duration, opened to any new member of the Program and coordinated by two therapists. Members' demographic and psychiatric data were gathered from the medical records of the Center. Information about SG was obtained from the reports of the sessions. The sample consisted of 18 women, with mean age 38.56 (±6.92) years. Most of them were high school graduates (61.1%), unmarried (83.3%), with low socioeconomic status (55.5%), suffering from a schizophrenic spectrum disorder (61.1%) with a mean duration 15.22 (±8.44) years. Out of 83 sessions in total, twenty-two (26.5%) were in absence of a co-therapist, 11 (13.3%) after a member's entrance or withdrawal and 11 (13.3%) after a session cancellation. Furthermore, an average of four issues was discussed per session, with mental illness (62.7%) and interpersonal relationships (73.5%) being the most popular topics during the sessions. The statistical analysis demonstrated that members' demographic (age, education, marital status, residence, socioeconomic status, working experience) and psychiatric characteristics (diagnosis, illness duration, rehabilitation program experience) were not associated with the attendance rate in the SG. Similarly, the proportion of participants attending the sessions did not seem to be significantly related to the absence of a co-therapist, to a member's entrance or withdrawal and to a session cancellation. In contrast, attendance seemed to be significantly reduced when the topic of a session focused on members' future expectations/goals (having a family, further education, finding a job) (Beta=-0.32, p=0.006). This finding highlights the need for future research in order to incorporate interventions that promote and address future goals and expectations of people with chronic-severe mental illness in psychosocial rehabilitation services.


Assuntos
Transtornos Mentais/reabilitação , Cooperação do Paciente/estatística & dados numéricos , Reabilitação Psiquiátrica/organização & administração , Grupos de Autoajuda/estatística & dados numéricos , Adulto , Doença Crônica , Centros Comunitários de Saúde Mental , Feminino , Humanos , Relações Interpessoais , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Reabilitação Psiquiátrica/estatística & dados numéricos , Psicoterapia de Grupo , Esquizofrenia/reabilitação , Fatores Socioeconômicos
5.
Fam Syst Health ; 37(2): 173-175, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31180709

RESUMO

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Gestão de Mudança , Centros Comunitários de Saúde Mental/tendências , Prestação Integrada de Cuidados de Saúde/tendências , Centros Comunitários de Saúde Mental/organização & administração , Prestação Integrada de Cuidados de Saúde/métodos , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , Humanos , Liderança , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , New York , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/tendências , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/terapia , Estados Unidos
6.
Prax Kinderpsychol Kinderpsychiatr ; 68(4): 253-270, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31044679

RESUMO

"I Would Never have done it Without Coercion …" - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic Coercion and compulsion have negative connotations, especially in psychiatric therapy. But in families, children are always also affected if parents do not want or are not able to make use of therapy. The avoidance of therapy can be a symptom of illness, e. g. separation anxiety. Perceived or real external coercion, e. g. from the youth welfare office or school, can be used to initially open up access to therapy and to allow parents to become capable of acting again. Coercion can initially reduce the ambivalence of the parents. The Family Therapeutic Centre (FaTZ) is a psychiatric and psychotherapeutic day clinic for parents and children. Family constellations are described in which initial coercion was a door-opener to therapy. During courses of treatment therapeutic alliances could be established, hope for positive change emerged, and the outcome was favourable. School avoidance of the child (e. g. due to separation anxiety) in combination with mentally ill parents is an exemplary constellation in which initial coercion can pave the way to therapy for families that otherwise wouldn't get access. Afterwards, voluntary cooperation should be intended, as the overriding objective is to reduce coercive measures to a minimum.


Assuntos
Coerção , Centros Comunitários de Saúde Mental , Terapia Familiar/métodos , Tratamento Psiquiátrico Involuntário/métodos , Transtornos Mentais/terapia , Pais/psicologia , Psicoterapia/métodos , Recusa do Paciente ao Tratamento/psicologia , Adolescente , Ansiedade de Separação , Criança , Filho de Pais Incapacitados/psicologia , Terapia Familiar/ética , Humanos , Tratamento Psiquiátrico Involuntário/ética , Transtornos Mentais/psicologia , Cooperação do Paciente/psicologia , Psicoterapia/ética
7.
An. psicol ; 35(2): 233-241, mayo 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-181693

RESUMO

Dual patients are usually treated in drug users services, mental health units, or both. However, each patient can choose the service to receive the health care. The aim of this study is to analyze the similarities and differences of the patient profiles that are treated in each one of these centers. The sample consists of 170 patients diagnosed with dual pathology treated at Servicio Provincial de Drogodependencias de Huelva (SPDH) and Unidades de Salud Mental Comunitaria (USMC) in the province of Huelva. In SPDH, higher prevalence of patients with cocaine and heroin dependence profile was observed (35.9% vs 2% in MH and 16.4% in coordinated). In USMC there is higher prevalence of patients with cannabis dependence profile (41.2% vs 9.4% in the DU and 16.4% in the coordinated service). The odds ratio for patients with hypomanic episodes was 2,879 (p <0.05) in SPDH compared to other services. Odds ratio observed for manic episodes was 0.483 (p <0.05) in SPDH. Patients with comorbid psychotic disorders are more prevalent in USMC compared to SPDH services (66% vs 37.5%). The differences observed in the profiles should be considered in the care planning of these centers


La atención médica y psicológica de pacientes con patología dual es realizada por servicios de salud mental, adicciones, o coordinada. No obstante, es elección de los pacientes acudir a uno u otro servicio. Este trabajo tiene como objetivo analizar las semejanzas y diferencias de pacientes con patología dual que acuden a estos centros. El estudio se ha realizado con170 pacientes diagnosticados de patología dual atendidos en el Servicio Provincial de Drogodependencias de Huelva (SPDH) y Unidades de Salud Mental Comunitaria (USMC) de la provincia de Huelva. En el SPDH la prevalencia de pacientes con dependencia a heroína y cocaína es mayor (35.9% vs 2% en USMC y 16.4% en coordinado). En las USMC se observa una mayor prevalencia de pacientes con dependencia a cannabis (41.2% vs 9.4% en el CTA y 16.4% en coordinado). La odds ratio para pacientes con episodios hipomaníacos fue de 2.879 (p<0.05) en el SPDH, y de 0.483 (p<0.05) para episodios maníacos. Hay una mayor prevalencia de pacientes con trastornos psicóticos en las USMC en comparación con el SPDH (66% vs 37.5%). Las diferencias detectadas en los perfiles deben ser consideradas en la planificación asistencial de los centros que atienden a estos pacientes


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Diagnóstico Duplo (Psiquiatria)/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Mentais/complicações , Centros Comunitários de Saúde Mental/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos
8.
Int J Geriatr Psychiatry ; 34(8): 1267-1274, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31034652

RESUMO

OBJECTIVES: Memory clinics (MCs) have been established to improve diagnosis and treatment of cognitive disorders, including dementia. The aim of this study was to determine the characteristics and working methods of MCs in the Netherlands in 2016. More insight into different working methods can be used to improve the quality of care in Dutch MCs. Additionally, the findings will be compared with earlier results to investigate the development of MCs since 1998. METHODS: A survey was sent in 1998, 2004, 2009, and 2017 to all operational Dutch MCs with questions about organization, collaboration, patients, and diagnostic procedures. RESULTS: From 1998 to 2016, the number of MCs increased substantially from 12 to 91. The capacity increased from 1560 patients to 24,388. In 1998, most patients received a dementia diagnosis (85%), while in 2016, half of the patients were diagnosed with milder cognitive problems. MCs are more often part of regional care chains and are better embedded within regional care organizations. Diagnostic tools, such as blood tests (97%), neuropsychological assessment (NPA) (95%), and neuroimaging (92%), were used in nearly all MCs. The number of patients in whom these tools were used differed greatly between MCs (NPA: 5%-100%, neuroimaging: 10%-100%, and CSF: 0.5%-80%). There was an increase in the use of NPA, while the use of neuroimaging, CSF, and EEG/ECG decreased by 8% to 15% since 2009. CONCLUSIONS: Since 1998, MCs have developed substantially and outgrown the primarily research-based university settings. They are now accepted as regular care facilities for people with cognitive problems.


Assuntos
Transtornos Cognitivos/terapia , Centros Comunitários de Saúde Mental/organização & administração , Transtornos da Memória/terapia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Centros Comunitários de Saúde Mental/tendências , Feminino , Humanos , Masculino , Transtornos da Memória/diagnóstico , Pessoa de Meia-Idade , Países Baixos , Testes Neuropsicológicos
9.
Behav Cogn Psychother ; 47(5): 548-558, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30859928

RESUMO

BACKGROUND: Cognitive behavioural therapy (CBT) is an evidence-based treatment for chronic fatigue syndrome (CFS). Stepped care for CFS, consisting of a minimal intervention followed by face-to-face CBT, was found efficacious when tested in a CFS specialist centre. Stepped care implemented in a community-based mental health centre (MHC) has not yet been evaluated. AIMS: (1) To test the effectiveness of stepped care for CFS implemented in a MHC at post-treatment and at long-term follow-up; and (2) compare post-treatment outcomes of implemented stepped care with treatment outcomes of a CFS specialist centre. METHOD: An uncontrolled study was used to test effectiveness of stepped care implemented in a MHC (n = 123). The outcomes of implemented care were compared with the outcomes of specialist care reported in previous studies (n = 583). Data on outcomes from implemented stepped care were gathered at post-treatment and at long-term follow-up. Mixed models were used as method of analysis. RESULTS: Fatigue decreased and physical functioning increased significantly following implemented stepped care (both p < .001). The follow-up was completed by 94 patients (78%) within 1-6 years after treatment. Treatment effects were sustained to follow-up. Patients in the MHC showed less improvement directly following stepped care compared with patients in a CFS specialist centre (p < .01). CONCLUSION: Implemented stepped care for CFS is effective with sustained treatment gains at long-term follow-up. There is room for improvement when compared with outcomes of a CFS specialist centre. Some suggestions are made on how to improve stepped care.


Assuntos
Terapia Cognitivo-Comportamental , Centros Comunitários de Saúde Mental , Síndrome de Fadiga Crônica/terapia , Adolescente , Adulto , Fadiga/psicologia , Fadiga/terapia , Síndrome de Fadiga Crônica/psicologia , Feminino , Seguimentos , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
10.
BMC Psychiatry ; 19(1): 65, 2019 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-30744590

RESUMO

BACKGROUND: Illness Management and Recovery (IMR) is a curriculum-based rehabilitation program for people with severe mental illness with the short-term aim of improving illness self-management and the long-term aim of helping people achieve clinical and personal recovery. METHOD: Participants with schizophrenia or bipolar disorders were recruited from three community mental health centers in the Capital Region of Denmark and randomized to receive group-based IMR and treatment as usual or only the usual intervention. All outcomes were assessed at baseline, postintervention, and the one-year follow-up. Long-term outcomes were categorized according to clinical recovery (i.e., symptoms, global functioning, and hospitalization) and personal recovery (i.e., hope and personal agency). Generalized linear mixed model regression analyses were used in the intent-to-treat analysis. RESULTS: A total of 198 participants were included. No significant differences were found between the IMR and control groups in the Global Assessment of Functioning one year after the intervention, nor were there significant differences in symptoms, number of hospital admissions, emergency room visits, or outpatient treatment. CONCLUSION: The present IMR trial showed no significant effect on clinical and personal recovery at the one-year follow-up. Together with the results of other IMR studies, the present study indicates that the effect of IMR on symptom severity is unclear, which raises questions regarding the impact of IMR on functioning. Additionally, IMR did not affect personal recovery. Although more research is needed, the results indicate that the development of other interventions should be considered to help people with severe mental illness achieve a better level of functioning and personal recovery. TRIAL REGISTRATION: Trial registered at http://www.clinicaltrials.gov ( NCT01361698 ).


Assuntos
Transtorno Bipolar/reabilitação , Centros Comunitários de Saúde Mental , Saúde Mental , Esquizofrenia/reabilitação , Autogestão , Adulto , Idoso , Dinamarca , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
11.
PLoS One ; 14(2): e0211938, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30768607

RESUMO

PURPOSE: This study aims to describe factors associated to treatment continuity and psychiatric relapses in patients treated with Long Acting Injectable antipsychotics (LAIs) in Bologna Community Mental Health Centers (CMHCs). METHODS: New LAI treatments administered between July 1, 2010 and June 30, 2015 in CMHCs were selected. The cohort was followed-up for 6 months; predictors of continuity and psychiatric admissions were investigated by using logistic regression- and Cox- analysis respectively. RESULTS: Among the cohort of 1 070 patients, only 222 (21%) continued LAI treatment during the follow-up. LAI continuity was higher with first generation agents (OR: 1.71, 95%CI 1.18-2.49) and in case of previous psychiatric hospitalizations (OR 2.00, 95%CI 1.47-2.74). Incidence of psychiatric hospital admissions showed a sharp reduction in the follow-up compared with 6-month period before initiation (from 458 to 212), and was associated with previous psychiatric hospitalizations (HR 3.20, 95%CI 2.22-4.59), immigration (HR 3.13, 95%CI 1.28-7.69) and LAI discontinuation (HR 1.14, 95%Cl 1.01-1.97). CONCLUSIONS: Psychiatric hospital admission before LAI initiation was the main predictor both of LAI continuity and hospitalization during the follow-up.


Assuntos
Antipsicóticos/administração & dosagem , Centros Comunitários de Saúde Mental , Hospitalização , Transtornos Mentais/tratamento farmacológico , Adulto , Feminino , Seguimentos , Humanos , Itália , Masculino , Pessoa de Meia-Idade
12.
Int J Soc Psychiatry ; 65(1): 38-45, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30791796

RESUMO

BACKGROUND: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. AIMS: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America - specifically, in Santiago (Chile) from a user perspective. METHOD: We analyzed 15 in-depth interviews ( n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. RESULTS: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users' perceptions of the peer support workers and the community mental health workers. CONCLUSIONS: CTI-TS was generally acceptable in this Latin American context. Users' perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.


Assuntos
Psicoterapia/métodos , Transtornos Psicóticos/psicologia , Autoimagem , Estigma Social , Adulto , Chile , Centros Comunitários de Saúde Mental , Feminino , Humanos , Entrevistas como Assunto , Masculino , Serviços de Saúde Mental , Pessoa de Meia-Idade , Transtornos Psicóticos/prevenção & controle , Pesquisa Qualitativa , Ensaios Clínicos Controlados Aleatórios como Assunto , Adulto Jovem
13.
Crisis ; 40(5): 326-332, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30644775

RESUMO

Background: Early identification and appropriate referral services are priorities to prevent suicide. Aims: The aim of this study was to describe patterns of identification and referrals among three behavioral health centers and determine whether youth demographic factors and type of training received by providers were associated with identification and referral patterns. Method: The Early Identification Referral Forms were used to gather the data of interest among 820 youth aged 10-24 years who were screened for suicide risk (females = 53.8%). Descriptive statistics and binary logistic regressions were conducted to examine significant associations. Results: Significant associations between gender, race, and age and screening positive for suicide were found. Age and race were significantly associated with different patterns of referrals and/or services received by youths. For providers, being trained in Counseling on Access to Lethal Means was positively associated with number of referrals to inpatient services. Limitations: The correlational nature of the study and lack of information about suicide risk and comorbidity of psychiatric symptoms limit the implications of the findings. Conclusion: The results highlight the importance of considering demographic factors when identifying and referring youth at risk to ensure standard yet culturally appropriate procedures to prevent suicide.


Assuntos
Serviços Comunitários de Saúde Mental , Encaminhamento e Consulta , Ideação Suicida , Suicídio/prevenção & controle , Adolescente , Afro-Americanos , Americanos Asiáticos , Criança , Centros Comunitários de Saúde Mental , Grupo com Ancestrais do Continente Europeu , Feminino , Georgia , Hispano-Americanos , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Medição de Risco , População Rural , Fatores de Tempo , Adulto Jovem
14.
Early Interv Psychiatry ; 13(4): 1011-1017, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30672134

RESUMO

AIM: To report on the development of an early intervention service in Modena, Italy, with information relevant to the first 4 years of implementation. METHODS: The 2-year service was offered to people aged 18-35 with psychotic manifestations, within 2 years from psychosis onset/or naïve to antipsychotics, by teams placed within community mental health Centres, according to a "specialist within generalist" model. Treatment included pharmacological consultation, psychoeducation and social inclusion programs. Health of the Nation Outcome Scale was administered at baseline and every 6 months. RESULTS: One hundred cases accepted the treatment from 1 March 2013 to 31 December 2016. Of these, 71% were male with a median age of 23. Ninety percent were diagnosed with non-affective psychosis, yielding an estimated treated incidence of 19.1/105 . General practitioners (GPs)represented the most frequent referrers to the program (38%), followed by referrals from acute general and psychiatric hospital units (22%) and self-referrals (14%). Meaningful clinical improvement was observed, 6 months after enrolment. CONCLUSIONS: An early intervention service for psychosis was successfully implemented within existing community outpatient services. GPs represented the main referrals, providing some validation of the "specialist within generalist" model of care. A promising clinical improvement and trend of reduction in duration of untreated psychosis was found, supporting the variety of early detection efforts in the community. The high median age and lack of information about pathways to care underline possible barriers to access for younger patients. These findings will inform refinement of treatments and service models for the Region.


Assuntos
Intervenção Médica Precoce , Transtornos Psicóticos/terapia , Adulto , Assistência Ambulatorial/organização & administração , Terapia Combinada , Centros Comunitários de Saúde Mental/organização & administração , Diagnóstico Precoce , Feminino , Implementação de Plano de Saúde/organização & administração , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Encaminhamento e Consulta/organização & administração , Adulto Jovem
15.
Community Ment Health J ; 55(1): 83-99, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29508179

RESUMO

CBT is considered the first-line treatment for anxiety disorders, particularly when it involves gradual confrontation with feared stimuli (i.e., exposure); however, delivery of CBT for anxiety disorders in real-world community clinics is lacking. This study utilized surveys we developed with key stakeholder feedback (patient, provider, and administrator) to assess patient and provider/administrator perceptions of the barriers to delivering (or receiving) CBT for anxiety disorders. Providers/administrators from two counties in California (N = 106) indicated lack of training/competency as primary barriers. Patients in one large county (N = 42) reported their own symptoms most often impacted treatment receipt. Both groups endorsed acceptability of exposure but indicated that its use in treatment provided/received had been limited. Implications and recommendations are discussed.


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Competência Clínica/estatística & dados numéricos , Terapia Cognitivo-Comportamental , Conhecimentos, Atitudes e Prática em Saúde , Participação dos Interessados/psicologia , Adulto , Centros Comunitários de Saúde Mental , Pesquisa Participativa Baseada na Comunidade , Feminino , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Los Angeles , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Inquéritos e Questionários
16.
Child Psychiatry Hum Dev ; 50(1): 1-12, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29855819

RESUMO

Research shows that parenting interventions are plagued with the problem of early treatment termination. A brief 6-week intervention, parent-child care (PC-CARE) was developed to minimize the time investment for parents while maximizing the probability of improving behavioral problems of their 1-10 year old children. The purpose of this study was to determine the feasibility of PC-CARE and examine preliminary outcomes. The data were collected as part of an open trial in a community mental health clinic and included pre- and post-treatment performance outcomes, weekly measures of treatment progress, and assessments of treatment fidelity. Participants were 64 children and their primary caregivers, referred by physicians, social workers, or self-referred for help with their children's difficult behaviors. The retention rate was 94%. Results of analyses pre- to post-intervention scores showed significant improvements in child behavioral problems as well as improvements in parenting stress and positive parenting skills. The findings suggest that PC-CARE may be a beneficial treatment for children with disruptive behaviors, encourage future research into the efficacy of this brief parenting intervention, and its effectiveness in other populations and contexts.


Assuntos
Transtornos do Comportamento Infantil , Comportamento Infantil/psicologia , Educação não Profissionalizante/métodos , Relações Pais-Filho , Poder Familiar/psicologia , Pais , Adulto , Criança , Transtornos do Comportamento Infantil/psicologia , Transtornos do Comportamento Infantil/terapia , Cuidado da Criança , Pré-Escolar , Centros Comunitários de Saúde Mental/estatística & dados numéricos , Feminino , Humanos , Lactente , Masculino , Pais/educação , Pais/psicologia , Comportamento Problema/psicologia , Técnicas Psicológicas
17.
Psychother Psychosom Med Psychol ; 69(5): 167-175, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-29653461

RESUMO

OBJECTIVE: Analysis of users experiences with a low-threshold psychosocial counselling and case management service across separate sectors (e. g., outpatient, inpatient) and legal provisions (e. g., V and XII Books of Social Code). METHODS: Nine semi-structured interviews were conducted and analysed using content analysis. RESULTS: Several aspects of the users' experiences with counselling services have contributed towards their satisfaction with the service. The importance of short waiting times and the on-call telephone service as well as sufficient time taken for consultations, the availability of outreach counselling and the quality of the relationship with the counsellor were all highlighted. Potential for improvement was seen in the visibility of the service in the community. CONCLUSION: The investigated counselling and case management service can help to provide a low-threshold crisis intervention and could place users in more custom-fit community integration services.


Assuntos
Centros Comunitários de Saúde Mental , Serviços Comunitários de Saúde Mental , Aconselhamento , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Telefone , Adulto Jovem
18.
Community Ment Health J ; 55(1): 57-62, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30062631

RESUMO

Minority groups experience higher depression but lower treatment rates. Student-run free mental health (MH) clinics, such as the East Harlem Health Outreach Partnership (EHHOP) MH clinic, address this disparity. This study scrutinized EHHOP MH's depression treatment by measuring adherence to antidepressants. Pharmacy data from seventy-nine patients were reviewed according to HEDIS criteria. Results compare EHHOP MH to New York State (NYS) Medicaid and NYS commercial insurance providers. In the acute treatment phase, EHHOP MH performed similarly to NYS Medicaid. In all other comparisons, EHHOP MH had lower adherence rates. Physician notes were reviewed to identify reasons for low adherence.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Adolescente , Adulto , Idoso , Auditoria Clínica , Centros Comunitários de Saúde Mental , Feminino , Humanos , Masculino , Medicaid , Pessoa de Meia-Idade , Cidade de Nova Iorque , Faculdades de Medicina , Estudantes de Medicina , Estados Unidos , Adulto Jovem
19.
Suicide Life Threat Behav ; 49(4): 1148-1156, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30073698

RESUMO

OBJECTIVE: This study examined whether (1) behavioral health providers were more likely to implement best practices when they were more confident in their abilities, (2) number of suicide prevention trainings was positively associated with perceived confidence in abilities and implementation of evidence-based practices, and (3) specific trainings were more impactful than others on increasing providers' level of confidence and/or practices. METHOD: Providers (N = 137) at three rural community behavioral health centers who had opportunities to attend multiple suicide prevention trainings completed the Zero Suicide Workforce Survey, a measure to evaluate staff knowledge, practices, and confidence in caring for patients at risk of suicide. RESULTS: There was a moderate association between provider's practice and confidence. The number of attended trainings had a significant correlation with both practice and confidence. Particular trainings demonstrated differential effects on provider's practice and confidence. CONCLUSION: These results suggest that behavioral health providers who are confident in their skills in assessing and treating suicide risk are more likely incorporate best practices into their clinical work. Also, it appears there is a small but significant benefit to multiple trainings for increasing both practice and confidence among providers.


Assuntos
Centros Comunitários de Saúde Mental , Suicídio/prevenção & controle , Adulto , Humanos , Masculino , Psiquiatria , Inquéritos e Questionários
20.
Community Ment Health J ; 55(1): 38-41, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30225578

RESUMO

Supplemental security income (SSI), is the lifeline for our patients living in the community. Absent disability benefits most of our patients are homeless. Many will be hungry, poorly clothed, and have only rudimentary health care. The disability determination system will approve disability for < 30% of those adults making an initial application. The rate of actual disability is much higher. A large cohort (n = 251) of likely disability applicants had comprehensive diagnostic evaluations. These evaluations revealed extensive co-occurring psychiatric symptoms and features, particularly obsessive-compulsive features. Recognition and appreciation of the burden of co-occurring conditions leads to a robust increase in approval rates. Administrative or structural features of the disability determination system also depress allowance rates.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/psicologia , Pessoas com Deficiência/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Previdência Social/estatística & dados numéricos , Chicago/epidemiologia , Estudos de Coortes , Centros Comunitários de Saúde Mental , Comorbidade , Humanos , Estudos Retrospectivos , Estados Unidos
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