The relevance of professionals' attachment style, expectations and job attitudes for therapeutic relationships with young people who experience psychosis

Developing a hope-focused intervention to prevent mental health problems and improve social outcomes for young women who are not in education, employment, or training (NEET): A qualitative co-design study in deprived coastal communities in South-East England

Young women who are not in education, employment, or training (NEET) experience poorer health and social outcomes compared to non-NEET young women and to NEET young men, especially in deprived areas with intersecting inequalities. The evidence on effective public health approaches is scarce. Interventions that target hope, which NEET young women notably lack, offer a promising theory-driven and intuitive means to prevent mental health problems and improve social outcomes. Hope can be defined as a goal-focused mindset comprising self-agency (motivation and self-belief) and pathways (identifying routes to achieving goals). Hope is implicated in a variety of evidence-based psychosocial interventions for young people, but is not directly targeted by existing prevention programmes for NEET populations. The current study used a phased qualitative research design and participatory methods to model a hope-focused intervention for NEET young women. Phase 1 investigated population needs and intervention parameters through semi-structured interviews with 28 key informants living or working in disadvantaged coastal communities in South-East England. The sample comprised eight NEET young women, four family members, and 16 practitioners from relevant support organisations. Phase 2 refined intervention parameters and outcomes through co-design sessions with four NEET young women, followed by a theory of change workshop with 10 practitioners. The resulting intervention model is articulated as a mentor-supported, in-person psychosocial intervention that builds hope by enhancing positive sense of self and time spent in meaningful activities, before explicitly teaching the skills needed to identify, set, and pursue personally meaningful goals.

"Attitudes to voices": a survey exploring the factors influencing clinicians' intention to assess distressing voices and attitudes towards working with young people who hear voices

Introduction

Due to the general psychopathological vulnerability of young people who hear distressing voices, research has stressed the importance for clinicians to assess this experience in youth. Nonetheless, the limited literature on the topic comes from studies with clinicians in adult health services and it primarily reports that clinicians do not feel confident in systematically assessing voice-hearing and doubt the appropriateness of doing so. We applied the Theory of Planned Behavior and identified clinicians' job attitudes, perceived behavioral control, and perceived subjective norms as putative predictors of their intent to assess voice-hearing in youth.

Method

Nine hundred and ninety-six clinicians from adult mental health services, 467 from Child and Adolescent Mental Health (CAMHS) and Early Intervention in Psychosis (EIP) services and 318 primary care clinicians across the UK completed an online survey. The survey gathered data on attitudes toward working with people who hear voices, stigmatizing beliefs, and self-perceived confidence in voice-related practices (screening for, discussing and providing psychoeducation material about voice-hearing). Responses from youth mental health clinicians were compared with professionals working in adult mental health and primary care settings. This study also aimed to identify what youth mental health clinicians believe about assessing distressing voices in adolescents and how beliefs predict assessment intention.

Results

Compared to other clinicians, EIP clinicians reported the most positive job attitudes toward working with young voice-hearers, the highest self-efficacy in voice-hearing practices, and similar levels of stigma. Job attitudes, perceived behavioral control and subjective norms explained a large part of the influences on clinician's intention to assess voice-hearing across all service groups. In both CAMHS and EIP services, specific beliefs relating to the usefulness of assessing voice-hearing, and perceived social pressure from specialist mental health professionals regarding assessment practices predicted clinician intention.

Discussion

Clinicians' intention to assess distressing voices in young people was moderately high, with attitudes, subjective norms and perceived behavioral control explaining a large part of its variance. Specifically in youth mental health services, promoting a working culture that encourages opening and engaging in discussions about voice-hearing between clinicians, and with young people, and introducing supportive assessment and psychoeducation material about voice-hearing could encourage conversations about voices.

The relationship between healthcare workers' attachment styles and patient outcomes: a systematic review

Purpose

To examine whether attachment styles of healthcare workers influence the quality of their relationships with patients, or impact patients' health outcomes.

Data source

Literature database searches on the CINAHL, Cochrane Library, Embase, MEDLINE and PsyCinfo, and hand searching of reference lists of the retained articles.

Study selection

Original empirical studies reporting an analysis of the relationship of interest were selected for review.

Data extraction

Estimates of association between healthcare workers' attachment style and patients' health outcomes were extracted.

Results of data synthesis

Results from 13 studies were mixed in terms of which attachment styles related to patients' perceptions of care or health outcomes, and the evidence overall was of poor quality and methodologically heterogeneous. However, there is limited evidence that secure attachment styles of healthcare workers have little or a negative effect on patients' health outcomes or perceptions in the short term but in the long term have a more positive effect. Conversely, insecure styles tend to have a positive effect in the short term but little or a negative effect on long-term relationships. Studies which used self-report attachment measurements tended to report stronger associations with patients' outcome measurements than studies using the interviewer rated Adult Attachment Interview.

Conclusion

It is unclear whether or not there is a relationship between attachment style of health workers and patients' health outcomes. Further research using consistent data collection tools, especially in relation to the attachment measurement construct selected, and analysis methods across studies is required to draw recommendations for clinical practice.