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Bennetts SL, Pepin G, Moylan S, Carolin R, Forrester-Bowling T, McLure J, Brown AD, Lucas JJ. Co-designing restrictive practice elimination: A systems thinking approach with mental health service users and practitioners in rural/regional Australia. Int J Ment Health Nurs 2024; 33:1564-1574. [PMID: 38757846 DOI: 10.1111/inm.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/22/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
Elimination of restrictive practices (physical/mechanical restraint and seclusion) from adult acute mental health care services has been demanded internationally for many decades. This study aimed to: (1) Identify priority issues in the elimination of and use of alternative approaches to restrictive practices (seclusion and physical/mechanical restraint) in rural/regional acute adult mental healthcare services, as told by mental healthcare service users and practitioners, (2) identify the community-based, system-level feedback loops that enhance or reduce the use of restrictive practices and viable alternatives and, (3) identify potential action areas to improve system structures to increase regional mental healthcare services' ability to eliminate restrictive practices and use alternative approaches. Group model building (GMB) workshops were held with a small group (n = 9) of mental healthcare practitioners and service users with lived experience of restrictive practice use. This participatory approach enables exploration and visual mapping of local structures causing behaviour patterns of practitioner and service user concern over time - in this case, the barriers, and enablers to alternative approaches to restrictive practices in adult acute mental healthcare services within the Geelong-Barwon region. This is the first study that specifically applies GMB in the discussion of the elimination of restrictive practices in mental health in the non-metropolitan regional/rural context. Participants identified four key priorities in relation to eliminating restrictive practices: (1) self-advocacy, (2) continuity of care, (3) early intervention, and (4) safety for all. The study findings were distilled into a novel preliminary set of mental healthcare practitioner and service user action ideas.
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Affiliation(s)
- Stephanie L Bennetts
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Change to Improve Mental Health (CHIME) Translation Research Partnership, Barwon Health & Deakin University, Geelong, Victoria, Australia
| | - Genevieve Pepin
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Steven Moylan
- Change to Improve Mental Health (CHIME) Translation Research Partnership, Barwon Health & Deakin University, Geelong, Victoria, Australia
| | - Renae Carolin
- Change to Improve Mental Health (CHIME) Translation Research Partnership, Barwon Health & Deakin University, Geelong, Victoria, Australia
| | - Tari Forrester-Bowling
- Change to Improve Mental Health (CHIME) Translation Research Partnership, Barwon Health & Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - James McLure
- Change to Improve Mental Health (CHIME) Translation Research Partnership, Barwon Health & Deakin University, Geelong, Victoria, Australia
| | - Andrew D Brown
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - James J Lucas
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Giorgi F, Fanali A, Tramonti F. A critical evaluation of choice negotiation for patient-centred medicine and psychotherapy. J Eval Clin Pract 2024; 30:1169-1175. [PMID: 38308615 DOI: 10.1111/jep.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/11/2024] [Indexed: 02/05/2024]
Abstract
STUDY AIMS The present paper aimed at discussing how the process of decision-making should be taken care of in healthcare services. METHODS This is a position paper based on a review of the relevant literature about meaning-making processes in medical encounters and psychotherapy. DISCUSSION Authors argued that choice options could be perceived as meaningful by patients if their uncertainties were taken into account and grounded on mutual understanding and reciprocal trust. To this end, any decision-making process should satisfy the patient's legitimate expectations by making choices and habits compatible. CONCLUSION In depht analysis of meaning-making processes is crucial for better refining good practices of shared decision-making.
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Fawor J, Hancock N, Scanlan JN, Hamilton DE. Supporting self-determination in mental health recovery: Strategies employed by occupational therapists. Aust Occup Ther J 2024; 71:88-101. [PMID: 37861243 DOI: 10.1111/1440-1630.12913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 10/02/2023] [Accepted: 10/07/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Self-determination is a core component of mental health recovery and a predictor of positive outcomes. The literature calls for occupational therapists to lead practice change to greater recovery-orientation, including facilitating people's self-determination. However, systemic challenges thwart translation of policy into practice and therapists report a lack of confidence in implementing recovery-oriented principles. This study aimed to understand the strategies that mental health occupational therapists employ to support people's self-determination. METHODS Data were collected through an international on-line questionnaire principally comprising two open-ended questions designed to elicit deep reflective personal accounts. Participants were asked about an experience in which they supported a person's self-determination and the factors that either facilitated or hindered this experience. Qualitative data were analysed using inductive thematic analysis, guided by constant comparative methods. FINDINGS Thirty-four therapists, predominantly from Australia (n = 30), participated. Therapists described supporting self-determination as a multifaceted process that involved: (1) working on myself, (2) working with the person, and (3) working with others. They emphasised that the combined use of various strategies across these three areas of work was important to support people's self-determination. Further, awareness of and addressing issues of power in their practice was key. CONCLUSION This study supports the translation of recovery-oriented principles into practice by revealing the nuanced strategies implemented by occupational therapists striving to support self-determination. Participants employed diverse strategies to empower people to take the 'driver's seat' in their mental health recovery journey. Insights from this study will support other occupational therapists to actualise recovery-oriented principles and better support self-determination in their practice. To effectively implement self-determination strategies, therapists must reflect on and address existing power differentials within mental health services, particularly between themselves and the people they support.
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Affiliation(s)
- Jasmine Fawor
- Discipline of Occupational Therapy, Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nicola Hancock
- Discipline of Occupational Therapy, Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Justin Newton Scanlan
- Discipline of Occupational Therapy, Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
| | - Debra Ellen Hamilton
- Discipline of Occupational Therapy, Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia
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Affiliation(s)
- Chizimuzo Zim Okoli
- Chizimuzo (Zim) Okoli, PhD, MPH, MSN, PMHNP-BC, FAAN, American Psychiatric Nurses Association, Falls Church, VA, USA
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5
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Micai M, Gila L, Caruso A, Fulceri F, Fontecedro E, Castelpietra G, Romano G, Ferri M, Scattoni ML. Benefits and challenges of a personal budget for people with mental health conditions or intellectual disability: A systematic review. Front Psychiatry 2022; 13:974621. [PMID: 35990078 PMCID: PMC9386381 DOI: 10.3389/fpsyt.2022.974621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 01/04/2023] Open
Abstract
Personal budgets (PBs) may improve the lives of people with mental health conditions and people with intellectual disability (ID). However, a clear definition of PB, benefits, and challenges is still faded. This work aims to systematically review evidence on PB use in mental health and ID contexts, from both a qualitative and quantitative perspective, and summarize the recent research on interventions, outcomes, and cost-effectiveness of PBs in beneficiaries with mental health conditions and/or ID. The present systematic review is an update of the existing literature analyzed since 2013. We performed a systematic search strategy of articles using the bibliographic databases PubMed and PsycINFO. Six blinded authors screened the works for inclusion/exclusion criteria, and two blinded authors extracted the data. We performed a formal narrative synthesis of the findings from the selected works. A total of 9,800 publications were screened, and 29 were included. Improvement in responsibility and awareness, quality of life, independent living, paid work, clinical, psychological, and social domains, and everyday aspects of the users' and their carers' life have been observed in people with mental health conditions and/or ID. However, the PBs need to be less stressful and burdensome in their management for users, carers, and professionals. In addition, more quantitative research is needed to inform PBs' policymakers. Systematic Review Registration [www.crd.york.ac.uk/prospero/], identifier [CRD42020172607].
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Affiliation(s)
- Martina Micai
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Letizia Gila
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Angela Caruso
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Francesca Fulceri
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
| | - Elisa Fontecedro
- Department of Mental Health, Friuli Centrale Healthcare Agency, Udine, Italy
| | | | - Giovanna Romano
- Directorate General of Health Prevention, Ministry of Health, Rome, Italy
| | | | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Rome, Italy
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Wells K, Hancock N, Honey A. How Do People Perceive and Adapt to Any Consequences of Electro Convulsive Therapy on Their Daily Lives? Community Ment Health J 2022; 58:1049-1059. [PMID: 34812963 DOI: 10.1007/s10597-021-00913-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022]
Abstract
Great controversy surrounds the use of electroconvulsive therapy or ECT. However, it continues to be used internationally. While research on short term effects of ECT abound, there is limited knowledge about long term impacts of ECT on individuals, especially from the lived experience perspective. The aim of this qualitative study was to gain an in-depth understanding of longer-term lived experiences of ECT and how people navigate any impacts on their daily lives. Twenty-three people participated in semi-structured interviews. Data collection and analysis involved an iterative process. Data were coded into four categories: (1) My ECT experience included physical mechanics, decision making, clinic experiences, post ECT support and attitudes and support of others); (2) Direct impacts of ECT on me encompassed both cognitive and emotional impacts; (3) Impacts on my life comprised daily activities, relationships, ongoing health care; and My strategies incorporated fixing or working around the problem, reframing, using support networks, protecting myself and taking control. Insights gleaned through lived experiences have important implications for other service users, direct service providers and those striving for system reforms that embrace more recovery orientated and trauma informed practices.
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Affiliation(s)
- Karen Wells
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia.
| | - Nicola Hancock
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia
| | - Anne Honey
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Centre for Disability Research and Policy (CDRP), The University of Sydney, Sydney, NSW, Australia
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7
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O'Sullivan S, Schmaal L, D'Alfonso S, Toenders YJ, Valentine L, McEnery C, Bendall S, Nelson B, Gleeson JF, Alvarez-Jimenez M. Characterizing Use of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: Cluster Analysis. JMIR Ment Health 2022; 9:e29211. [PMID: 35389351 PMCID: PMC9030973 DOI: 10.2196/29211] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/18/2021] [Accepted: 01/10/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in use makes it difficult to determine which components lead to improved treatment outcomes. OBJECTIVE This study aims to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention for first-episode psychosis that incorporates therapeutic content and social networking, along with clinical, vocational, and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective is to compare each user profile with young people receiving treatment as usual (TAU). METHODS Participants comprised 82 young people (aged 16-27 years) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. In addition, 6-month use data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression, and anxiety were assessed at baseline and 6-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes and between each user profile with TAU. RESULTS A total of 3 user profiles were identified based on the following system use metrics: low use, maintained use of social components, and maintained use of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F2,51=3.58; P=.04), negative symptoms (F2,51=4.45; P=.02), and overall psychiatric symptom severity (F2,50=3.23; P=.048) compared with the other user profiles. This group also showed improvements in social functioning (F1,62=4.68; P=.03), negative symptoms (F1,62=14.61; P<.001), and overall psychiatric symptom severity (F1,63=5.66; P=.02) compared with the TAU group. Conversely, the maintained social group showed increases in anxiety compared with the TAU group (F1,57=7.65; P=.008). No differences were found between the low use group and the TAU group on treatment outcomes. CONCLUSIONS Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social use and low use outcomes were broadly comparable with TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits.
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Affiliation(s)
- Shaunagh O'Sullivan
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lianne Schmaal
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Simon D'Alfonso
- Orygen, Parkville, Australia.,School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Yara Jo Toenders
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Lee Valentine
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Carla McEnery
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Sarah Bendall
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - John F Gleeson
- Health Brain and Mind Research Centre, Australian Catholic University, Melbourne, Australia.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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8
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Balogun-Katung A, Carswell C, Brown JVE, Coventry P, Ajjan R, Alderson S, Bellass S, Boehnke JR, Holt R, Jacobs R, Kellar I, Kitchen C, Lister J, Peckham E, Shiers D, Siddiqi N, Wright J, Young B, Taylor J, on behalf of the DIAMONDS research team. Exploring the facilitators, barriers, and strategies for self-management in adults living with severe mental illness, with and without long-term conditions: A qualitative evidence synthesis. PLoS One 2021; 16:e0258937. [PMID: 34699536 PMCID: PMC8547651 DOI: 10.1371/journal.pone.0258937] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/10/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND People living with severe mental illness (SMI) have a reduced life expectancy by around 15-20 years, in part due to higher rates of long-term conditions (LTCs) such as diabetes and heart disease. Evidence suggests that people with SMI experience difficulties managing their physical health. Little is known, however, about the barriers, facilitators and strategies for self-management of LTCs for people with SMI. AIM To systematically review and synthesise the qualitative evidence exploring facilitators, barriers and strategies for self-management of physical health in adults with SMI, both with and without long-term conditions. METHODS CINAHL, Conference Proceedings Citation Index- Science, HMIC, Medline, NICE Evidence and PsycInfo were searched to identify qualitative studies that explored barriers, facilitators and strategies for self-management in adults with SMI (with or without co-morbid LTCs). Articles were screened independently by two independent reviewers. Eligible studies were purposively sampled for synthesis according to the richness and relevance of data, and thematically synthesised. RESULTS Seventy-four articles met the inclusion criteria for the review; 25 articles, reporting findings from 21 studies, were included in the synthesis. Seven studies focused on co-morbid LTC self-management for people with SMI, with the remaining articles exploring self-management in general. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the burden of SMI; living with co-morbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; and routine, structure and planning. CONCLUSIONS The synthesis identified a range of barriers and facilitators to self-management, including the burden of living with SMI, social support, attitudes towards self-management and access to resources. To adequately support people with SMI with co-morbid LTCs, healthcare professionals need to account for how barriers and facilitators to self-management are influenced by SMI, and meet the unique needs of this population.
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Affiliation(s)
- Abisola Balogun-Katung
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Claire Carswell
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Peter Coventry
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ramzi Ajjan
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sarah Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sue Bellass
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Jan R. Boehnke
- Department of Health Sciences, University of York, York, United Kingdom
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Richard Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Charlotte Kitchen
- Department of Health Sciences, University of York, York, United Kingdom
| | - Jennie Lister
- Department of Health Sciences, University of York, York, United Kingdom
| | - Emily Peckham
- Department of Health Sciences, University of York, York, United Kingdom
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Ben Young
- Department of Health Sciences, University of York, York, United Kingdom
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Jo Taylor
- Department of Health Sciences, University of York, York, United Kingdom
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Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:79-87. [PMID: 33956268 DOI: 10.1007/s10488-021-01142-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ2(17) = 47.64, p < .0001 and explaining 30% (Nagelkerke R2) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B = .90, p = .008, OR 2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.
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de Vries A, Tiemens B, Cillessen L, Hutschemaekers G. Construction and validation of a self-direction measure for mental health care. J Clin Psychol 2020; 77:1371-1383. [PMID: 33219531 DOI: 10.1002/jclp.23091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/23/2020] [Accepted: 10/31/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aims were to describe and develop a measure of the concept of the active self as self-direction and to assess the extent to which clients in a mental healthcare setting were becoming self-directive instead of being directed by their therapist. METHODS A panel of experts was formed to discuss the concept self-direction and to formulate a tentative model of self-direction. An initial questionnaire was constructed. A cross-section of clients completed the questionnaire to evaluate its validity and reliability with exploratory factor analysis. RESULTS A 31-item questionnaire was constructed that included six factors that measured actorship, commitment, demoralization, readiness, understanding, and monitoring progress and two broader underlying factors called gaining control and loss of control. CONCLUSION The developed questionnaire measures the degree to which people are experiencing self-direction in their lives, and their capability of solving their problems.
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Affiliation(s)
- Arie de Vries
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona Research, Renkum, The Netherlands
| | - Bea Tiemens
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona Research, Renkum, The Netherlands.,Indigo, Utrecht, The Netherlands
| | - Linda Cillessen
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona Research, Renkum, The Netherlands
| | - Giel Hutschemaekers
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona Research, Renkum, The Netherlands
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Croft B. Self-direction and the Social Determinants of Health. Community Ment Health J 2020; 56:1504-1507. [PMID: 32125590 DOI: 10.1007/s10597-020-00597-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
Social determinants of health-defined by the World Health Organization as "the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age"-are increasingly discussed as having relevance in community mental health service systems. This brief report describes how self-direction-an approach in which people with serious mental health conditions choose the services and supports that work best for them to support their recovery-is a tool that may directly and uniquely promote the social determinants of health by expanding the bounds of traditional service delivery to address the needs of the whole person.
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Affiliation(s)
- Bevin Croft
- Human Services Research Institute, 2336 Massachusetts Avenue, Cambridge, MA, 02140, USA.
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