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Harris M, Scott J, Hope V, Busza J, Sweeney S, Preston A, Southwell M, Eastwood N, Vuckovic C, McGaff C, Yoon I, Wilkins L, Ram S, Lord C, Bonnet P, Furlong P, Simpson N, Slater H, Platt L. Safe inhalation pipe provision (SIPP): protocol for a mixed-method evaluation of an intervention to improve health outcomes and service engagement among people who use crack cocaine in England. Harm Reduct J 2024; 21:19. [PMID: 38263202 PMCID: PMC10804795 DOI: 10.1186/s12954-024-00938-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Over 180,000 people use crack cocaine in England, yet provision of smoking equipment to support safer crack use is prohibited under UK law. Pipes used for crack cocaine smoking are often homemade and/or in short supply, leading to pipe sharing and injuries from use of unsafe materials. This increases risk of viral infection and respiratory harm among a marginalised underserved population. International evaluations suggest crack pipe supply leads to sustained reductions in pipe sharing and use of homemade equipment; increased health risk awareness; improved service access; reduction in injecting and crack-related health problems. In this paper, we introduce the protocol for the NIHR-funded SIPP (Safe inhalation pipe provision) project and discuss implications for impact. METHODS The SIPP study will develop, implement and evaluate a crack smoking equipment and training intervention to be distributed through peer networks and specialist drug services in England. Study components comprise: (1) peer-network capacity building and co-production; (2) a pre- and post-intervention survey at intervention and non-equivalent control sites; (3) a mixed-method process evaluation; and (4) an economic evaluation. Participant eligibility criteria are use of crack within the past 28 days, with a survey sample of ~ 740 for each impact evaluation survey point and ~ 40 for qualitative process evaluation interviews. Our primary outcome measure is pipe sharing within the past 28 days, with secondary outcomes pertaining to use of homemade pipes, service engagement, injecting practice and acute health harms. ANTICIPATED IMPACT SIPP aims to reduce crack use risk practices and associated health harms; including through increasing crack harm reduction awareness among service providers and peers. Implementation has only been possible with local police approvals. Our goal is to generate an evidence base to inform review of the legislation prohibiting crack pipe supply in the UK. This holds potential to transform harm reduction service provision and engagement nationally. CONCLUSION People who smoke crack cocaine in England currently have little reason to engage with harm reduction and drug services. Little is known about this growing population. This study will provide insight into population characteristics, unmet need and the case for legislative reform. TRIAL REGISTRATION ISRCTN12541454 https://doi.org/10.1186/ISRCTN12541454.
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Affiliation(s)
- Magdalena Harris
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Jenny Scott
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, Bristol, BS8 2PS, UK
| | - Vivian Hope
- Public Health Institute/School of Public and Allied Health, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - Joanna Busza
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sedona Sweeney
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Andrew Preston
- Exchange Supplies, 1 Great Western Industrial Centre, Dorchester, Dorset, DT1 1, UK
| | | | | | - Cedomir Vuckovic
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Caitlynne McGaff
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Ian Yoon
- Department of Global Health and Development, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Louise Wilkins
- The Health Shop, 12 Broad Street, Nottingham, NG1 3AL, UK
| | - Shoba Ram
- The Maples, Verona House, 53 Filwood Rd, Bristol, BS16 3RX, UK
| | - Catherine Lord
- Bristol Drugs Project, 11 Brunswick Square, St Paul's, Bristol, BS2 8PE, UK
| | - Philippe Bonnet
- The Hepatitis C Trust, 72 Weston Street, London, SE1 3QG, UK
| | - Peter Furlong
- Change Grow Live, 34 Albion Place, Leeds, LS1 6JH, UK
| | | | - Holly Slater
- POW Nottingham, 16 Independent Street, Nottingham, NG7 3LN, UK
| | - Lucy Platt
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Lafferty L, Schroeder S, Marshall AD, Drysdale K, Higgs P, Stoové M, Baldry E, Dietze P, Treloar C. Trust and service engagement among people who inject drugs after release from prison. Int J Drug Policy 2023; 111:103925. [PMID: 36525780 DOI: 10.1016/j.drugpo.2022.103925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Compounding histories of injecting drug use and incarceration can marginalise people engaging with services, making it difficult for them to address their health and social welfare needs, particularly when they navigate community re-entry service supports. Drawing on Hall and colleagues' five components of trust, this paper seeks to understand how trust in service providers fosters (or inhibits) effective service engagement from the perspective of people who inject drugs during the prison post-release period. METHODS Between September 2018 and May 2020, qualitative in-depth interviews were completed with 48 adults (33 men, 15 women) recruited from SuperMIX (a longitudinal cohort study of people with a history of injection drug use in Victoria, Australia). Data relating to service engagement were coded against the five components of trust: competence, fidelity, honesty, global trust, and confidence. RESULTS Reflections of post-release service engagement frequently focused on interactions with community corrections (parole) officers. Depictions of trust were consistently portrayed within the context of negative experiences and deficits, whereby trusting provider relationships and interactions were rarely described. Most participants recounted a stark absence of fidelity (that is, "pursuing a [client's] best interests"), with some participants detailing circumstances in which their vulnerability was purposefully, almost strategically, exploited. These encounters nearly always had the consequence of impeding the participant's positive progression in the post-release integration period. CONCLUSION There is an urgent need to prioritise the client in health and social service delivery in the post-release transition-to-community period and recognise the importance of trust in delivering effective services to people whose life histories make them highly vulnerable to marginalisation.
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Affiliation(s)
- L Lafferty
- Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney NSW 2052, Australia; The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney NSW 2052, Australia.
| | - S Schroeder
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road,, Melbourne VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3004, Australia
| | - A D Marshall
- Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney NSW 2052, Australia; The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth, Sydney NSW 2052, Australia
| | - K Drysdale
- Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney NSW 2052, Australia
| | - P Higgs
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road,, Melbourne VIC 3004, Australia; Department of Public Health, La Trobe University, Plenty Rd, Bundoora VIC 3086, Australia
| | - M Stoové
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road,, Melbourne VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3004, Australia
| | - E Baldry
- Division of Equity, Diversity and Inclusion, UNSW Sydney, Sydney NSW 2052, Australia
| | - P Dietze
- Behaviours and Health Risks, Burnet Institute, 85 Commercial Road,, Melbourne VIC 3004, Australia; Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3004, Australia; National Drug Research Institute, Curtin University, GPO Box U1987, Perth, WA 6845, Australia
| | - C Treloar
- Centre for Social Research in Health, UNSW Sydney, Level 1, Goodsell Building, Sydney NSW 2052, Australia
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Nkire N, Kingston T, Kinsella A, Russell V, Waddington JL. Mixed-effects models reveal prediction of long-term outcome by duration of untreated psychosis (DUP) and illness (DUI) varies with quantile gradation but is invariant with time across 7 years in the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Schizophr Res 2022; 248:124-130. [PMID: 36037645 DOI: 10.1016/j.schres.2022.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/01/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022]
Abstract
While associations between duration of untreated psychosis (DUP) and outcome have been widely reported, how long these relationships endure following initiation of treatment and how such associations are distributed across the range of DUP values encountered remain unclear. This study investigates prospectively (i) whether prediction of outcome by DUP and by duration of untreated illness (DUI) diminishes, remains stable or increases in the long term after initiating treatment, and (ii) whether these relationships for differing indices of outcome vary across gradations of DUP-DUI values. Sixty-two subjects were evaluated prospectively for DUP, DUI, premorbid features, psychopathology and quality of life at both first episode psychosis (FEP) and at 7-year follow-up; functionality and service engagement were assessed at follow-up. Data were analysed using mixed-effects models for DUP and DUI quantiles. Prediction by longer DUP and DUI of greater psychopathology, particularly negative symptoms, and lower quality of life remained stable between FEP and follow-up; longer DUP and DUI also predicted lower functionality and service engagement at follow-up. While most associations were confined to the longest DUP-DUI quartile, those between DUP-DUI and negative symptoms and quality of life were distributed in a graded manner across DUP-DUI quartiles. Material confounding with premorbid features, including lead-time bias, was not supported. These findings suggest that benefits of reducing DUP-DUI may endure for at least a decade beyond FEP and that even modest reductions in DUP-DUI may confer particular advantage in the more debilitating and intransigent domain of impairment.
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Affiliation(s)
- Nnamdi Nkire
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Tara Kingston
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland; School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Anthony Kinsella
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Vincent Russell
- Department of Psychiatry, RCSI University of Medicine and Health Sciences, Beaumont Hospital, Dublin, Ireland
| | - John L Waddington
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric-Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.
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Dimitrakopoulos S, Stefanatou P, Vlachos I, Selakovic M, Xenaki LA, Ralli I, Soldatos RF, Nianiakas N, Kosteletos I, Foteli S, Mantonakis L, Kollias CT, Stefanis NC. Don't blame psychosis, blame the lack of services: a message for early intervention from the Greek standard care model. BMC Psychiatry 2022; 22:565. [PMID: 35996121 PMCID: PMC9396840 DOI: 10.1186/s12888-022-04212-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Early Intervention Services (EIS) aim to reduce relapse rates and achieve better treatment and functional outcomes for first episode psychosis (FEP) patients. Existing models of services in Greece are still treatment as usual (TAU), however a reform of mental health services is underway and initial steps have been taken to shift standard care towards EIS. The purpose of the study is to address therapeutic gaps by exploring service engagement and relapse rates in the current standard care model for psychosis. METHODS We examined follow-up and relapse rates one year after initial treatment contact in the first longitudinal FEP study conducted in Greece. 225 patients were enrolled between 2015-2020. Sociodemographic, clinical and functional characteristics were assessed in association with follow-up and relapse rates. RESULTS Within a TAU follow-up setting, one year attrition rates were high. Only 87 patients (38,7%) retained contact with services after one year and within this time frame, 19 of them (21,8%) experienced a severe relapse requiring rehospitalization. Demographic, clinical and functional contributors failed to predict service engagement and relapse rates, with the exception of treatment adherence. CONCLUSION Both follow-up and one-year rehospitalization rates in our FEP sample, highlight the need for the implementation of early intervention services, that will aim at engagement maximization and relapse prevention. These indexes also provide a benchmark against which future early intervention services for psychosis in Greece will have to demonstrate superior efficacy.
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Affiliation(s)
- Stefanos Dimitrakopoulos
- First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528, Athens, Greece. .,414 Military Hospital of Athens, P. Penteli, Greece.
| | - Pentagiotissa Stefanatou
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Ilias Vlachos
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Mirjana Selakovic
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Lida-Alkisti Xenaki
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Irene Ralli
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Rigas-Filippos Soldatos
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Nikolaos Nianiakas
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Ioannis Kosteletos
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Stefania Foteli
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Leonidas Mantonakis
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Costas T. Kollias
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece
| | - Nikos C. Stefanis
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, National and Kapodistrian University of Athens Medical School, Eginition Hospital, 72-74 Vasilissis Sofias Avenue, GR-11528 Athens, Greece ,Neurobiology Research Institute, Theodor-Theohari Cozzika Foundation, Athens, Greece
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Wymbs F, Doctoroff GL, Chacko A, Sternheim G. Preferences for Parenting Programs in Head Start: Using Conjoint Analysis to Understand Engagement in Parenting Health Promotion Programs. Prev Sci 2021; 22:866-879. [PMID: 34453658 DOI: 10.1007/s11121-021-01288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
The impact of evidence-based parenting health promotion programs is threatened by limited enrollment and attendance. We used a discrete choice experiment (DCE) to examine how Early Head Start and Head Start parents prioritized key attributes of parenting programs when considering potential participation. Utility values and importance scores indicate that parents placed the highest priority on a program that optimized child academic outcomes, and after that, on a program that offered incentives and logistical supports, and maximized potential effects on friendship skills, behavioral skills, and the parent-child relationship. Next, we used simulations or forecasting tools to estimate parents' preferences for types of programs. Sixty-five percent of parents preferred Outcome-focused Programs that fostered parents' understanding and practice of skills, whereas 23% prioritized Enhanced Support Programs offering logistic support, such as incentives, followed by child outcomes. The remaining 12% of parents preferred Format-focused Programs that targeted positive outcomes via one 30-min meeting. Parents preferring Outcome-focused Programs reported higher child prosocial behaviors compared to parents preferring Enhanced Support and Format-focused Programs. Parents preferring Outcome-focused Programs were more likely to be those of 3- and 4-year-old children than of 2-year-olds. Findings challenge the one-size-fits-all approach to offering parenting programs and suggest ways to enhance accessibility and program reach.
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Affiliation(s)
- Frances Wymbs
- Department of Primary Care, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA.
| | - Greta L Doctoroff
- Department of Psychology, Ferkauf Graduate School, Yeshiva University, New York, NY, USA
| | - Anil Chacko
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | - Gillian Sternheim
- Department of Psychology, Ferkauf Graduate School, Yeshiva University, New York, NY, USA
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Cowan T, Pope MA, MacDonald K, Malla A, Ferrari M, Iyer SN. Engagement in specialized early intervention services for psychosis as an interplay between personal agency and critical structures: A qualitative study. Int J Nurs Stud 2020; 108:103583. [PMID: 32502820 DOI: 10.1016/j.ijnurstu.2020.103583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Specialized early intervention programs for individuals experiencing a first episode of psychosis prioritize service engagement, generally operationalized as attendance, treatment completion, therapeutic alliance, and treatment adherence. However, there are critical theoretical and methodological gaps in understanding how service users experience and define their engagement with the service. OBJECTIVES This study aimed to explore how current and former service users define their engagement with a specialized early intervention program. DESIGN A qualitative descriptive approach was used to explore service users' decisions to use, remain involved with, and/or leave early intervention services. SETTING This study took place in an early intervention service for psychosis in Montreal, Canada. PARTICIPANTS Twenty-four participants who had experienced a first episode of psychosis and had been engaged in the service to varying degrees (fully engaged, partially engaged, disengaged) took part in in-depth interviews. METHODS In-depth interviews were employed to collect rich insights into participants' experiences and perceptions. The interviews were transcribed and analysed using thematic analysis, beginning with an inductive approach and completing the analysis using a theoretical approach. During the analysis, our original notions of engagement and disengagement were challenged by theorizing engagement in terms of agency and structure. Researchers engaged in reflexive practices to maintain and promote research rigor and trustworthiness. RESULTS Participants' narratives were thematically analyzed and organized into three themes: fluidity and temporality of engagement and disengagement; engagement as an ongoing negotiation; and critical structures and agency. Participants described engagement in a variety of ways, some of which were broader than service use and focused on self-care and commitment to recovery. These conceptions were subject to change as the individuals' perceptions of their needs changed. As needs changed, individuals also negotiated and renegotiated their care needs with themselves and with their treatment team. These exercises of agency were constrained by key structures: the treatment team, family and friends, and societal conceptions of mental health. CONCLUSIONS Our study findings argue for an expanded definition of engagement which prioritizes individuals' experience and acknowledges the steps towards recovery that they may make outside of the purview of the service. It also underlines the importance of a treatment structure which aligns with individuals' needs for both support and autonomy.
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Tindall RM, Allott K, Simmons M, Roberts W, Hamilton BE. The missing voice of engagement: an exploratory study from the perspectives of case-managers at an early intervention service for first-episode psychosis. BMC Psychiatry 2019; 19:312. [PMID: 31651268 PMCID: PMC6814013 DOI: 10.1186/s12888-019-2315-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key component of case-management in early intervention services for first-episode psychosis is engaging a person with the service and building a relationship from which therapy and treatment can be facilitated. The aim of this study was to understand how case-managers at an early intervention service experience the process of engagement and working with varying levels of attendance and participation. METHODS Qualitative interviews were conducted with the case-managers of nine young people treated at an early intervention service for first-episode psychosis within 6 months of treatment entry. Interviews discussed the process of working with the young person and factors that influenced service engagement. Interviews were analyzed using thematic analysis. RESULTS Case-managers described a range of influences on engagement which were grouped under the themes: young person and caregiver influences on engagement, case-manager influences on engagement, and influences of the early intervention service system on engagement. The experience of engagement was described as relational, however it occurred in the context of broader influences, some of which were unable to be changed or challenged by the case-manager (e.g., resource allocation, models of treatment, young person demographics). CONCLUSION This study illustrates the challenges that case-managers face when working with young people with first-episode psychosis, and the direct influence this has on engagement with treatment. Understanding these challenges and addressing them in policy and service design may lead to improvements in young peoples' recovery from first-episode psychosis and increase case-manager job satisfaction.
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Affiliation(s)
- Rachel M. Tindall
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia ,0000 0001 2179 088Xgrid.1008.9Department of Nursing, The University of Melbourne, Melbourne, Australia
| | - Kelly Allott
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Magenta Simmons
- grid.488501.0Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, Melbourne, VIC 3052 Australia ,0000 0001 2179 088Xgrid.1008.9Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Winsome Roberts
- 0000 0001 2179 088Xgrid.1008.9Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Bridget E. Hamilton
- 0000 0001 2179 088Xgrid.1008.9Department of Nursing, The University of Melbourne, Melbourne, Australia
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Lal S, Ungar M, Malla A, Leggo C, Suto M. Impact of Mental Health Services on Resilience in Youth with First Episode Psychosis: A Qualitative Study. Adm Policy Ment Health 2018; 44:92-102. [PMID: 26604203 DOI: 10.1007/s10488-015-0703-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The purpose of this qualitative study is to understand how mental health and related services support and hinder resilience in young people diagnosed with first-episode psychosis. Seventeen youth between the ages of 18-24 were recruited and 31 in-depth interviews were conducted. Findings illustrated that informational and meaning making, instrumental, and emotional supports were experienced positively (i.e., resilience-enhancing); whereas services with ghettoizing, engulfing, regulating, and out of tune practices were experienced negatively (i.e., resilience-hindering). These results demonstrate how various types of service-related practices influence resilience in youth and can inform future planning of services for psychosis.
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Affiliation(s)
- S Lal
- School of Rehabilitation, University of Montreal, Montreal, Canada. .,University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada. .,Douglas Mental Health University Institute, Montreal, Canada.
| | - M Ungar
- School of Social Work, Dalhousie University, Halifax, Canada
| | - A Malla
- Douglas Mental Health University Institute, Montreal, Canada.,Department of Psychiatry, McGill University, Montreal, Canada
| | - C Leggo
- Department of Language and Literacy Education, Faculty of Education, University of British Columbia, Vancouver, Canada
| | - M Suto
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
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Abstract
The present study examined variables related to the quality of the therapeutic alliance in out-patients with schizophrenia. We expected recovery orientation and insight to be positively, and self-stigma to be negatively associated with a good therapeutic alliance. We expected these associations to be independent from age, clinical symptoms (i.e. positive and negative symptoms, depression), and more general aspects of relationship building like avoidant attachment style and the duration of treatment by the current therapist. The study included 156 participants with DSM-IV diagnoses of schizophrenia or schizoaffective disorder in the maintenance phase of treatment. Therapeutic alliance, recovery orientation, self-stigma, insight, adult attachment style, and depression were assessed by self-report. Symptoms were rated by interviewers. Hierarchical multiple regressions revealed that more recovery orientation, less self-stigma, and more insight independently were associated with a better quality of the therapeutic alliance. Clinical symptoms, adult attachment style, age, and the duration of treatment by current therapist were unrelated to the quality of the therapeutic alliance. Low recovery orientation and increased self-stigma might undermine the therapeutic alliance in schizophrenia beyond the detrimental effect of poor insight. Therefore in clinical settings, besides enhancing insight, recovery orientation, and self-stigma should be addressed.
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Affiliation(s)
- Sara Kvrgic
- Psychiatric University Clinics Basel, Basel, Switzerland
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