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  • Establishing the evidence base for ‘multiple site single service’ (MSSS) models of care

    Sokal, Rachel (2019)
    Background In England plans for service reconfiguration increasingly include options for clinical services which are delivered across more than one clinical site, often in differing geographical locations or towns. The rationale for such models include the difficult and often conflicting balance between exacerbating inequalities in access to clinical services for patients whilst at the same time trying to improve quality and outcomes through consolidation.Aim The East Midlands Clinical Senate in partnership with Public Health England (PHE) established a proactive workstream to review the clinical evidence for ‘multiple site, single service models of care’ (MSSS) to support clinical senates, commissioners and providers of services better assess the evidence base for these types of models of care.Methods Systematic review (SR) undertaken. Framework developed to Support Clinical Senates through qualitative data collection and consultation with national and local clinical senate meetings to consider the experience of MSSS models and where they have worked successfully to improve outcomes.Results SR identified 18 papers for inclusion. Evidence on this topic was largely service-specific and heterogeneous in study design and outcomes. We found evidence of 10 key enablers and barriers to implementation of MSSS models. There was no universal definition for MSSS models in the literature, but shared characteristics were identified which enabled the development of a descriptive framework. Mortality was the most frequently reported outcome and no study reported increased mortality as a result of service change. 4 studies reported on patient experience related to service change, with some evidence of improvement in patient satisfaction with care delivered via a MSSS modelConclusion Using the systematic review findings and the qualitative feedback, a clinical outcomes based framework has been developed to utilise when reviewing these types of models of care.
  • Survey to evaluate care of complex clients in residential settings

    Sadraei, Rosa; Pathy, Puru; Collins, Michael (2021)
    Aims Delivering a new efficient assessment and shorter term secondary mental Health intervention service for individual sectors Background In November 2015, there was a transition to services with the focus on delivering more efficient service to clients Previously we had been a combined sector Service. This transition, a reduction in resources and a move away from delivering care Through specialist mental health teams created from the national service framework - such as Assertive outreach, early intervention in psychosis and community rehabilitation - to a more Streamlined generic service, catering for these differing groups of people using a “Pathways Model” approach Result Across the two sectors we had 47 clients on CPA Pathway living in 24 hour residential Settings who all had a current care coordinator. These 47 clients represented the workload currently of 2.8 FTE Band 6 care coordinators. There were at Origin, 13 Residential/Nursing/Secure 24 Hour care providers, where clients were residing. However of these 90% of residents lived in one of 5 settings, 3 settings in Ashfield and 2 in Mansfield. Over 50% of individuals residing did not have existing connections with Mansfield or Ashfield before being placed into the area. 18 Clients (%38) were under section of the mental health act and 1client (%2) was on a life-Licence from criminal justice. Conclusion Transfer of CPA Care Coordination Protocol To send paper referral to our Single Point of Access Meeting at the listed address at the earliest point relocation/placement is confirmed.Formal handover meeting for care will be coordinated, not sooner than 3 months after the placement commences. It will be expected that services currently involved in provision of service continue to hold care responsibility in the interim period. As we move to a paperless environment, provision of electronic documentation such has previous CPA documents, Risk assessments, social circumstance reports & Discharge summaries, would be greatly appreciated
  • The transition from children’s services to adult services for young people with attention deficit hyperactivity disorder: the CATCh-uS mixed-methods study

    Hollis, Chris P.; Sayal, Kapil (2020)
    Background: Attention deficit hyperactivity disorder was previously seen as a childhood developmental disorder, so adult mental health services were not set up to support attention deficit hyperactivity disorder patients who became too old for child services. To our knowledge, this is the first in-depth study of the transition of attention deficit hyperactivity disorder patients from child to adult health services in the UK. Objectives: Our objectives were to explore how many young people with attention deficit hyperactivity disorder are in need of services as an adult, what adult attention deficit hyperactivity disorder services are available and how attention deficit hyperactivity disorder stakeholders experience transition from child to adult services. Design: An interactive mixed-method design was adopted with three study streams: (1) a 12-month surveillance study with 9-month follow-up to find out how many young people required ongoing medication when they were too old for child services (929 surveys completed by children’s clinicians); (2) a mapping study to identify and describe services for young adults with attention deficit hyperactivity disorder (2686 respondents to online surveys for patients and health workers and freedom of information requests to service providers and commissioners); and (3) a qualitative study to explore key stakeholders’ experiences of transition from child to adult services (144 interviews with 64 attention deficit hyperactivity disorder patients, 28 parents and 52 health clinicians; 38 working in child or adult secondary health services and 14 general practitioners). Members of the public advised at each stage of the study. Results: When corrected for non-response and case ascertainment, the annual number of young people with an ongoing need for medication for attention deficit hyperactivity disorder lies between 270 and 599 per 100,000 people aged 17–19 years. Among 315 individuals eligible for transition, 64% were accepted, but only 22% attended their first adult services appointment. Our interactive map describes 294 unique services for adults with attention deficit hyperactivity disorder across the UK, of which 44 are ‘dedicated’ attention deficit hyperactivity disorder services. Few services provide the full range of recommended provision; most focus on diagnosis and medication. Services are unevenly distributed across the UK, with nearly all ‘dedicated’ services being in England. Exploring stakeholders’ experiences revealed how invested the stakeholders are in continuing attention deficit hyperactivity disorder treatment and how the architecture of services affects transition. An association between attention deficit hyperactivity disorder, education and continuance of medication into young adulthood, plus parent involvement and feeling prepared for transition and adult life with attention deficit hyperactivity disorder, influenced investment. However, even with investment, how accessible adult services are, how patient needs fit with the remit of the adult service and the level of patient information available affect transition outcomes. The results also highlight how general practitioners can end up as care co-ordinators during transition by default. Limitations: Transition estimates were based on those who want medication, so these indicate a minimum level of need. Conclusions: Few of those who need ongoing support for attention deficit hyperactivity disorder successfully transfer to adult services, and a small proportion of those who transfer experience optimal transitional care. Adult attention deficit hyperactivity disorder service provision is patchy. Even among ‘dedicated’ services, few provide the whole range of National Institute for Health and Care Excellence-recommended treatments. Future work: We need to evaluate various models of transitional care and adult attention deficit hyperactivity disorder provision, as well as develop and evaluate psychosocial interventions for young people and adults with attention deficit hyperactivity disorder.
  • Delivering quality

    Money, Della (2000)
  • Transition between child and adult services for young people with attention-deficit hyperactivity disorder (ADHD): findings from a British national surveillance study

    Sayal, Kapil (2019)
    BACKGROUNDOptimal transition from child to adult services involves continuity, joint care, planning meetings and information transfer; commissioners and service providers therefore need data on how many people require that service. Although attention-deficit hyperactivity disorder (ADHD) frequently persists into adulthood, evidence is limited on these transitions.AimsTo estimate the national incidence of young people taking medication for ADHD that require and complete transition, and to describe the proportion that experienced optimal transition.METHODSurveillance over 12 months using the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveillance System, including baseline notification and follow-up questionnaires.RESULTSQuestionnaire response was 79% at baseline and 82% at follow-up. For those aged 17-19, incident rate (range adjusted for non-response) of transition need was 202-511 per 100 000 people aged 17-19 per year, with successful transition of 38-96 per 100 000 people aged 17-19 per year. Eligible young people with ADHD were mostly male (77%) with a comorbid condition (62%). Half were referred to specialist adult ADHD and 25% to general adult mental health services; 64% had referral accepted but only 22% attended a first appointment. Only 6% met optimal transition criteria.CONCLUSIONSAs inclusion criteria required participants to be on medication, these estimates represent the lower limit of the transition need. Two critical points were apparent: referral acceptance and first appointment attendance. The low rate of successful transition and limited guideline adherence indicates significant need for commissioners and service providers to improve service transition experiences.Declaration of interestNone.
  • Changing roles in changing times

    Baldwin, Laurence (2017)
    It is in the nature of publications like this that any attempt to look at policy necessarily becomes dated very quickly. Thus, this chapter looks at developments leading up to the current situation and draws some conclusions from the themes that have developed across the English-speaking world. Within the UK, the devolution of healthcare to the different administrations in England, Scotland, Wales and Northern Ireland has led, for example, to broadly similar services but with some differences in speed of implementation and emphasis. Across England, the commissioning arrangements through local clinical commissioning groups mean that there are variations in local provision whereas inpatient services are separately commissioned by NHS England and have been subject to a separate review. We try to draw out some of the implications of current changes for professional practice in nursing, social work, psychotherapies and the allied health professions in particular. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: chapter)
  • Managing madness, murderers and paedophiles: Understanding change in the field of English forensic psychiatry

    Vollm, Birgit A. (2016)
    This paper discusses changes occurring in the field of English forensic psychiatry which appear to be linked to feelings of discomfort amongst medical professionals who manage care in such settings. These changes are neither the result of a sudden ‘shock’ to the system, nor small improvisations at the margins, but instead appear to reflect a growing perception amongst psychiatrists of accepted field practice as inadequate for some types of patients. To understand how feelings and emotions are implicated in these changes we draw on and develop the work of Pierre Bourdieu to suggest that changes must be seen in the context of field tensions, which have implications for habitus. However, we do not view feelings of discomfort merely as a response to these tensions. Instead we suggest a more dynamic process. The habitus plays a key role in structuring what people pay attention to, how they perceive it and therefore, whether they experience particular feelings in the first place. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (Source: journal abstract)
  • Short text messages to encourage adherence to medication and follow-up for people with psychosis (Mobile.Net): Randomized controlled trial in Finland

    Adams, Clive E. (2017)
    BACKGROUND: A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce. OBJECTIVE: The main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs. METHODS: Between September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis). RESULTS: There was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI -8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI -2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean euro10,103 vs euro9210, respectively, P<.001). CONCLUSIONS: High-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up. Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6rVzZrbuz).
  • Ensuring the successful transition of adolescents to adult services

    Cutajar, Peter; Jones, Jo; Bagelkote, Deval (2013)
    The movement of adolescents with learning disabilities from children's to adult services can sometimes be unsatisfactory, causing upset for the young people involved and raising costs for the NHS. This article discusses an examination of the casenotes of young people referred from children's to adult learning disability services in an NHS mental health trust in Nottinghamshire over an eight-month period. It reviews the ages of clients at referral and transfer, and the specialties of referring organisations, and discusses the potential reasons why transfers can fail.
  • The transition into adulthood for children with a severe intellectual disability: Parents' views

    Biswas, Sanchia; Tickle, Anna C. (2016)
    Objectives: This study used the grounded theory to explore parents' views of the transition into adulthood of their child with a severe intellectual disability. The study also sought to explore the processes that parents engage in for making psychological adjustments, to appreciate their role during this transition. This study is imperative for developing a psychologically informed theory that can be understood by both parents and clinicians. Methods: Twelve parents of 11 children with a severe intellectual disability were recruited for interview from charitable organizations accessed by parents (e.g. Mencap). Data collection used a combination of open-ended structured questions and non-directed probing. NVivo 10 software was used to assist the grounded theory coding and analysis process. Results: The analysis developed five processes that parents engaged in during their child's transition into adulthood: 'defining adulthood', 'noticing adult development', 'perceiving barriers to adulthood', 'worrying,' and 'making psychological adjustments'. Common to these was seen to be a core process of 'making comparisons with perceived "norms"'. Contrasting findings are critically discussed alongside extant literature. Additionally, a transition model of parents' views and adjustments is proposed, grounded in the study findings. Conclusions: Parents engage in a series of interactional processes throughout the transition trajectory, which are likely to influence how they make adjustments. Clinical interventions could challenge parent perceptions; encourage peer support; embrace systemic ways of working with parents through their child's transition into adulthood; and use the presented model to help parents understand their experiences and any adjustment-related problems. Copyright © 2016 The British Society of Developmental Disabilities
  • Supporting transitions

    Clegg, Jennifer (2006)
    We introduce this chapter by describing the context of our work and the various ways that systemic ideas have affected it. Three systemic ideas inform our transition interventions: "side-step autonomy", "keep multiple realities alive", and "expect engagement and disengagement". These ideas organize the structure of subsequent sections. We summarize the research literature that supports and explains the ideas, some of which may be unfamiliar to professionals working in intellectual disability services. Vignettes illustrate the issues and give some ideas of how we engaged with families or systems seen within our clinic. We conclude by pulling together our thoughts about this work, including some personal reflections. (PsycINFO Database Record (c) 2016 APA, all rights reserved)(chapter)
  • Predictors of progression from high to medium secure services for personality-disordered patients

    Tetley, Amanda C.; Evershed, Sue (2010)
    A significant number of inpatients in English high secure hospitals are detained under the Mental Health Act of 2007 with a diagnosis of personality disorder. The main route of discharge for these patients is via medium-security units. This study sought to determine if male personality-disordered patients' ability to progress from high to medium secure services is associated with a level of violent risk (Historical, Clinical, Risk Management 20), clinical psychopathy (Psychopathy Checklist-Revised (PCL-R)) and evidence of specific personality disorder diagnoses (assessed using the Personality Diagnostic Questionnaire-4th edition plus (PDQ-4+) and Personality Assessment Inventory (PAI)). Sixty-five male inpatients within an English high secure personality disorder service who had been assessed using the relevant instruments in 2001 were followed up six years post-assessment to determine if they had progressed to a medium secure service. The results revealed that the antisocial scales of the PAI and PDQ-4+, the PCL-R (particularly factor 1) and the PAI-Paranoid scale were reliable inverse predictors of institutional progression. The findings from this study suggested that the needs of more severely antisocial and psychopathic, individuals might require greater consideration within forensic psychiatric services. Copyright (C) 2009 John Wiley & Sons, Ltd.
  • Difficulties in the pathway from high to medium secure services for personality-disordered patients

    Tetley, Amanda C.; Evershed, Sue; Krishnan, Gopi (2010)
    Personality-disordered patients detained in high secure psychiatric hospitals appear to experience difficulties progressing to medium secure services. Accordingly, this study sought to explore the problems encountered in this pathway. To do this, data relating to referrals to medium secure services were collated for previous and current patients from a Personality Disorder service (n = 68) and a Dangerous and Severe Personality Disorder service (n = 12) in one English high secure hospital. The results highlighted the poor success rate of referrals to medium secure units and revealed the extensive delays encountered in the transfer process. Further to this, they also identified the poor success rate of patients periods of trial leave at medium secure units. Taken together, these findings are consistent with reports that consultants in medium secure units are reluctant to accept personality-disordered patients and that these units lack the infrastructure to treat this patient group. © 2010 Taylor & Francis.
  • Destination and dependency of psychogeriatric inpatients at discharge from Nottingham hospitals following the 1990 NHS and Community Care Act

    Page, Kim; Blagden, Karen; Biswas, Asit (1996)
    This study examines the impact of the National Health Service (NHS) and Community Care Act on the discharge of patients from inpatient psychogeriatric wards in Nottingham. All inpatients discharged from five psychogeriatric acute assessment wards between April 1 and September 30, 1993 were included in the study. The dependency ofeach patient was assessed using the balance of care method and relationships between dependency and destination at discharge were examined. The dependency status of patients discharged between April 1993 and September 1993 was compared with the dependency and destination at discharge of all inpatients admitted during the corresponding period in the previous year. There was a larger proportion of high-dependency patients admitted in 1993 than in 1992. There was no difference between the two periods in the median length of stay. No association was found between length of stay and dependency, nor between dependency status and destination at discharge. The first 6 months of the implementation of the Act has had negligible impact on discharge activity in these wards as measured by length of stay and destination at discharge.
  • Principles of service provision in old age psychiatry

    Dening, Tom (2013)
    The past decade has seen considerable changes in the shape of mental health services for older people. This has sometimes been so radical as to include the disappearance of the service as a separate entity, and yet this is at a time when the population of older people is growing and therefore it might be assumed that the demand for specialist services would also be increasing. How this can be so is the story of this chapter. There are two main strands to service provision to support mental health in older people. One is the general question of how mental health needs in this section of the population are to be met, and the other topic is the organization of specialist mental health services for older people. These strands are interwoven but also at risk of unwinding from each other. In this chapter, the focus is on the principles underlying services, rather than on much detail, partly because the situation will vary in different parts of the world but also partly because the way services are organized will continue to change, rendering anything too detailed obsolete in a short space of time. The chapter takes a largely UK, specifically England, focus. Many of the general issues are, however, global and also, as the UK has been one of the leaders in developing service models for old age psychiatry, it is likely that what happens there will be of interest to readers internationally. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
  • Forensic telepsychiatry in UK

    Saleem, Younus (2010)
    Having developed the first Forensic Tele-psychiatry Service in UK in 2005 the presenter would like to share this experience with the attendees of the symposia. Recommendations under Part III of the Mental Health Act 1983 have also been made. They have been accepted by both the Magistrates' as well as Crown Courts. Assessments were primarily undertaken using the already existent video-link facilities within local Magistrates'/Crown courts and HM Prisons. The above experience supports the view that this saves time, cost and improves access to psychiatric services. The presenter has also developed a Forensic Telepsychiatry Steering Group, with a research subcommittee, based in Nottingham. They are coordinating several research projects, exploring the use of teleconferencing facilities within forensic psychiatry. The session will discuss how the above is relevant to Forensic Psychiatrists and also address its importance to the training of forensic psychiatrists. Tele-psychiatry has been used by other services in UK in Forensic settings albeit in a narrow remit not involving actual gate keeping assessments, preparation of Court Reports etc. The session will discuss how it is crucial for services across the UK and beyond to share experiences and promote innovative practices. It will aim to explore ways to succeed with regard to delivering timely, easily accessible and clinically sound psychiatric services, with the additional spotlight on cost-efficiency, saving valuable professional time and 'going green' with respect to health service delivery.
  • Professionalizing action research--a meaningful strategy for modernizing services?

    Hall, Julie E. (2006)
    Background: This paper outlines how a specific action research approach can be used to secure practice development in services which have found sustained change difficult. For the purpose of this paper discussion focuses upon using professionalizing action research (a form of action research) to secure transformation in acute inpatient mental health services. This speciality has experienced long-term difficultly in meaningful practice change. Not limited to this context parallels can be made with other health and social care services requiring significant modernization.; Aim: The aim is to critically discuss the use of professionalizing action research as an approach to sustainable change.; Discussion: clarifies whether this method is a suitable vehicle for change, which is ideally suited to services which have a poor record of practice development.; Method: A review of action research and practice development literature forms the basis of this paper. The literature is sourced through bulletin boards, electronic databases and the British Library Classification Scheme. Keywords searched are action research, team learning, managing change and practice development. Following definition; the components of professionalizing action research are analysed using the themes of educative base, problem focus, improvement and involvement.; Findings: The educative base of professionalizing action research is collaborative reflective practice which is used to initiate meaningful change, rooted in everyday practice. The benefit of this is that change actions are based in real-time situations. The problem focus component of professionalizing action research is used to emphasize the views of service users and carers. This is positive in terms of the patient and public involvement agenda although this theme does emphasize limitations of the approach. The final components are involvement and improvement, these are debated as pluralistic notions and the implications of this are acknowledged.; Conclusion: Reviewing the literature and theoretical application indicates the value of professionalizing action research as a process for modernization. The strength of the approach lies in the opportunity for team learning and change which is grounded in the context of services and pursued through collaboration.;
  • The closure of a long-stay psychiatric hospital: A longitudinal study of patients' behavior

    Francis, Valerie M.; Vesey, Patrick; Lowe, Gail (1994)
    This paper summarises longitudinal data based on repeat assessments of the behavioural functioning of 90 long-stay psychiatric patients. Data were gathered over a period of 4-5 years that spanned a hospital closure and the resettlement of patients in various alternative settings. Time-series analyses of individual data sets showed that resettlement led to no significant behavioural change in the majority of patients. However, some significant behavioural improvements were evidenced for approximately 20% of the group, while behavioural deterioration occurred in approximately 12%. Supplementary findings showed that following resettlement the quality of care provided significantly improved in many respects. However, access to social, recreational or vocational activities was reduced. In addition, the level of physical health symptomatology was shown to increase for this group of patients.;
  • Can we risk recovery? A grounded theory of clinical psychologists' perceptions of risk and recovery-oriented mental health services

    Tickle, Anna C. (2014)
    Objectives: This study sought to explore the views of clinical psychologists towards the concepts of 'risk' and 'recovery' and to set those views against the context of mental health services.; Design: An exploratory, social constructionist grounded theory methodology was adopted.; Methods: Eleven clinical psychologists working in adult mental health services each participated in one individual semistructured interview.; Results: The clinical psychologists studied were aware of the emergence of recovery-oriented approaches, but felt unable to incorporate them in practice because of perceptions of being bound by both their own limitations and those of their circumstances, including issues of risk, thus giving rise to dilemmas in professional practice. Narrow definitions of risk as equated to danger dominated over broader conceptualizations of risk with positive consequences. The existing culture of mental health services was seen as emphasizing the need to avoid harmful consequences of taking risks, which in turn was seen to limit innovations in implementing recovery-oriented approaches.; Conclusions: Participants' ability to work in a recovery-oriented manner seemed to be limited by the way in which services perceived and responded to risk. Participants did not discuss risks arising from stigma, social exclusion, racism, sexism, or iatrogenic effects of psychiatric treatment. Narrow conceptualizations of risk as related to harm and danger seen in this study contribute to a sense of needing to be risk averse. However, the implications for practice included ideas about what might increase the possibilities for adopting recovery approaches across disciplines.; © 2012 The British Psychological Society.

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