The Impact of Health Care Reform: A Survey of Victim and Offender Treatment Providers

Health care reform and, especially, managed care may have important consequences for providers of mental health treatment to sexual assault victims and sexual offenders. This study is an initial effort to identify the impact of changes in health care delivery systems on specialist providers. A survey was mailed to 380 therapists in Washington state who were identified as having specialized expertise in either victim or offender treatment. Of the total sample, 39% (N= 135) responded, including 64 providers of treatment to sexual offenders and 86 providers of treatment to victims of sexual abuse. A substantial minority of subjects (46%) reported having made changes in the type of client or treatment approach or seeing fewer clients (43%). A majority (68%) stated that requirements for documentation or reports had increased. Overall, three-quarters of respondents reported that managed care had at least a moderate level of impact on their practice. Differences between providers of treatment to victims and providers to offenders emerged only in the perceived degree of impact on practice, with therapists who work with victims reporting significantly greater impact. Comments from providers revealed that reductions in the number of sessions, increases in administrative expectations, and compromised confidentiality were considered significant threats to the delivery of effective services. It is suggested that the impact of health care reform is more likely to be experienced by victim treatment providers. Offender evaluation and treatment have rarely been covered by commercial insurance and are often sought because of external pressure. As a result, managed care will have less effect on current offender treatment practice.     

Family-Driven Youth-Guided Practices in Residential Treatment: Findings from a National Survey of Residential Treatment Facilities

Family-driven, youth-guided practices have shaped the development of community-based mental health services for children and youth; however, the extent to which residential treatment providers have adopted these practices is unclear. This study reports the findings from a survey of 293 residential treatment providers conducted to examine the adoption of family-driven, youth-guided care. Residential treatment providers reported several practices consistent with family-driven, youth-guided care, including strength-based individualized treatment planning, collaboration with community-based providers to develop treatment plans, and the provision of various forms of support to families. Thirty percent of providers reported that the youth or family member was the primary decision maker in the development of treatment plans, 20.9% included youth or family members in program oversight, and 88.0% reported that staff had not heard of family-driven, youth-guided principles or required further training to implement them.     

New Hope and Help for Forgotten Youth

TOPIC:   Juvenile sex offender treatment programs have been at the forefront of discussion among some policy-makers and certainly those who provide treatment for these youth. While the research in this area supports the use of community-based treatment strategies, clinicians with strong training background are rare.
PURPOSE:   There is a need for a certificate training program to develop clinicians who are specifically trained to treat juvenile sex offenders. Through a unique academic/community initiative providing a multimodal approach to treatment, a collaborative 2-day national conference related to treatment of juvenile sex offenders was established. The program core was a 9-month clinical treatment certificate training program. This article describes the community program, and outlines in detail its purpose, goals, trainee requirements, conceptual areas for competency development, and the content areas.
CONCLUSIONS:    The Mental Health Policy Institute for Leadership and Training of Baltimore and the School of Nursing of the University Maryland jointly recognized a need to address the quality and efficacy of community-based treatment and expand the number of trained clinicians to work with sex offending youth. As a result of positive program evaluations, this community program will be provided annually.     

Community notification: Neither a panacea nor a calamity

Community notification of the release of sex offenders has provoked opposition from offender treatment providers who fear that it does not enhance community safety and is a short-sighted response to the problem of sex offending. Many of the arguments opposing community notification misunderstand its role, are based on speculation and might jeopardize the justifications for treatment alternatives. Sex offender treatment providers take risks when they denigrate or oppose the wishes of the community.     

Advanced practice nurse attitudes toward sex offender patients

PURPOSE: To determine advanced practice nurses' (APNs') attitudes and behaviors toward patients in their practices who are registered sex offenders. DATA SOURCES: An online survey of 300 APN members of a local APN organization asking respondents to identify the behavioral actions they were likely to agree or disagree with when faced with a scenario of realizing that a sex offender was a patient in their practice. Sixty-nine respondents submitted completed surveys. CONCLUSIONS: There was an ambiguity of behavioral responses and no consensus among APNs on how to respond to the issue of a sex offender patient in a healthcare practice. There was also a lack of awareness of whether sex offenders were patients in their practice. IMPLICATIONS FOR PRACTICE: The modest number of respondents and their demographic homogeneity limit the ability to draw any conclusions or generalizations from this study. While awareness of a known sex offender in a practice is unlikely to alter direct patient care, it may have an impact on office policies and procedures and should be a consideration of all involved staff, including providers, ancillary team members, and administrative personnel.     

Strategies Used by Prehospital Providers to Overcome Language Barriers

Objective: Language barriers are commonly encountered in the prehospital setting but there is a paucity of research on how prehospital providers address language discordance. We sought to identify the communication strategies, and the limitations of those strategies, used by emergency medical services (EMS) providers when confronted with language barriers in a variety of linguistic and cultural contexts. Methods: EMS providers were queried regarding communication strategies to overcome language barriers as part of an international, multi-site, sequential explanatory, qualitative-predominant, mixed methods study of prehospital language barriers. A survey of EMS telecommunicators was administered at dispatch centers in New Mexico (United States) and Western Cape (South Africa). Semi-structured qualitative interviews of EMS field providers were conducted at agencies who respond to calls from participating dispatch centers. Survey data included quantitative data on demographics and communication strategies used to overcome language barriers as well as qualitative free-text responses on the limitations of strategies. Interviews elicited narratives of encounters with language-discordant patients and the strategies used to communicate. Data from the surveys and interviews were integrated at the point of analysis. Results: 125 telecommunicators (overall response rate of 84.5%) and a purposive sample of 27 field providers participated in the study. The characteristics of participants varied between countries and between agencies, consistent with variations in participating agencies’ hiring and training practices. Telecommunicators identified 3rd-party telephonic interpreter services as the single most effective strategy when available, but also described time delays and frustration with interpreter communications that leads them to preferentially try other strategies. In the field, all providers reported using similar strategies, relying heavily on bystanders, multilingual coworkers, and non-verbal communication. Prehospital providers described significant limitations to these strategies, including time delays, breaches of patient confidentiality, and inaccurate interpretation. Participants suggested various resources to improve communication with language-discordant patients. Conclusions: Prehospital providers rely upon similar, informal strategies for overcoming language barriers across a variety of locations, provider types, and linguistic and cultural contexts.     

Capturing Information Needs of Care Providers to Support Knowledge Sharing and Distributed Decision Making

Background

This paper reports on work carried out to elicit information needs at a trans-disciplinary, nurse-managed health care clinic that serves a medically disadvantaged urban population. The trans-disciplinary model provides a “one-stop shop” for patients who can receive a wide range of services beyond traditional primary care. However, this model of health care presents knowledge sharing challenges because little is known about how data collected from the non-traditional services can be integrated into the traditional electronic medical record (EMR) and shared with other care providers. There is also little known about how health information technology (HIT) can be used to support the workflow in such a practice.

Objectives

The objective of this case study was to identify the information needs of care providers in order to inform the design of HIT to support knowledge sharing and distributed decision making.

Methods

A participatory design approach is presented as a successful technique to specify requirements for HIT applications that can support a trans-disciplinary model of care.

Results

Using this design approach, the researchers identified the information needs of care providers working at the clinic and suggested HIT improvements to integrate non-traditional information into the EMR. These modifications allow knowledge sharing among care providers and support better health decisions.

Conclusions

We have identified information needs of care providers as they are relevant to the design of health information systems. As new technology is designed and integrated into various workflows it is clear that understanding information needs is crucial to acceptance of that technology.     

Treatment Retention in a Prison-based Residential Sex Offender Treatment Program

This study assessed the role of static factors, a dynamic factor (motivation to change sexually deviant behavior), and an administrative factor in predicting treatment retention within a prison-based sex offender treatment program. The analyses also included assessing differences in initial levels of motivation and differences in beginning-versus end-of-treatment motivation scores for various types of program discharges. The sample consisted of 251 individuals who were admitted to a residential prison-based sex offender treatment program where 46% completed the program. Paired comparison t-tests showed higher motivation scores at the end of treatment only among treatment completers. Multivariate analyses showed that treatment retention was associated with higher initial motivation scores, higher levels of education and admission to treatment within 3 months of initial commitment to prison. Implications for motivational enhancement programming as well as for changes in admission criteria are discussed. The viewpoints expressed in this paper reflect the views of the author and do not necessarily reflect the views the Federal Bureau of Prisons.     

Collaborative practices between correctional and mental health services in Norway: Expanding the roles and responsibility competence domain

Internationally, mental illness is high in prison populations. Collaboration between the correctional services (CS) and mental health services (MHS) is required to address this. Little is known of the collaborative processes in this context, however. This article presents the findings of a study exploring the characteristics of collaborative practices between the MHS and CS in a Norwegian context. A purposeful sample (n = 12) of MHS and CS leaders was recruited from one region in Norway. Taking a generic qualitative approach, semi-structured interviews with each participant explored specific structures that promoted collaboration, the nature of collaborative relationships, and factors that facilitated or constrained these. The study indicated that leaders are exercised by one dimension of collaborative practice in particular, namely the distribution of responsibility for the care of the offender across systems. This activity is mediated by highly complex external structures as well as the individual characteristics of the professionals involved. They speculate that professionals and organisations who fail to take responsibility for the offender as expected may be constrained from doing so by resource limitations, logistical issues, and poor attitudes towards the offender population. Based on these findings, this study suggests that the MHS and CS workforce would benefit from a great knowledgeability of the roles and responsibility domains of collaborative practice. Improving competence in the workforce in this area would achieve this. However, competency frameworks that address this domain are currently limited. Recommendations on how to extend the remit of this domain in light of the current findings are provided.     

Perceptions of sex offenders about treatment: satisfaction and engagement in group therapy

Surveying the views of sex offender clients can help ensure that treatment is relevant and responsive to client needs. The purpose of this exploratory study is to elicit sex offender clients' perceptions of their experiences in treatment in order to better understand the components of treatment perceived to be helpful in preventing reoffense. Samples (N = 338) of male sex offenders in outpatient group therapy are found to be generally satisfied with treatment services and have positive perceptions of treatment effectiveness. Offenders in treatment value the role of group therapy, and they find accountability, victim empathy, relapse prevention, and "good lives" concepts to be most helpful in managing their behavior. Their engagement in group therapy is assessed using the Group Engagement Measure, and a positive correlation is found between engagement and treatment satisfaction. Eliciting client opinions about the helpfulness of program content and process, and adjusting treatment protocols accordingly, is consistant with the principles of risk, need, and responsivity, a model recommended for therapeutic interventions with criminal offenders.     

Feasibility of Long-Term Outcomes Measurement by Residential Providers

ABSTRACT

Policy makers and funders working to address best practices for residential care and treatment require evidence for the effectiveness of residential interventions, particularly related to maintenance of effects post-discharge. With support from the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services, the Building Bridges Initiative and providers of residential interventions partnered with Chapin Hall to study the feasibility of a method for collecting follow-up data on the functioning of young people who were recently discharged from residential treatment. This paper describes the implementation and findings regarding the feasibility of (1) identifying the location of youth 6 months post-discharge, (2) contacting the caregivers of these youth for the purpose of administering a follow-up survey, and (3) administering a brief (10-min) survey inquiring about youth functioning in key domains. The results of this research provide guidance for measuring youth progress and outcomes after residential interventions. This study also lays the groundwork for a larger post-discharge outcomes study that includes linkage to administrative data, baseline data on youth functioning, and assessment of the services received in the context of residential interventions. Data and information obtained from the feasibility study provide evidence for the viability of a brief, telephone-administered post-discharge survey with caregivers.     

Community-based research to explore safer sex behaviors among women: implications for CNS practice

PURPOSE/OBJECTIVES: This article illustrates how data from community-based surveys can be used to inform clinical nurse specialist (CNS) practice and ultimately influence patient care related to sex behaviors. BACKGROUND/RATIONALE: Clinical nurse specialists design, implement, and evaluate research to develop specific prevention and intervention strategies for populations. Much of this research is conducted in the tertiary setting although many of the interventions are carried out in the community setting. DESCRIPTION OF THE PROJECT: A sample of rural women (N = 578) participated in a community-based survey to determine characteristics which influence safer sex behaviors. OUTCOME: Results of the survey suggest that age, education, and relationship status influence safer sex behaviors. Women in the community tended to believe that safer sex behaviors were linked to pregnancy prevention and lacked understanding about the importance of safer sex behaviors to prevent sexually transmitted diseases including HIV/AIDS. INTERPRETATION/CONCLUSION: The findings of this study can inform CNSs about sex behaviors among women in a selected community, translating community-based research into evidence-based, patient-centered care. IMPLICATIONS FOR NURSING PRACTICE: Results from community-based research can be used to develop educational and prevention programs, and interventions for specialty populations.     

A review of clinical characteristics and residential treatments for adolescent delinquents with mental health disorders: a promising residential program

As treatment systems throughout the country have deinstitutionalized, under-use of community-based residential treatment systems has escalated. Reliance on juvenile justice systems for the care of the mentally ill adolescent has increased. There is considerable overlap between the mentally ill adolescent population within the community-based mental health systems and the offender population within the juvenile justice systems. With the inconsistent epidemiological prevalence and longitudinal treatment data, mental health treatment providers have also begun addressing this problem. This is currently being done by designing and implementing community-based residential mental health programs for delinquent adolescents of the juvenile justice system as well as nondelinquent adolescents within the mental health treatment systems. Providers have relied on both systems' literature in establishing theoretical treatment programs. The authors review critical treatment components currently used by both the treatment and juvenile justice systems. A promising integrative program is described.     

Telepsychiatry by APRNs: An Answer to the Shortage of Pediatric Providers?

Approximately 20% of US children have a mental health condition, but only a fraction of that population receives care. Inequitable distribution of the limited number of child and adolescent psychiatric providers is partly to blame. Telepsychiatry offers a way to increase access to mental health services for those that are currently underserved. Published literature demonstrates high levels of patient and provider satisfaction for telepsychiatry with children. However, providers in these studies are primarily telepsychologists or telepychiatrists, not advanced practice registered nurses (APRNs). This article describes the services of a nurse practitioner providing pediatric telepsychiatry and gives the results from a parental satisfaction survey that evaluated both the modality and the provider. The survey, previously validated, used a 5-point Likert scale to assess strong disagreement to strong agreement on 12 statements followed by a section for comments and suggestions. Results of the survey showed high levels of parental satisfaction with the modality and the provider. Specific details on parental satisfaction with technical functioning, comfort level, and access to care, as well as patient characteristics and service types, are presented.     

State-of-the-art sex offender treatment: Outcome and issues

Ill-advised negative media coverage on sex offender treatment program outcomes has increased in recent years. The following article provides current brief insights into why state-of-the-art sex offender treatment programs offer the safest, most cost-effective option in response to sex offender behavior. Issues on the developing discipline of sex offender treatment, current changes in treatment, benefits of treatment versus incarceration, program efficacy and recidivism and politics surrounding these issues are discussed. The article closes with specific advice in providing information to the media.     

Attitudes,Provider and Treatment Selection of Complementary and Integrative Health among Individuals with Pain-Related Conditions

Complementary and integrative therapies are used by people to address many conditions, including pain-related conditions. There has been concern about the quality of online health information, including information pertaining to complementary and integrative health (CIH). In this qualitative interview study, we sought to investigate how individuals interact with CIH-related information online and how this might affect their subsequent behavior. We conducted semi-structured interviews with 14 individuals with chronic pain conditions. We report findings based on three main themes: individuals’ beliefs about CIH; approach to CIH, including how people view provider information and personalize their CIH use strategy; and factors that affect trust in the information encountered. Overall, study participants believed there was value in CIH therapies and that treatments were effective. Many described experiences that had influenced their views of complementary therapies over time. We also found that individuals form impressions of CIH providers based on structural and personal characteristics, particularly cost and proximity, that are conveyed in information to which they are exposed. These findings have various implications. First, over time individuals with chronic pain conditions develop their own beliefs and attitudes, which play a role in their selection of providers and modalities relating to CIH. Health care providers should consider how people view information relating to, and make decisions about, CIH therapies and work collaboratively with patients to develop effective health management strategies. Information services should also consider patients’ perspectives in developing websites and other informational materials.     

Smallpox Vaccination: A National Survey of Emergency Health Care Providers

Concerns about bioterrorism have prompted a national voluntary smallpox (SP) vaccination program in the United States. Although emergency health care providers are among the first targeted for vaccination, little is known about how these providers view the risks and benefits of SP vaccination. OBJECTIVES: To assess the willingness of emergency health care personnel to receive pre-event SP vaccination prior to the start of the national program. METHODS: The authors conducted a national cross-sectional, anonymous survey of 1,701 emergency physicians, nurses, and mid-level practitioners working full time in 13 adult and pediatric academic emergency departments in large U.S. cities in November and December 2002. The main outcome measure was willingness to be vaccinated against SP. Secondary outcomes included the prevalence of self-reported contraindications, and reasons for and against vaccination. RESULTS: 732 emergency health care providers returned questionnaires (response rate 43%). Overall, 73% (95% CI = 66% to 80%) were willing to receive pre-event SP vaccination. 18% (95% CI = 14% to 23%) reported contraindications to vaccination, and 50% (95% CI = 39% to 61%) of these providers were willing to receive pre-event SP vaccination. Self-protection (72%) was the most common reason cited for desiring vaccination against SP; concern about vaccine-related adverse events (54%) was the most common reason cited for not wanting immunization. CONCLUSIONS: Most emergency health care providers express a willingness to receive pre-event SP immunization; self-protection is a principal motivating reason. A subset of health care providers, however, may place themselves at increased risk by desiring vaccination despite contraindications.     

Measuring Preferred Role Orientations for Patients and Providers in Veterans Administration and University General Medicine Clinics

BACKGROUND: Congruence between patients' and providers' preferred healthcare role orientations has been shown to be important for improved clinical outcomes and patient satisfaction. Thus, it is important to know how different patient and provider populations might vary in preferred role orientations. OBJECTIVE: To measure the range of role orientation preferences among patients and providers in two different general medicine clinic populations. METHODS: Role orientation preferences of patients (n?=?319) and providers (n?=?151) in six Veterans Administration (VA) primary care clinics and two university-based primary care clinics were measured in a cross sectional survey using the 9-item Patient-Practitioner Orientation Scale (PPOS) sharing subscale among patients and providers. RESULTS: VA patients had lower mean PPOS scores (i.e. more provider-centered role preference) than the university clinic patients (31.2 vs 39.7, respectively; p?相似文献   

Tried, True, and New: Public Health Nursing in a County Substance Abuse Treatment System

Abstract The Milwaukee Target Cities (MTC) project was the only site within 19 federally funded Target Cities programs to feature a public health nursing model as its sole means of providing comprehensive health-related services to indigent substance abuse clients. We first describe MTC's implementation process, focusing on the public health nursing component, and then present a program evaluation section with selected findings from the ongoing qualitative evaluation. Initially, misunderstandings about the nurses' community-based, family-centered strategy of assuring access to health care through cross-system service linkage dogged the nurses' efforts to explain their roles and mission to federal funders, project management, coworkers. and treatment providers. In the end, after federal funding ended, public health nursing left an enduring legacy of partnerships in the county substance abuse treatment system: education about public health nursing, networking, referral processes, and resources to meet the complex health-related needs of indigent substance abusers. Despite the project's many changes, the nurses (a) became specialists in substance abuse, gaining expertise and recognition in a new community, particularly with isolated subpopulations; (b) assured substance abuse clients and their families access to health-related resources through core public health nursing skills; and (c) educated project staff, administrators, providers, and clients about public health nursing.