Application of the European quality indicators for psychosocial dementia care in long-term care facilities in the Asia-Pacific region: a pilot study

ABSTRACT

Objectives: An Asia-Pacific regional collaboration group conducted its first multi-country research project to determine whether or not European quality indicators (QIs) for psychosocial care in dementia could be implemented as a valid tool in residential aged care across seven Asia-Pacific sites (Australia, Hong Kong Special Administrative Region, Mainland China, Malaysia, Singapore, South Korea, and Thailand).

Method: Following the European QI protocol, auditing and data extraction of medical records of consenting residents with dementia were conducted by trained auditors with relevant health care backgrounds. Detailed field notes by the auditors were also obtained to describe the characteristics of the participating care facilities, as well as key issues and challenges encountered, for each of the 12 QIs.

Results: Sixteen residential care facilities in the seven Asia-Pacific sites participated in this study. Data from 275 residents’ records revealed each of the 12 Qis’ endorsement varied widely within and between the study sites (0%–100%). Quality of the medical records, family and cultural differences, definitions and scoring of certain indicators, and time-consuming nature of the QI administration were main concerns for implementation.

Conclusion: Several items in the European QIs in the current format were deemed problematic when used to measure the quality of psychosocial care in the residential aged care settings in participating Asia-Pacific countries. We propose refinements of the European QIs for the Asian-Pacific context, taking into account multiple factors identified in this study. Our findings provide crucial insights for future research and implementation of psychosocial dementia care QIs in this region.     

Patient experiences with care across various types of mental health care: Questionnaire development,measurement invariance,and patients' reports

To describe the development, validation, and findings of a patient experience questionnaire across 7 types of residential and ambulatory mental health care services. Thirty‐five items were hypothesized to cover information, participation, therapeutic relationship, personalized care, organization and collaboration, safety, patient rights, outcomes of care, and discharge preparation and after‐care. Also included were 2 overall rating items (scoring and recommending the organization). This Dutch questionnaire was applied in 79 organizations in Belgium (N patients = 5,168). Exploratory structural equation modelling was conducted on a random split‐half sample to examine dimensionality. Confirmatory factor analysis and multiple group confirmatory factor analyses were conducted on the holdout sample to confirm dimensionality and assess measurement invariance across type of service and patient characteristics. Multilevel logistic regression models linking subscale top box scores to overall rating items were used to assess criterion validity. The hypothesized dimensionality was partly confirmed, and configural and scalar invariance were demonstrated across types of organizations and patient characteristics. Subscale scores were significantly associated with overall ratings. Process evaluation showed that participating organizations strongly support continued use of this questionnaire. This validated patient experience questionnaire supports comparison across organizations from different types of services to improve the quality of mental health care.     

A state-university collaboration program: residents' perspectives

Little information is currently available about how residents perceive the recently developed state-university collaboration programs in psychiatry. To determine the opinions of residents participating in the collaboration program in Kentucky, the authors administered a questionnaire to 18 residents who had completed at least one rotation at Eastern State Hospital in Lexington. The questionnaire asked the residents to respond to statements about the clinical, organizational, and educational aspects of the experience. Most respondents rated the experience as favorable, and 78 percent indicated interest in state employment. In addition, the state hospital was noted as one of residents' three future career choices.     

Work and mental illness. I. Toward an integration of the rehabilitation process

For centuries, philosophers and physicians have noted the beneficial impact of work for the restoration and maintenance of mental health. This paper reports the findings from a survey in which all the principal components (both providers and consumers in one catchment area) contributed data about the degree to which vocational rehabilitation was integrated into systems of care for the mentally ill. The major repetitive themes found at the interface of each participating sector were: rigidity, isolation, compensatory ad hoc operations, and narrow frames of reference. Vocational and other forms of rehabilitation were accomplished by persistent, energetic personnel inventing ingenious solutions to the roadblocks set up at system interfaces. Their problem-solving techniques pointed to ingredients that might help to integrate treatment and rehabilitation efforts. These key elements were flexibility, collaboration, data-based training, and a unified theoretical framework.     

Universal Emotional Health Screening at the Middle School Transition

This article describes the implementation of the Developmental Pathways Screening Program (DPSP) and an evaluation of program feasibility, acceptability, and yield. Using the Mood and Feelings Questionnaire (MFQ) and externalizing questions from the Youth Self Report (YSR; Achenbach, 2001), universal classroom-based emotional health screening was implemented with students as they began middle school. Of all sixth graders enrolled in four participating Seattle schools, 861 (83%) were screened. Students who screened positive for emotional distress (15% of students screened) received onsite structured clinical evaluations with children's mental health professionals. Seventy-one percent of students who were evaluated were found to be experiencing significant emotional distress, with 59% warranting referral to academic tutoring, school counselor, and/or community mental health services. Successful implementation of in-class screening was facilitated by strong collaboration between DPSP and school staff. Limitations of emotional health screening and the DPSP are discussed, and future steps are outlined.     

R4P – Un réseau régional de professionnels dédié à l’enfant en situation de handicap

A regional health network for children and teenagers with disabilities (R4P) was created in Rhône-Alpes region (France) in 2007 with the aim to improve the quality of care provided to those patients. The main projects of the R4P concern training, harmonization of care and communication. R4P is a very special regional health network in France because of two particularities. First, it concerns all types of disabilities; secondly, it includes each kind of professionals concerned by children with disabilities: health care professionals of hospital and ambulatory care, social workers, administrations and education professionals. Decompartmentalization and collaboration between all kinds of professionals is necessary to improve global care of children and teenagers with disabilities. Today, 750 professionals are participating in the R4P network.     

Screening for Co-occurring Disorders and the Promotion of Collaborative Care

Using the BC/Yukon Collaborative Care Project as an example, this paper demonstrates the effectiveness of screening for co-occurring disorders within a collaborative context. One of the goals of the project was to standardize approaches for screening and assessment to improve consistency and avoid duplication of patient information. The discussion of screening gradually exposed issues that required attention, including the role of administrative support, the need to reform interprofessional communications, and communications with patients. Although the rates of screening and case-finding increased through this initiative, there were also a number of attitudinal changes from participating clinicians. Overall, the joint selection and implementation of screening practices was an enabling process. It provided an opportunity for collaboration outside of the clinical context, involving practitioners and administrators together.     

Best practices: the Johnson & Johnson--Dartmouth community mental health program: disseminating evidence-based practice

This column describes a private-public-academic collaboration in six states and the District of Columbia designed to provide evidence-based supported employment for persons with psychiatric disabilities by using best practices for program implementation. Dissemination strategies included collaborative state-level administrative oversight, longitudinal training based on established fidelity criteria, outcome-based supervision, problem solving by local experts, and selection of intervention sites on the basis of their motivation to participate. The number of clients served at participating sites increased steadily over 11 quarters, and the proportion of clients competitively employed stayed consistently over 40 percent. The project successfully combined industry's emphasis on outcomes with academia's emphasis on research-based interventions to enhance public services.     

Associated and Mediating Variables Related to Job Satisfaction among Professionals from Mental Health Teams

Using a structural analysis, this study examines the relationship between job satisfaction among 315 mental health professionals from the province of Quebec (Canada) and a wide range of variables related to provider characteristics, team characteristics, processes, and emergent states, and organizational culture. We used the Job Satisfaction Survey to assess job satisfaction. Our conceptual framework integrated numerous independent variables adapted from the input-mediator-output-input (IMOI) model and the Integrated Team Effectiveness Model (ITEM). The structural equation model predicted 47% of the variance of job satisfaction. Job satisfaction was associated with eight variables: strong team support, participation in the decision-making process, closer collaboration, fewer conflicts among team members, modest knowledge production (team processes), firm affective commitment, multifocal identification (emergent states) and belonging to the nursing profession (provider characteristics). Team climate had an impact on six job satisfaction variables (team support, knowledge production, conflicts, affective commitment, collaboration, and multifocal identification). Results show that team processes and emergent states were mediators between job satisfaction and team climate. To increase job satisfaction among professionals, health managers need to pursue strategies that foster a positive climate within mental health teams.     

Community-Based Collaboration in Prevention and Mental Health Promotion: Benefiting from and Building the Resources of Partnership

Successful primary prevention and promotion initiatives in mental health recognize and include the perspectives of multiple stakeholders. Community-based collaboration is an important strategy for achieving this balance and for facilitating the achievement of other key characteristics that are consistently associated with effective programs. We examine the powerful benefits of collaboration – described in terms of the resources contributed by each partner as well as the environment and processes created by diverse partners working together – within the context of ten characteristics of successful prevention and promotion programs. We also review some of the most common challenges to collaboration and offer recommendations for overcoming them in order to facilitate success in mental health promotion.     

An Employer-Driven Community Initiative on Depression

The Mid-America Coalition on Health Care is a 29-year-old employer-driven collaboration of all health care stakeholders in the bistate, 15-county Kansas City region. The Coalition's mission is to improve the health of employees, promote community wellness, develop cost containment strategies, and communicate health care information. In 1998, the Coalition embarked on a project with eight Kansas City area employers to identify the leading health risks among the local employed population and their dependents, using the Behavioral Risk Factor Surveillance System. The Community Initiative on Depression (CID) grew out of the results of that survey. The broad objectives of the CID were to destigmatize depression, identify the direct and indirect costs of depression, and create a community infrastructure to support appropriate and timely diagnosis and treatment. It was further intended to develop a model for this employer-driven collaboration of all stakeholders that would be replicable in other communities. Fifteen employers (140,000 impacted lives) engaged in a five-year project focused on the workplace as well as clinical and community environments. A unique Employee Attitudinal Survey was developed and conducted, and several worksite educational programs grew out of the survey. Clinical projects focused on primary care and comorbid specialties, researching physician practice patterns and reimbursements, and educating the medical community about employers' concerns and resources for their patients. The community component of the initiative featured the participating employers communicating what they had learned to local and national employers and organizations. CID developed partnerships with a wide range of regional and national partners, and other communities are replicating portions of the initiative. The success of this depression initiative model led to the creation of a similar employer-driven community approach to cardiovascular disease and risk factors.     

Pediatric quality circles moderated by child psychiatrists--a suitable quality assurance measure in basic psychosomatic care?

The important role of pediatricians in private practice for the care of psychologically noticeable children makes it seem necessary to implement quality assurance measures. As part of an integrated project for quality assurance in psychosomatic basic care the pediatricians in the medical care district G?ttingen were offered two quality circles for two years which in contrast to the original concept were conducted by child psychiatrists. The evaluation of this offer by the participating pediatricians after one year (n = 16) and after the end (n = 15) yielded very positive results regarding the structural characteristics of the quality circles (such as length of sessions, subject selection, moderation, working atmosphere) and also the general usefulness of such a quality assurance measure. The increase in competence regarding practical skills (diagnostics, treatment in the own practice, referee indication, forming the physician-patient relationship) however, was evaluated as being less pronounced. The attractiveness of a quality circle modified by continuously integrating a child psychiatrist/psychotherapist was confirmed by the results of a national survey. In another survey the participating pediatricians documented cases where they suspected psychological problems before the quality circles began and after the first year. Sensitivity and specificity of the pediatricians' assessments increased at the second evaluation point which is a sign for an increased diagnostic competency of pediatricians.     

Psychometric characteristics of the Mobility Inventory in a longitudinal study of anxiety disorders: replicating and exploring a three component solution

Psychometric characteristics of the Mobility Inventory (MI) were examined in 216 outpatients diagnosed with panic disorder with agoraphobia participating in a longitudinal study of anxiety disorders. An exploratory principal components analysis replicated a three-component solution for the MI reported in prior studies, with components corresponding to avoidance of public spaces, avoidance of enclosed spaces, and avoidance of open spaces. Correlational analyses suggested that the components tap unique but related areas of avoidance that were remarkably stable across periods of 1, 3, and 5 years between administrations. Implications of these results for future studies of agoraphobia are discussed.     

Collaboration in outpatient antipsychotic drug treatment: analysis of potentially influencing factors

Knowledge of factors relevant for medication adherence and patient collaboration is still limited. Our study aims at exploring the contribution of a variety of factors to collaboration in outpatients with schizophrenia and schizoaffective disorder. We obtained self-rated and observer-rated data from 108 outpatients during an interview 6 months after hospital discharge. The compliance rating scale (CRS) classified 76% of the patients as collaborative. Factors related to the patient, illness, treatment, and social environment were analysed in two-step explorative correlation and regression analyses in order to determine their relative contribution to collaboration. Only trust in medication and lack of insight were associated with collaboration, and they accounted for 38% of the variance. Neither medication side effects nor neuropsychological functioning correlated with collaboration. The conceptualisation of medication adherence is complex, and there are a number of unresolved methodological problems. The data indicate that illness and treatment-related subjective attitudes may be more relevant than side effects, cognitive functioning or any sociodemographic variable.     

Key processes, Ingredients and Components of Successful Systems Collaboration: Working with Severely Emotionally or Behaviorally Disturbed Children and Their Families

Systems collaboration has repeatedly been cited as a component of successful social service delivery. Through qualitative data, this study explored the process involved in inter-agency collaboration when providing Integrative Family and Systems Treatment (I-FAST) for families with severely emotionally or behaviorally disturbed children. Data were collected through a series of eight focus groups with 26 agency collaborators across 11 counties in Ohio. Data analysis revealed two emergent phenomena: the process of developing collaboration, consisting of making initial contact, a trial period and developing trust; and the key ingredients of collaboration, focusing on interpersonal and professional qualities. Implications of each theme are discussed.     

Cognitive predictors of psychosocial functioning outcome in schizophrenia: a follow-up study of subjects participating in a rehabilitation program

The aims of this prospective study were to explore in subjects with psychosis participating in a rehabilitation program whether cognitive performances at baseline predicted (i) psychosocial functioning over a 15-16 month follow-up; (ii) improvement in psychosocial functioning over the rehabilitation program. Visuo-spatial tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) were administered to assess cognitive performance in 55 subjects with schizophrenia spectrum disorders who completed a rehabilitation program. The Multnomah Community Ability Scale (MCAS) was used to measure dimensions of community functioning. One subscale of the Client's Assessment of Strengths, Interests, and Goals (CASIG) provided a measure of subjective quality of life (QoL). Improvement was defined as a 15% or more increase in psychosocial scores between baseline and follow-up. Worse baseline sustained attention predicted better self-rated quality of life, and better baseline visual memory predicted better community functioning over the rehabilitation follow-up period, in particular, higher autonomy in activities of daily living, and less physical and psychiatric symptoms that could interfere with rehabilitation. Baseline cognitive performances predicted community functioning improvement during the follow-up period: visual memory predicted improvement in daily living autonomy and in social competence; sustained attention predicted improvement in behavioral problems (such as medication compliance, collaboration with treatment providers or impulse control) and social competence; planning performances predicted improvement in social competence. These cognitive functions could be specifically targeted in a rehabilitation program aimed at enhancing functioning in those particular dimensions.     

Peer Relationships and Social and Recreational Activities Among Adolescents and Adults with Autism

In this study, we investigate peer relationships and participation in social and recreational activities among 235 adolescents and adults with autism who live at home. The prevalence of having friendships, peer relationships, and participating in social and recreational activities were all low and comparable to previous research. Both individual and environmental factors were investigated as predictors of having peer relationships and participation in social and recreational activities. Having peer relationships was predicted by individual characteristics (younger age, and less impairment in social interaction skills), but not by characteristics of the environment. Greater participation in social and recreational activities was predicted by characteristics of the individual with autism (greater functional independence, less impairment in social interaction skills, higher levels of internalizing behaviors) and characteristics of the environment (greater maternal participation in social and recreational activities, greater number of services received, and inclusion in integrated settings while in school).