芜湖市中小学心理健康教育教师工作现状调查

采用自编的《中小学心理健康教育状况调查(心理教师问卷)》对安徽省芜湖市三县四区105名心理教师进行调查。结果发现:(1)中小学教师对心理健康教育了解不够;(2)中小学心理健康教育供不应求;(3)学校心理健康教育工作问题较多。对策:(1)加大培训力度,提供交流渠道;(2)利用积极态度,加快教育进程;(3)针对学生实际,切实解决问题;(4)壮大师资队伍,提高教师待遇。     

The evaluation of a model of primary mental health care in rural Tasmania

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a primary care mental health service. DESIGN: The study used a naturalistic longitudinal design to follow groups of participants who received intervention from a rural mental health worker, or 'usual' mental health service, or no treatment, over a period of 12 months. SETTING: The service was evaluated in a rural primary care setting. PARTICIPANTS: One hundred and forty-five primary care patients. OUTCOME MEASURES: Changes in symptomatology were assessed using the SCL-90R summary scales, and changes in quality of life were assessed using the EuroQOL. RESULTS: Those participants treated by the primary mental health worker showed significant improvements in symptoms and quality of life compared to both the usual and no-treatment groups. CONCLUSION: There are few studies evaluating mental health services in rural settings. This study demonstrated that a particular model of primary mental health care was more effective than usual mental health care and no treatment at resolving symptoms and improving quality of life.     

Challenges faced by general practitioners and allied mental health services in providing mental health services in rural Queensland

OBJECTIVE: To examine the views of rural practitioners concerning issues and challenges in mental health service delivery and possible solutions. DESIGN: A qualitative study using individual semi-structured interviews. SETTING: Eight general practices from eight rural Queensland towns, three rural mental health services and two non-government organisations, with interviews being conducted before recent changes in government-subsidised access to allied health practitioners. PARTICIPANTS: A sample of 37 GPs, 19 Queensland Health mental health staff and 18 participants from community organisations. MAIN OUTCOME MEASURES: Analysis of qualitative themes from questions about the key mental health issues facing the town, how they might be addressed and what challenges would be faced in addressing them. RESULTS: There was substantial consensus that there are significant problems with inter-service communication and liaison, and that improved collaboration and shared care will form a critical part of any effective solution. Differences between groups reflected differing organisational contexts and priorities, and limitations to the understanding each had of the challenges that other groups were facing. CONCLUSIONS: Improvements to mental health staffing and to access to allied health might increase the ability of GPs to meet the needs of less complex patients, but specific strategies to promote better integrated services are required to address the needs of rural and regional patients with complex mental health problems. The current study provides a baseline against which effects of recent initiatives to improve mental health care can be assessed.     

Patterns of use of a maternal mental health service in a low‐resource antenatal setting in South Africa

The prevalence of perinatal common mental disorders in South Africa is high, yet little is known about mental health service use among pregnant and postnatal women. This paper reports on pregnant women's patterns of use of a counselling service at a primary level obstetric facility in Cape Town, South Africa, between January 2010 and December 2011. It investigates whether these are associated with demographics, severity and risk of depressive symptoms. Participants (N = 3311) were screened for psychological distress using the Edinburgh Postnatal Depression Scale (EPDS) at their first antenatal visit. Risk factors for antenatal depression were assessed using a 11‐item checklist. Questionnaires were self‐administered, but some participants required assistance. Participants scoring positive (≥13) on the EPDS were offered referral to on‐site, individual counselling, and assigned to one of three groups according to their service use: declined referral; accepted referral and attended counselling sessions; and accepted referral but defaulted all appointments. Consent to participate was received by 3437 (96.4%) participants who were offered screening, of which 627 (18.9%) screened positive on the EPDS. Of these, 363 (57.9%) attended counselling. Both bivariate analyses and regression analyses revealed that age and risk factor assessment score were associated with screening positive on the EPDS. Odds ratios (OR) for accepting counselling were OR = 0.94 (95% CI = 0.92–0.97) for gestation, OR = 1.27 (95% CI = 1.15–1.39) for EPDS score and OR = 0.48 (95% CI = 0.23–0.99) for reporting three or more risk factors. OR for attending counselling were, for age: OR = 1.06 (95% CI = 1.00–1.12) and for reporting three or more risk factors: OR = 0.60 (95% CI = 0.37–0.97). While the majority of women with psychological distress accessed the counselling service provided, strategies to increase service use of younger pregnant women specifically are required.     

Evaluation of community mental health services: comparison of a primary care mental health team and an extended day hospital service

Alongside mental health policies emphasising the need to focus on people experiencing serious, long-term problems, recent general healthcare policy is leading to the development in the UK of a primary care-led National Health Service. While most primary care-led mental health initiatives have focused on supporting general practitioners (GPs) in managing milder depression and anxiety, this article describes an evaluation comparing primary care-based and secondary care-based services for people with serious long-term problems. A survey of service users was carried out at three points in time using three measures: the Camberwell Assessment of Need, the Verona Satisfaction with Services Scales and the Lancashire Quality of Life Profile. Staff views were sought at two time intervals and carers' views were obtained towards the end of the 2-year study period. The results indicate that both services reduced overall needs and the users' need for information. The primary care service also reduced the need for help with psychotic symptoms whereas the secondary care service reduced users' need for help with benefits and occupation. There were no major differences in terms of satisfaction or quality of life. Primary care-based services therefore appear to have the potential to be as effective as more traditional secondary care services. However, a more comprehensive range of services is required to address the whole spectrum of needs, a conclusion supported by the views of staff and carers.     

Rural professionals’ perceptions of interprofessional continuing education in mental health

We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10‐session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty‐five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals’ confidence (n = 49) with mental health interventions, issues and populations was measured pre‐ and post‐programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter‐agency linkages and collaborations had increased. Conditions that appeared to underpin the programme’s success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co‐ordinators as liaisons. Participants’ dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health.     

Developing community mental health services: an evaluation of Glasgow's mental health resource centres

Greater Glasgow Health Board's strategy for the development of community mental health services includes the establishment, over a 7-year period, of multi-disciplinary community mental health resource centres throughout Glasgow. An evaluation of the first phase of the development was carried out in three resource centres. This focused on three key themes: the establishment of multi-disciplinary teams, targeting of those with the most severe illnesses and the participation of users in the care process. The evaluation exercise comprised five substantive elements: analysis of the clinical database; interviews with staff within each of those centres, interviews with representatives of key external agencies associated with each centre; a survey of general practitioners; and a survey of the views of clients, their carers, their key workers, and their general practitioners (GPs). Clients were generally very satisfied with the services and felt that the resource centres met all their mental health needs. Although the majority of current centre cases had severe mental illnesses and those with the more severe conditions had the highest contact rates there was evidence that in the absence of a clear framework for referral the centres were also providing services for those with less severe illnesses. Despite a wish by centre staff to move towards modes of working less dominated by health professionals and more inclusive of other resources and especially of clients themselves, these goals remained to be achieved: there was a lack of clarity in the definition of the appropriate target groups for the centres; access to crisis support was regarded as problematic; the concept of multi-disciplinary team working had yet to be fully realized with evidence suggesting that some psychiatrists working in the resource centres had not embraced many aspects of the new approach to service delivery including a focus on the severely ill; and progress towards the ideal of active client involvement had been slow.     

深圳市孕期健康教育师资规范化培训效果评价

目的了解孕期健康教育授课教师妇幼保健相关知识掌握情况，评价孕期健康教育师资规范化培训效果。方法以卫生部-惠氏药厂妇幼卫生合作项目《孕期健康教育培训教材》（教师用书）为参考用书。对全市各医疗保健单位“孕妇学校”的专（兼）职教师88人进行规范化培训，培训前后用同样的孕产期保健知识问卷进行调查，用SPSS13统计软件对问卷结果进行统计。结果培训前问卷中的20项孕产期保健知识知晓率普遍偏低，其中在添加辅食的基础上母乳喂养的最佳时间、致畸的高敏期一般在受孕后的几周、12小时正常的胎动次数、孕产妇合理用药原则、营养索包括什么、孕晚期重点预防的并发症等12项知识知晓率在踟％以下。培训后20项知识的正确率均达到96％以上，培训前后比较，20项中有17项问存在显著性差异（P＜0．05）。结论培训后学员孕产期保健知识知晓率提高明显，证明孕期健康教育授课教师规范化培训有效，培训方法可行。     

Improving access to and outcomes from mental health care in rural Australia

OBJECTIVE: Rural Australians face particular difficulties in accessing mental health care. This paper explores whether 51 rural Access to Allied Psychological Services projects, funded under the Better Outcomes in Mental Health Care program, are improving such access, and, if so, whether this is translating to positive consumer outcomes. DESIGN AND METHOD: The paper draws on three data sources (a survey of models of service delivery, a minimum dataset and three case studies) to examine the operation and achievements of these projects, and makes comparisons with their 57 urban equivalents as relevant. RESULTS: Proportionally, uptake of the projects in rural areas has been higher than in urban areas: more GPs and allied health professionals are involved, and more consumers have received care. There is also evidence that the models of service delivery used in these projects have specifically been designed to resolve issues particular to rural areas, such as difficulties recruiting and retaining providers. The projects are being delivered at no or low cost to consumers, and are achieving positive outcomes as assessed by standardised measures. CONCLUSION: The findings suggest that the rural projects have the potential to improve access to mental health care for rural residents with depression and anxiety, by enabling GPs to refer them to allied health professionals. The findings are discussed with reference to recent reforms to mental health care delivery in Australia.     

Engaging consumers in the Australian emergency mental health context: a qualitative perspective from clinicians working in the community

Successfully engaging with consumers is seen as an essential component of mental healthcare, yet doing so can be challenging and little is understood about the unique engagement skills and attributes employed by mental health clinicians working in the emergency community context. Consequently, this qualitative study explored the engagement experiences of clinicians to identify the attributes used when engaging with consumers in this unique setting. We conducted two semi‐structured focus groups in July and August 2011 with 16 clinicians employed at one metropolitan mental health organisation in South Australia. Using thematic analysis, we identified two key themes pertaining to the skills and attributes used for successful consumer engagement: (i) building trust, through communication style, an honest approach, facilitating choice and locating trust networks; and (ii) portraying genuine care, through showing respect, offering practical assistance and taking the least restrictive pathway. These findings highlight the unique nature of engagement in the emergency community mental health setting, as well as the flexibility and resourcefulness required to facilitate it.     

Perspectives of rural health and human service practitioners following suicide prevention training programme in Australia: A thematic analysis

There are well‐established training programmes available to support health and human services professionals working with people vulnerable to suicide. However, little is known about involving people with lived experience in the delivery of suicide prevention training with communities with increased rates of suicide. The aim of this paper was to report on a formative dialogical evaluation that explored the views of health and human services workers with regard to a suicide prevention training programme in regional (including rural and remote areas) South Australia which included meaningful involvement of a person with lived experience in the development and delivery of the training. In 2015, eight suicide prevention training workshops were conducted with health and human services workers. All 248 participants lived and worked in South Australian regional communities. We interviewed a subsample of 24 participants across eight sites. A thematic analysis of the interviews identified five themes: Coproduction is key, It is okay to ask the question, Caring for my community, I can make a difference and Learning for future training. The overall meta‐theme was “Involvement of a person with lived experience in suicide prevention training supports regional communities to look out for people at risk of suicide.” This paper highlights the need for suicide prevention training and other workforce development programmes to include lived experience participation as a core component in development and delivery.     

The development of a community child and family mental health service

The Community Child and Family Service is a primary care and community-based child mental health service working in a socio-economically disadvantaged area of inner London. This paper outlines the strategic framework and value base from which the service has developed. The clinical projects set up by the service in general practice, community and education settings are described, as are the training and supervision programmes that have been undertaken. The framework for evaluating the clinical and economic outcomes of the projects is outlined. There has been a positive response from purchasers, providers and clients to the introduction of this Service. The relationship between community- and hospital-based child mental health services is discussed, as is the future direction of the Service.     

Training teachers to implement a school oral health education programme in Tanzania

Tanzania has a national programme for oral health educationwhich is implemented by teachers at primary school level. Mostteachers are not trained for this task and they have low abilitiesand willingness for it. In this study, the oral health educationsessions conducted by teachers at school were observed to bedeficient in content and in methods, addressing only toothbrushingin theory. Thus, a training model for the teachers was designed,implemented and evaluated, that was based on the teachers' trainingneeds and other local conditions. A simple oral health educationmanual was designed to answer the educational needs of the pupils,and using it as a framework, all 125 teachers involved in schooloral health education in one district were trained in workshops.These were conducted by dental personnel in cooperation withschool administrators. For comparison, a sample of primary schoolteachers in an adjacent district were provided with the oralhealth education manual for self-learning without workshop training.Evaluation done 2 months afterwards revealed that the teacherstrained in workshops, but not those who had studied the manualalone, had improved remarkably the quality of their oral healtheducation sessions. The new sessions taught both the conceptsand the skills of oral health care in a manner that activelyinvolved the pupils in the learning process. This action studydone in a Third World setting reveals the need for evaluationand support of the implementation of school oral health education,and demonstrates a feasible and effective means for doing it.     

深圳市中小学教师身心健康影响因素分析

目的了解深圳市福田区中小学教师身心健康状况及其群体特点,分析影响身心健康的主要因素,为进一步有针对性地维护教师身心健康提供参考依据。方法采用身心健康状况测验量表,对314名教师进行测试。结果福田区中小学教师身心健康状况8个因素中,锻炼因素得分低于正常,其他因素得分均在正常及以上。锻炼因素低于正常的检出人数为195人,占调查总数62.10%,其中女教师得分(4.53±2.20)明显低于男教师的得分(6.05±2.29,P<0.01)。教师的身心健康状况与性别、学校类别、岗位、职称、年龄、学历有一定的关系。结论福田区中小学教师身心健康状况反映在锻炼方面的问题比较突出,要予以积极关注,尤其是女教师的锻炼问题。     

高校教师心理健康与教学效能感关系

目的 探讨高校教师心理健康水平与教学效能感的关系,建立心理健康对教学校能感影响的路径模型。方法 以520名高校教师为研究对象,应用教师教学效能感量表、症状自评量表(SCL-90)和艾森克人格简式量表为研究工具,进行团体测试。结果 (1)高校教师教学效能感与心理健康水平、人格特质显著相关。(2)心理健康不但直接影响高校教师的教学效能感,同时又是人格特质对教学效能感影响的中介变量。结论 教师心理健康水平与教学效能感显著相关。     

A collaborative approach to embedding graduate primary care mental health workers in the UK National Health Service

The UK National Health Service (NHS) workforce has recently seen the arrival of the Graduate Mental Health Worker (GMHW) in primary care. We established a Quality Improvement Collaborative to assist in embedding this new workforce in one Strategic Health Authority Area of England. The intervention utilised 'collaborative' technology which involves bringing together groups of practitioners from different organizations to work in a structured way to improve the quality of their service. The process was evaluated by an action research project in which all stakeholders participated. Data collection was primarily qualitative. During the project, there was an increase in throughput of new patients seen by the GMHWs and increased workforce satisfaction with a sense that the collaborative aided the change process within the organizations. Involvement of managers and commissioners from the Primary Care Trusts where the GMHWs were employed appeared to be important in achieving change. This was not, however, sufficient to combat significant attrition of the first cohort of workers. The project identified several barriers to the successful implementation of a new workforce for mental health problems in primary care, including widespread variation in the level and quality of supervision and in payment and terms of service of workers. A collaborative approach can be used to support the development of new roles in health care; however, full engagement from management is particularly necessary for success in implementation. The problems faced by GMHWs reflect those faced by other new workers in healthcare settings, yet in some ways are even more disturbing given the lack of governance arrangements put in place to oversee these developments and the apparent use of relatively unsupported and inexperienced novices as agents of change in the NHS.     

军人心理健康教育骨干培训模式探讨

通过对军人心理健康教育骨干培训的理论和实践探索，提出了军人心理健康教育骨干培训的基本模式——“一个目标、二个关键、三个阶段、四种途径、五项内容”的整合培训模式。①一个目标：培训部队实用型心理健康教育骨干；②两个关键：理论与实际结合，院校与部队结合；③三个阶段：军人心理健康教育知识技能培训阶段、心理健康评估和干预培训阶段、心理健康教育知识技能应用实践阶段；④四种途径：理论学习、实习操作、临床见习、部队实践；⑤五项内容：心理健康的评估和心理档案建立、心理障碍的识别与诊断、军人心理健康讲座、心理健康教育报刊、个别与团体咨询。