Clients as mediators of interprofessional collaboration in mental health services in Iran

Interprofessional collaboration (IPC) has long been identified as a way of providing optimal mental health services (MHS). It is important, therefore, to identify and facilitate factors driving IPC. This paper presents health professionals' experiences and perceptions regarding the clients' role as a driving factor for IPC in MHS in an Iranian context. Health professionals included nurses, physicians (general physicians and medical specialists), psychologists and consultants. Qualitative methods were employed in the form of in-depth individual interviews and focus groups to collect data from 24 professionals and 4 clients. Data analysis generated four key themes: “Clients as axis of IPC”, “Seamless services as a common incentive for IPC”, “Clients as a common interprofessional linkage” and “Clients as a driving force to achieve IPC”. From the professionals' perspective, it was found that clients had a mediating role in their collaborative relationships and practices. These findings are discussed in relation to the interprofessional literature. This paper goes on to argue that professionals need to be aware of and be trained about how to manage, as well as benefit from, the clients' fundamental role in IPC.     

Collaboration between mental health and employment services to support employment of individuals with mental disorders

Purpose: The aim of this study was to investigate the extent of the interdisciplinary collaboration between mental health (MHS) professionals and social security professionals (SSI), their perceptions of this interdisciplinary collaboration and whether these perceptions differed between professionals of the two organizations. Method: We obtained data from mental health professionals and social security professionals in the context of a national agreement between MHS and SSI to improve the collaboration between MHS professionals and SSI professionals in the support of individuals with mental disorders to improve work outcome of these individuals. Results: Mental health professionals as well as SSI professionals reported a moderate level of interdisciplinary collaboration, which does not seem to be affected by demographic variables, such as age, gender, profession and region. When professionals collaborated in a structural way they were more positive regarding their interdisciplinary collaboration with professionals of the other organization than professionals that collaborated in an ad hoc manner. Conclusions: Interdisciplinary collaboration was perceived as moderate by collaborating mental health professionals and social security professionals. In order to improve the collaboration between MHS and SSI on a local microlevel, organizations need to facilitate more structural collaboration between the professionals.

• Implications for Rehabilitation

• Collaborating mental health professionals and social security professionals perceived their interdisciplinary collaboration as moderate.

• In order to improve the collaboration between mental health services (MHS) and vocational rehabilitation services on a local microlevel, organizations need to facilitate more structural collaboration between the professionals.

• Integrated services with the participation of MHS as well as vocational rehabilitation services, e.g. to share client information and to refer clients to each other, need to be developed.

• A national agreement between MHS and vocational rehabilitation services is a good starting point to improve collaboration between both the sectors.

     

Interprofessional care review with medical residents: lessons learned, tensions aired--a pilot study

Integrated interprofessional care teams are the focus of Canadian and American recommendations about the future of health care. Keeping with this, a family medicine teaching site developed an educational initiative to expose trainees to interprofessional care processes and learning (Interprofessional Care Review; IPC). A formative evaluation pilot study was completed using one-on-one interviews and a focus group (n = 6) with family medicine residents. A semi-structured guide was utilized regarding: knowledge, skills and attitudes related to interprofessional care; their experience of the processes utilized in IPC. Data were analyzed using content analysis. Residents' perspectives on their learning revolved around four themes: changes to understanding and practice of interprofessional care; personal impact of IPC; learning about other health professionals; tension and challenges of IPC learning and clinical implementation. Residents valued the educational experience, but identified that faculty supervisors provided "mixed messages" in the value of collaborating with other health professionals. Implications regarding future educational and research opportunities are discussed.     

A multiple-group measurement scale for interprofessional collaboration: Adaptation and validation into Italian and German languages

This article presents a study that aimed to validate a translation of a multiple-group measurement scale for interprofessional collaboration (IPC). We used survey data gathered over a three month period as part of a mixed methods study that explored the nature of IPC in Northern Italy. Following a translation from English into Italian and German the survey was distributed online to over 5,000 health professionals (dieticians, nurses, occupational therapists, physicians, physiotherapists, speech therapists and psychologists) based in one regional health trust. In total, 2,238 different health professions completed the survey. Based on the original scale, three principal components were extracted and confirmed as relevant factors for IPC (communication, accommodation and isolation). A confirmatory analysis (3-factor model) was applied to the data of physicians and nurses by language group. In conclusion, the validation of the German and Italian IPC scale has provided an instrument of acceptable reliability and validity for the assessment of IPC involving physicians and nurses.     

Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study

This article draws on data from a 5-year project that examined the effectiveness of Comprehensive primary healthcare (CPHC) in local communities. A hallmark of CPHC services is interprofessional teamwork. Drawing from this study, our article presents factors that enabled, or hindered, healthcare teams working interprofessionally in Australian primary healthcare (PHC) services. The article reports on the experiences of teams working in six Australian PHC services (four managed by state governments, one non-government sexual health organisation, and one Aboriginal community-controlled health service) during a time of significant health sector restructure. Findings are drawn from two key methods: an online survey of practitioners and managers (n = 154), and interviews with managers and practitioners (n = 60) from the six study sites. The majority of survey respondents worked with other health professionals in their service to provide interprofessional care to clients. Processes included formal team meetings, case conferencing, referring clients to other health professionals if needed, informal communication with other health professionals about clients, and team-based delivery of care. A range of interrelated factors affected interprofessional work at the services, from contextual, organisational, processual, and relational domains. Funding cuts and policy changes that saw a reorientation and re-medicalisation of South Australian services undermined interprofessional work, while a shared CPHC culture and commitment among some staff was helpful in resisting some of these effects. The co-location of services was a factor in PHC teams working interprofessionally and not only enabled some PHC teams to work more interprofessionally but also created barriers to interprofessional teamwork through disruption resulting from restructuring of services. Our study indicates the importance of decision makers taking into account the potential effects of policy and structural changes on interprofessional teamwork. Decision makers should strive to minimise unintended negative effects of changes on the functioning of interprofessional teams.     

More than one dollop of cortex: patients' experiences of interprofessional care at an urban family health centre

While Canada's government has called for collaborative patient-centered care, there is a paucity of research on patients' perspectives of such interprofessional care. This qualitative study conducted at an urban health centre begins to address our knowledge gap through semi-structured interviews and narrative analysis strategies. Findings indicate that "good care" is interprofessional care in the sense that patients perceive it as based in a strong patient-professional relationship that facilitates access to and communication amongst health professionals. Patients affirmed a frequent refrain of family physicians that the most valued characteristics of a health care team are the three "A's": availability, affability and ability. While on several dimensions, the delivery of care was rooted in a patient-centered model, professionals, at points, struggled to find common ground with patients and initiated interprofessional care as a strategy for grappling with this conflict.     

Perception of risk by home health care nurses in Taiwan

A study of cross-sectional design was used to understand the level of risk perceived by home health care nurses in Taiwan and its correlators. A total of 413 self-administrated structured questionnaires were sent by mail. 300 responses were received, with 258 valid ones. The response rate was 72.6%. The 90 occupational hazards fell into six risk factors: "professional", "traffic", "geographical", "clients' condition and interaction among clients and families", "law" and "organization". The highest scores among the six factors were associated with "law", "clients' condition and interaction among clients and families", and "organization". Marital status and home health care training were significant variables related to the level of risk perceived. Respondents who were married or had home health care training had higher level of risk perceived in the six risk factors than those who were not married or without any training. The variable of years of experience in home health care had a significantly negative correlation with both level of risk perceived for the factors "professional" and "clients' condition and interaction among clients and families". There was a significant positive correlation between the number of visits made by respondents and level of risk perceived for the traffic and geographical factors. There was no statistically significant correlation between the demographics of respondents and level of risk perceived in law. The variables educational level, whether received home health care training, and whether obtained training certificate showed no significant difference in six levels of risk perceived by respondents. The study proposed several suggestions for practice, education, policy and future study.     

Developing interprofessional communication skills for pharmacists to improve their ability to collaborate with other professions

Successful communication between health professionals is a prerequisite for collaborative practice. Clinical pharmacists completed a learning and practice module introducing them to a framework for successful interprofessional communication (IPC) in the course of their postgraduate studies. A face-to-face discussion of a contemporary clinical topic with a health professional was then scheduled, mainly with junior doctors, in their practice setting. An exploratory case study methodology was employed to investigate pharmacists’ written reflections on their experience applying their newly acquired IPC skills. Thematic analysis of reflections developed five categories relating to interprofessional collaboration, learning, and education. Themes describing pharmacists’ preconceptions about the health professional and scheduled interprofessional encounter, how it allowed them to learn about doctors’ and other health professionals’ practice and build collaborative relationships were identified. Reflections also elaborated that applying the communication framework and strengthening of collaboration created opportunities for IPE, with added observations about these increasing potential impact on patient care and change of practice. Analysis of anonymous feedback provided by the health professionals yielded similar themes and was integrated for triangulation. Applying successful IPC skills in healthcare settings may increase interprofessional collaboration and create practice models which facilitate interprofessional learning in health profession programmes.     

Inclusive early childhood education and care: a longitudinal study into the growth of interprofessional collaboration

ABSTRACT

Inclusive early childhood education and care (ECEC) requires interprofessional collaboration between professionals with diverse professional backgrounds. Following developments in human services, there is a growing interest in the role of interprofessional teams in community-based settings for young children. In a three-year longitudinal study, we investigated interprofessional collaboration (IPC) between staff from childcare, education and youth care. At the individual level, a survey was used for the analysis of IPC competences. At the network level, we investigated professional relationships between individuals using social network analysis. Results of a multilevel mixed linear model showed an increase in interdependence and reflection on process of individual staff, followed by the progressive development of perceived team performance. Smaller networks with higher density and professionals’ centrality predicted more positive perceptions of inclusive ECEC. We discuss our findings in the context of growing interest in interprofessional teams in ECEC.     

Interprofessional care review with medical residents: Lessons learned,tensions aired – A pilot study

Integrated interprofessional care teams are the focus of Canadian and American recommendations about the future of health care. Keeping with this, a family medicine teaching site developed an educational initiative to expose trainees to interprofessional care processes and learning (Interprofessional Care Review; IPC). A formative evaluation pilot study was completed using one-on-one interviews and a focus group (n?=?6) with family medicine residents. A semi-structured guide was utilized regarding: knowledge, skills and attitudes related to interprofessional care; their experience of the processes utilized in IPC. Data were analyzed using content analysis. Residents' perspectives on their learning revolved around four themes: changes to understanding and practice of interprofessional care; personal impact of IPC; learning about other health professionals; tension and challenges of IPC learning and clinical implementation. Residents valued the educational experience, but identified that faculty supervisors provided “mixed messages” in the value of collaborating with other health professionals. Implications regarding future educational and research opportunities are discussed.     

Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionals

This paper identifies and describes the experiences of 13 rural mental health professionals who care for clients diagnosed with a mental illness and a coexisting alcohol and other drug disorder (dual diagnosis). Dual diagnosis is a common problem which is often poorly understood and managed by mental health professionals. The effect of excessive substance use on a person's mental well-being can present as a diagnostic challenge as each condition may mask symptoms of the other. The authors utilized a phenomenological approach to discover the experiences of a group of mental health professionals working in rural communities in Victoria, Australia. Caring for clients diagnosed with dual diagnosis was found to be a complex and stressful role that involved high levels of skill and knowledge. Despite the fact that health professionals in rural areas are expected to deliver the most appropriate care to individuals with a dual diagnosis, a number of these rural health professionals have limited preparation and experience in dealing with arising clinical diagnosis issues. Clinicians experience frustration, resentment and powerlessness in their attempt to understand their clients' drug misuse whilst simultaneously endeavouring to provide a quality mental health service.     

Helpfulness of mental health day care: client and staff views

Seventeen clients of a mental health day service were interviewed regarding their treatment experiences Content analysis of this information was undertaken, and the clients then rank-ordered the reported aspects of treatment from most to least helpful Staff undertook a similar procedure to enable clients' views to be placed in context Both clients and staff reported counselling as the most helpful aspect of treatment Clients and staff disagreed as to the relative helpfulness of medical and group aspects of treatment Clients reported medical treatment as the second most helpful aspect, and staff reported groups and the planned approach to care second Social contact with other clients was reported to be just as helpful as organized group therapy by clients Clients identified that just having somewhere to go to meet people was very helpful Communication difficulties between staff and clients were evident with regard to the planned approach to care, discharge planning, and group activities The ability of clients to evaluate their treatment experiences differentially is highlighted     

Interprofessionality as the field of interprofessional practice and interprofessional education: an emerging concept

This paper proposes a new concept and a frame of reference that should permit the development of a better understanding of a phenomenon that is the development of a cohesive and integrated health care practice among professionals in response to clients' needs. The concept is named "interprofessionality" and aims to draw a clear distinction with another concept, that of interdisciplinarity. The utilization of the concept of interdisciplinarity, which originally concerns the development of integrated knowledge in response to fragmented disciplinary knowledge, has caused some confusion. We need a concept that will specifically concern the development of a cohesive practice among different professionals from the same organization or from different organizations and the factors influencing it. There is no concept that focuses clearly on this field. Interprofessionality concerns the processes and determinants that influence interprofessional education initiatives as well as determinants and processes inherent to interprofessional collaboration. Interprofessionality also involves analysis of the linkages between these two spheres of activity. An attempt to bridge the gap between interprofessional education and interprofessional practice is long overdue; the two fields of inquiry need a common basis for analysis. To this end, we propose a frame of reference, an interprofessional education for collaborative patient-centred practice framework. The framework establishes linkages between the determinants and processes of collaboration at several levels, including links among learners, teachers and professionals (micro level), links at the organizational level between teaching and health organizations (meso level) and links among systems such as political, socio-economic and cultural systems (macro level). Research must play a key role in the development of interprofessionality in order to document these linkages and the results of initiatives as they are proposed and implemented. We also believe that interprofessionality will not be pursued without the requisite political will.     

Risk: A Concept Worthy of Attention

Clients often engage in behavior that involves risk. Consequences of this behavior are sometimes harmful, but not always. Many times clients' views of the risks they are taking are often based on personal decisions they have made about their own health. People who take risks are frequently quite knowledgeable. The author uses case studies to examine the concept of risk. The author posits that teaching plans must account for the risks that clients take. Teaching plans should reflect that risks/benefits need to be discussed. Teaching should reflect respect for patient choices. An open discussion with the client that reflects what is really happening in the client's everyday life is of far more value than scanty, often glossed-over reports clients are accustomed to giving health professionals.     

Delisting publicly funded community-based physical therapy services in Ontario,Canada: A 12-month follow-up study of the perceptions of clients and providers

Publicly funded community-based physical therapy (PT) services in Canada's most populous province of Ontario were partially delisted, or deinsured, in April 2005. Two previous studies examined the short-term effects from the client and provider perspectives; and in this study, we follow up with participants from these preceding studies to assess long-term consequences of this policy. Sixteen of 18 providers (89%) and 64 of 98 clients (65%) agreed to participate in a follow-up telephone interview. Our results indicate that 12 months following delisting, and despite government assurances that access would be preserved, clients rendered ineligible for publicly funded services report ongoing access barriers across Ontario. Clients in this study also express concern about their overall health and report an increased use of other insured health professionals (e.g., physicians) and services (e.g., hospitals). On the other hand, providers within the network of publicly funded clinics report an important decrease in demand for PT services, whereas those from other settings report little change. We conclude that delisting policies may have long-term consequences on uninsured or underinsured clients and that evidence-based policy planning is warranted to ensure that the goals of reform are aligned with the desired outcomes at the client, provider, and system levels.     

Delisting publicly funded community-based physical therapy services in Ontario, Canada: a 12-month follow-up study of the perceptions of clients and providers

Publicly funded community-based physical therapy (PT) services in Canada's most populous province of Ontario were partially delisted, or deinsured, in April 2005. Two previous studies examined the short-term effects from the client and provider perspectives; and in this study, we follow up with participants from these preceding studies to assess long-term consequences of this policy. Sixteen of 18 providers (89%) and 64 of 98 clients (65%) agreed to participate in a follow-up telephone interview. Our results indicate that 12 months following delisting, and despite government assurances that access would be preserved, clients rendered ineligible for publicly funded services report ongoing access barriers across Ontario. Clients in this study also express concern about their overall health and report an increased use of other insured health professionals (e.g., physicians) and services (e.g., hospitals). On the other hand, providers within the network of publicly funded clinics report an important decrease in demand for PT services, whereas those from other settings report little change. We conclude that delisting policies may have long-term consequences on uninsured or underinsured clients and that evidence-based policy planning is warranted to ensure that the goals of reform are aligned with the desired outcomes at the client, provider, and system levels.     

Exploring the potential for joint training between legal professionals in the criminal justice system and health and social care professionals in the mental-health services

Effective screening of mentally-ill defendants in the criminal court system requires cooperation between legal professionals in the criminal justice system (CJS), and health and social care workers in the mental-health service (MHS). This interagency working, though, can be problematic, as recognized in the Bradley inquiry that recommended joint training for MHS and CJS professionals. The aim of this study was to examine the experiences and attitudes of workers in the CJS and MHS to inform the development of relevant training. The method was a survey of mental-health workers and legal professionals in the court. The results showed that both agencies were uncertain of their ability to work with the other and there is little training that supports them in this. Both recognized the importance of mentally-ill defendants being dealt with appropriately in court proceedings but acknowledged this is not achieved. There is a shared willingness to sympathize with defendants and a common lack of willingness to give a definite, unqualified response on the relationship between culpability, mental-illness and punishment. Views differ around defendants' threat to security.Findings suggest there is scope to develop interprofessional training programs between the CJS and MHS to improve interagency working and eventually impact on the quality of defendants' lives. Recommendations are made on the type of joint training that could be provided.