Secondary analysis of primary and preventive services accessed and perceived service barriers by children with developmental disabilities and their families

Children and youths with developmental disabilities (DD) have needs for more community-based services to address ongoing health, educational, employment, housing, transportation, and recreational concerns. Secondary data analysis was conducted to examine the array of services accessed and service obstacles to primary, preventive and special health care services of 102 children and youths with developmental disabilities. The two services most frequently reported as being used by families were SSI (29.4%) and MediCal (California's Medicaid program) (27.8%). Speech therapy was the most frequently identified support service accessed by respondents (51%). Respondents identified a number of unaddressed concerns and perceived barriers to having these concerns addressed as it related to service referrals for speech therapy, nutrition services, dental services, and behavior management services.     

Bridging Cultures for Latino Children: School Nurse and Advanced Practice Nurse Partnerships

TOPIC:  Barriers to use of mental health services by Latino families include stigma, service costs, and disparity of services with cultural values and traditions. School nurses are in key positions to recognize mental health needs of Latino children and form relationships that facilitate family connections with mental health services. Advanced practice psychiatric nurses may be contracted by school districts to provide consultation to school nurses or may be available to school nurses through connections with school-based health centers. Case examples are provided to illustrate the value of school nurse consultation with an advanced practice psychiatric nurse in promoting awareness of cultural influences on children's symptoms and behaviors and developing culturally sensitive approaches to engage Latino children and families in school and health services.
PURPOSE:  This paper aims to review literature on Latino mental health and present rationale for school nurse and advanced practice nurse partnerships to promote culturally sensitive approaches that facilitate Latino family access and utilization of health services.
SOURCES:  Published literature and case scenarios.
CONCLUSIONS:  With advanced practice nurse consultation, school nurses identify mental health needs of Latino children and develop culturally sensitive approaches that bridge Latino families' access to and utilization of health services.     

Service users and mental health nursing

A better understanding of the views of service users has become increasingly relevant in providing mental health services and for the role of the mental health nurse in meeting users' needs. The four key issues that this research endeavoured to address were: (1) What are the views and perceived needs of users of mental health services in the context of the role that users see nurses fulfilling? (2) How do student nurses perceive their future role given the changes in nurse preparation? (3) To what extent do the answers to the first two questions converge and/or diverge? (4) Recommend actions on ways in which mental health nurse training could be improved, in light of the findings of this research. Methodologically, both qualitative and quantitative data gathering approaches were used, the former for stage one in setting the agenda and the latter for stage two by means of questionnaires. The findings indicate that the key concerns for users are issues of choice, individuality, information and quality of care in terms of positive interpersonal relationships with those who have responsibilities for helping them and who are sensitive to their real needs. Users are not asking for any costly or extravagant therapies but support that is relevant to their needs and provided in a compassionate manner. The context of their lives and the degree to which users feel integrated into society is a prominent concern. These findings have implications for how mental health nurses are educated and trained and how on qualifying they function in practice. The findings throw into question whether mental health nursing can adapt to the desired changes that are being called for.     

A needs assessment of clients with HIV in a home-based care program in Guyana

ABSTRACT Objective: To assess the needs of clients in a home‐based care (HBC) program aimed at improving the quality of lives of people living with HIV in Region 4 of Guyana (Demerara‐Mahaica region) following their involvement with the HBC program, volunteers, and nurse providers. Design and Sample: A cross‐sectional analysis of a needs assessment conducted through a verbally administered questionnaire. We collected a cross‐sectional sample of 84 HBC clients living with HIV from Region 4 in Guyana. Measures: Respondents were administered a questionnaire that asked questions regarding the demographics; services received; quality of service delivery; and mental health and substance abuse. Results: The services most commonly received by respondents included nutritional assessment and counseling, HIV prevention education, emotional support, hygiene education, support for antiretroviral adherence, and support for HIV disclosure. Respondents reported further need of referrals to income‐generation opportunities, food and nutritional supplement support, and support for children. Forty‐two percent of the respondents screened positive for probable depression, and 37% of respondents screened positive for being at risk for a drinking problem. Conclusions: While a substantial portion of needs were addressed by the HBC program, outstanding needs included linking people living with HIV to income‐generation opportunities, food support, mental health, and services for children. We suggest that mental health and substance use services be factored into HIV programming and that referral systems be strengthened to ensure access to support services for people living with HIV.     

Meeting health care needs of a vulnerable population: perceived barriers

This study utilized the qualitative methodology of focus groups to explore health care needs and perceived barriers to obtaining health care for urban and rural women and children in areas served by nurse practitioner (NP) and certified nurse midwife (CNM) clinics. The clinics operate in a southeastern county with a rural health professional shortage area designation, and an urban ZIP code area with high rates of infant mortality and serious pediatric conditions. The aim of the study was to delineate barriers to health care in order to develop appropriate services at the clinics and to improve access. Four focus groups with a total of 31 women from the communities were convened. Content analysis shows that access to the clinics is hampered by the community women's limited knowledge of CNMs and NPs and their specific roles in providing health care services. The women suggested that clinics counter their low profile by a more vigorous outreach promotion.     

The role of child health nurses in enhancing mothering know-how

Supporting early parenting and promoting family health is an important aspect of contemporary child health nursing in Australia. Recent studies suggest that within a service climate that increasingly funds targeted, population-based needs rather than universal needs, child health nurses are concerned about maintaining individual nurse-client relationships, particularly with individual families. There is however, limited evidence available to use in response to these concerns. In this paper the way a group of middle-class mothers of infants, who, in today's health service climate, may not be a target group for health services, develop their caregiving know-how, is discussed. The findings presented suggest that both expert and lay knowledge have a part to play in supporting women in their early mothering. Women such as these, in essence, need a clearing-house to help them sift through the overwhelming information they access, respond to, and turn into everyday practices that work. Well placed child health nursing services may achieve this. While there is significant support for this claim in the literature, mechanisms for effective support remains the challenge. A key may be found in nurses focusing on the promotion of communicative or interactive health literacy as an outcome of their programs.     

Supportive care needs of people with brain tumours and their carers

Goals of work The diagnosis and treatment of a brain tumour may result in long-term changes in a patient’s functional and social abilities and/or in a greatly reduced life span. A qualitative investigation was conducted to examine the supportive care needs of patients with brain tumour and their carers.Materials and methods Overall, 18 patients and 18 carers participated in focus groups or telephone interviews, following a structured interview guide to elicit supportive care services of importance to these patients and carers.Main results Six major themes were identified using the framework analysis method, including needs for information and coping with uncertainty, practical support, support to return to pretreatment responsibilities or prepare for long-term care, support to deal with social isolation and organize respite care, support to overcome stigma/discrimination and support to discuss potentially reduced life expectancy.Conclusions Five recommendations to improve service delivery include: assignment of a dedicated member of the care team or case manager; proactive dissemination of information, education and psychosocial support; access to objective assessment of neuropsychological functioning; facilitating easier access to welfare payments; and services facilitating communication about difficult illness-related topics. Provision of services along these recommendations could improve supportive care of brain tumour patients and their carers.     

Teenagers' and parents' views on a short-break service for children with life-limiting conditions: a qualitative study

Few opportunities exist outside the home for children and teenagers with life-limiting conditions to have a break in a setting specifically designed and adequately staffed and resourced to meet their complex clinical, practical and emotional needs; until recently provision focused primarily on providing respite for parents/carers. Based on policy recommendations, a short-break service was established with the aim of working in partnership with families and voluntary and statutory agencies to provide a fun break for children and teenagers with life-limiting conditions and complement the range of services available. This qualitative study used interviews and focus groups to determine teenagers' and parents' views of the service. Three themes emerged: accessibility and communication; needs and boundaries; and shaping the service. Teenagers enjoyed regular planned residential breaks, access to skilled staff and bespoke facilities to support their needs, opportunities to meet others with life-limiting conditions and fun time away from home, thereby giving parents peace of mind, a regular planned break from care-giving, opportunities to meet other parents and to spend exclusive time with their other children. If specialist short-break services become part of the national range of services available, children and teenagers with life-limiting conditions and their parents and siblings could all benefit.     

Use of mental health and support services among families of children with disabilities: discrepant views of parents and paediatricians

Viewing families of children with disabilities in terms of normative coping responses to stress is a relatively recent trend. This investigation examined differences between parents of children with spina bifida and paediatricians in their views of families' mental health support service needs. The study involved 21 parents and 23 paediatricians who completed a needs assessment instrument. Although the views of the two groups were similar in regard to a perceived need for services, discrepancies were evident in the type of mental health support service providers thought to be most appropriate, and the perceived severity of families' psychosocial problems. Results are discussed in relation to family compliance in paediatric health care settings, and the need to consider parental attitudes when family mental health support service issues are raised.     

Adolescents & young adults: Issues in transition from active therapy into follow-up care

PurposeThe development of services focused on addressing the needs of Adolescent & Young Adult (AYA) cancer patients as they transition from active therapy into follow-up care is an area of growth, development and research across the globe. This is important as much of the empirical literature and service development to date has focused on children or older adults. In Victoria, Australia, as elsewhere, survivorship studies focusing on the AYA age group are needed to answer questions regarding their medical, psychological and social needs. This article examines the qualitative exploration of the findings of a small focus group study with young people and the subsequent development of a practice framework by the onTrac@PeterMac Victorian Adolescent & Young Adult Cancer Service.MethodEight young people, with a mean age at diagnosis of 24 years and 8 months, participated in a 3 h focus group. A qualitative analytic approach was utilized to examine themes.Key resultsThe participants identified a number of survivorship concerns relating to three broad categories: finishing treatment, ongoing health concerns and future directions.ConclusionsThe research findings supported the development of a practice framework designed to assist in the management of AYA living with cancer in Victoria. Results also supported previously documented evidence that indicate gaps in cancer knowledge and services provided to this age group. Further collaborative research is required to understand AYA treatment and survivorship issues to assist in the development of more formalised aged appropriate protocols.     

Help-seeking and access to mental health care in a university student population

BACKGROUND: University students represent an important population in which to study access to mental health care. Understanding their unmet needs will enhance efforts to prevent and treat mental disorders during a pivotal period in life. OBJECTIVE: To quantify mental health service use and estimate how various factors are associated with help-seeking and access in a university student population. DESIGN: A Web-based survey was administered to a random sample of 2785 students attending a large, public university with a demographic profile similar to the national student population. Nonresponse bias was accounted for using administrative data and a nonrespondent survey. MEASURES: Mental health was measured using the Patient Health Questionnaire screens for depressive and anxiety disorders. Mental health service utilization was measured as having received psychotropic medication or psychotherapy in the past year. RESULTS: Of students with positive screens for depression or anxiety, the proportion who did not receive any services ranged from 37% to 84%, depending on the disorder. Predictors of not receiving services included a lack of perceived need, being unaware of services or insurance coverage, skepticism about treatment effectiveness, low socioeconomic background, and being Asian or Pacific Islander. CONCLUSIONS: Even in an environment with universal access to free short-term psychotherapy and basic health services, most students with apparent mental disorders did not receive treatment. Initiatives to improve access to mental health care for students have the potential to produce substantial benefits in terms of mental health and related outcomes.     

Evaluation of occupational therapy school-based consultation service for students with fine motor difficulties

PURPOSE: This paper describes a 2-year study that addressed the perceived occupational performance changes among students with fine motor difficulties receiving occupational therapy school-based consultation (OTSBC) services. METHOD: The sample included 52 stakeholders of students with fine motor difficulties who received occupational therapy services. Six exploratory focus groups and one participatory and action-based focus group were conducted with parents, teachers, occupational therapists, and Community Care Access Centre case managers. RESULTS: Results supported the benefits of OTSBC. Key concerns identified were the wait for service, confusion about service expectations, inadequate communication among stakeholders, school board issues, and constraints in the health care system. Recommendations identified were to train teachers, provide early intervention, address service delivery issues related to health and education systems, and promote awareness of occupational therapy service and its effectiveness. PRACTICE IMPLICATIONS: Occupational therapists working with students with fine motor difficulties could consider providing formal education programs for teachers, promoting early intervention of fine motor problems, and communicating to stakeholders regarding the expectations and effectiveness of OTSBC.     

The experience of mental health service use for African American mothers and youth

Little is known about African American families' experiences with mental health services. A purposive sample of 40 dyads of African American youth (aged 13 to 19) and their mothers participated in a cross-sectional qualitative research design using semi-structured interviews that elicited information about their past experiences and satisfaction with mental health services. Though rarely received, group and family therapy were perceived favorably. However, both mothers and youth reported dissatisfaction centered on medication and lack of professionalism, confidentiality, and concern by providers. The failure of mental health services providers to meet basic standards of quality and professionalism may explain the low rate of service use by African Americans.     

Recovery concept in a Norwegian setting to be examined by the assertive community treatment model and mixed methods

Recovery is a crucial concept in the mental health field. The research of recovery is split into the categories of personal, social and clinical recovery. The purpose of this study was to explore the fragmented concept of recovery in light of assertive community treatment (ACT) in Norway. The study has a mixed methods design with a pragmatic approach. The Questionnaire about the Process of Recovery and open‐ended questions posed to 70 participants from 12 ACT teams in Norway, gathered by the “Users interview users” method, are combined with interviews or focus groups with eight of these participants. Surprisingly those under a community treatment order (CTO) report the highest degree of personal recovery. The qualitative material shows that the service users interpreted the concept of recovery differently than researchers and professionals. The ACT service users highlighted three important elements: flexible treatment, medication and access to a car. They emphasized the necessity for basic needs to be met in order to experience a meaningful recovery process, and these basic needs may be of even greater importance to those under CTOs. Their experiences should imply a greater emphasis on securing basic needs such as secure housing, sounder finances and access to the normal benefits offered by society.