Evaluation of an employment program for people with mental illness using the Supported Employment Fidelity Scale

Background: The Individual Placement and Support (IPS) model aims to achieve open employment for people with mental illness. The Supported Employment Fidelity Scale (SEFS) is a 15-item instrument that evaluates the extent to which a service follows the IPS principles of best practice. This paper describes the IPS model and an evaluation of a specialist employment program for people with mental illness using the SEFS.
Methods: The SEFS enabled a quantitative assessment of service provision against the criteria of evidence-based practice principles. Data were collected from multiple sources. In addition, a literature review was conducted, and personnel engaged in implementation of the IPS model at other Australian employment programs were consulted.
Results: The program achieved a score of 59 of a possible 75 on the SEFS, which is described as fair supported employment.
Discussion: Analysis of the 15-scale items resulted in the identification of strengths, areas for further development, and a set of recommendations.
Conclusions: The program was operating substantially in line with evidence-based practice principles and had considerable scope for further development. Issues arising from the evaluation, areas of applicability of the SEFS and the underlying literature, and implications for occupational therapy are highlighted.     

The experiences of people with severe and enduring mental illness engaged in a physical activity programme integrated into the mental health service

Objectives

Regular physical activity can be beneficial for people with severe and enduring mental illness (SEMI). However there is little information about how this might be initiated and maintained. This work reports findings from qualitative research, the aim of which was to identify factors influencing adherence to an activity programme and the perceived effects of physical activity on well-being.

Methods

Seventeen people (18–65 years of age) with SEMI were recruited from several groups within an established physical activity programme (specifically designed for mental health service users). One-to-one semi-structured interviews were recorded with audio equipment, transcribed and member checked. Thematic analysis was adopted to extract perceptions about programme participation, its benefits and drawbacks.

Results

Results indicated that a combination of the mental illness and effects of medication were the main barriers to participation. The main enabling factors to participation were the support of the mental health staff and the organisation and structure of the physical activity sessions. Emerging themes illustrate the benefits of physical activity in enhancing mental well-being, physical health and in providing social opportunities.

Conclusion

This qualitative research demonstrates that a physical activity programme integrated into the mental health service and supported by partnership working can address several of the unique barriers faced by this population. Through the provision of opportunity, appropriate support and structure of the sessions, people with SEMI can take part in sustained regular physical activity. Outcomes indicate benefits to mental well-being which can assist in recovery of those with SEMI and help with adherence to the programme.     

Attitudes towards people with mental illness. Effects of a training program for secondary school students

This article reports a control study on the influence of a training program on attitude change towards people with mental illness. One hundred and seventeen students from 13 schools formed school-based mental health clubs, which composed the treatment group. They were given a mental health training program at different schools. The comparison group consisted of 102 secondary school students who had received no intervention. Students of both groups were assessed before the commencement, at the last session, and seven months after completion of the program with an OMICC (Opinion about Mental Illness in Chinese Community) scale developed by the authors. The study revealed significant positive changes, which could last a longer period of time, in specific attitudes on separatism and stigmatization of people with mental illness among students after the training program.     

Effectiveness of a community health service program using exercise intervention for elderly people with osteoarthritis of the knees: a randomized controlled trial

OBJECTIVE: The objective of this study was to evaluate the effectiveness of an exercise program conducted as part of community health services to improve pain and physical function in elderly people with osteoarthritis of the knee (knee OA). METHODS; The subjects were 88 (12 males aged 77.8 +/- 5.4 years and 76 females aged 73.2 +/- 5.3 years) community-dwelling independent elderly people with knee OA who participated voluntarily in exercise classes sponsored by Musashino city of Tokyo. They were allocated randomly to the intervention group (n = 44) and the control group (n = 44). For the intervention group, exercise classes of 90 min duration were held 8 times over 3 months. The exercise program comprised flexibility exercises (stretching of knee and ankle joints), resistance exercises (strengthening of quadriceps, extension and flexion of the knee joint with an elastic band), and movement exercises (turning over, getting up, standing up). The subjects were instructed to perform these exercises at home every day. Knee pain scores (Western Ontario and McMaster Universities OA Index; WOMAC), peak torque of joint during knee flexion and extension, range of motion (ROM) of the knee joint, and functional fitness (standing and walking ability) were evaluated before and after the intervention period. RESULTS: Significant inter-group differences were observed for peak torque during knee flexion and standing and walking ability of females. Assessment of interactions between time and group by repeated measure ANOVA adjusted for age and sex revealed significance differences for the WOMAC score (P = 0.031), the peak torque during knee extension (P = 0.016) and knee flexion (P = 0.000), ROM (P = 0.037), standing ability (P = 0.000)and walking ability (P = 0.000). The effect of the intervention was 0.44 for WOMAC score, 0.23 for peak torque during knee extension, 0.64 for knee flexion, 0.32 for ROM, 0.81 for standing ability, and 1.13 for walking ability. CONCLUSIONS: These results suggested that the exercise program for elderly people with knee OA improved knee pain and physical function.     

Controlled trial of discharge planning by video-link in a UK urban mental health service: responses of staff and service users

We examined the use of videoconferencing in a UK urban mental health service for discharge planning within the framework of the Care Programme Approach (CPA). The study was an AB design. Baseline data were collected over three months, before the introduction of the CPA by videoconferencing. Twenty-seven CPA meetings were held in the baseline phase of the study and 23 during the video-link phase. Service users and professional participants were asked to complete the Guy's Communication Questionnaire (GCQ) at the end of the meeting. A total of 204 GCQs were completed (88% of those issued). Responses were compared between the face-to-face and video-link conditions. No significant differences were found in satisfaction measures between the two conditions. These data suggest that the video-link medium is acceptable to service users and professionals alike for discharge planning.     

Controlled trial of discharge planning by video-link in a UK urban mental health service: responses of staff and service users

We examined the use of videoconferencing in a UK urban mental health service for discharge planning within the framework of the Care Programme Approach (CPA). The study was an AB design. Baseline data were collected over three months, before the introduction of the CPA by videoconferencing. Twenty-seven CPA meetings were held in the baseline phase of the study and 23 during the video-link phase. Service users and professional participants were asked to complete the Guy's Communication Questionnaire (GCQ) at the end of the meeting. A total of 204 GCQs were completed (88% of those issued). Responses were compared between the face-to-face and video-link conditions. No significant differences were found in satisfaction measures between the two conditions. These data suggest that the video-link medium is acceptable to service users and professionals alike for discharge planning.     

Impact of a population‐wide mental health promotion campaign on people with a diagnosed mental illness or recent mental health problem

Objectives : To determine the impact of the Act‐Belong‐Commit mental health promotion campaign on people with a diagnosed mental illness or who had sought professional help for a mental health problem in the previous 12 months. Method : In 2013 and 2014, 1,200 adults in Western Australia were interviewed by telephone. The questionnaire measured campaign reach, impact on beliefs about mental health and mental illness and behavioural impact. Results : Campaign impact on changing the way respondents thought about mental health was significantly higher among those with a mental illness or who had sought help (41.4% vs 24.2%; p<0.001), as was doing something for their mental health as a result of their exposure to the campaign (20.5% vs 8.7%; p<0.001). Conclusions : The campaign appears to empower people with a mental illness or who recently sought help to take steps of their own to enhance their mental health.     

Uncovering the limits of patient-centeredness: implementing a self-management trial for chronic illness

Research evaluating self-management of chronic conditions points to the effectiveness of interventions' changing the health behavior of individuals. However, we know little about how self-management is negotiated within health services. The authors designed a qualitative investigation to illuminate the quantitative findings of a randomized controlled trial (RCT) of a self-management program for people with inflammatory bowel disease. They conducted in-depth interviews with physicians and patients, and qualitative analysis illuminated the nature of doctor-patient encounters and possible reasons for lack of change in patient satisfaction with the consultation. The findings suggest that factors inhibiting effective patient-centered consultations include failure of physicians to incorporate expressed need relevant to people's self-management activities fully, interpretation of self-management as compliance with medical instructions, and the organization of outpatients' clinics. Giving attention to these barriers might maximize the opportunities for patient self-management of chronic illness based on a therapeutic alliance with health care professionals.     

Long-term effectiveness of the ACCESS program in linking community mental health services to homeless persons with serious mental illness

This study examined the long-term effectiveness of the ACCESS (Access to Community Care and Effective Services and Supports) project on service utilization and continuity of care among homeless persons with serious mental illness. A 3-year longitudinal analysis, using Medicaid claims data, tracked behavioral health service utilization among 146 Medicaid-eligible participants in the Pennsylvania ACCESS program. Utilization patterns of inpatient, outpatient, and emergency department services for psychiatric and substance abuse treatment were examined during the year prior to, during, and one year after the implementation of the ACCESS project. Use of psychiatric ambulatory care significantly increased among intervention participants and remained greater following ACCESS intervention. Better continuity of care following hospitalization was achieved during and after the intervention. The number of days spent hospitalized significantly decreased during the intervention. These results suggest that the ACCESS intervention was effective in linking hard-to-reach homeless persons with serious mental illness to the community mental health service system, and that this effect was maintained after termination of the intervention.     

Learning what matters for patients: qualitative evaluation of a health promotion program for those with serious mental illness

Sedentary lifestyle, poor dietary behaviors and metabolic alterations associated with psychiatric medications contribute to poor health and high rates of obesity among individuals with serious mental illness (SMI). Interventions that increase engagement in physical exercise, dietary modifications, lifestyle changes and preventive health care can provide health benefits across the lifespan. These interventions have led to substantial physical improvements in some persons with SMI, while others have not improved or have experienced worsening physical health. We set out to identify characteristics of a health promotion program that persons with SMI associated with physical health improvements. Interviews were conducted with eight participants from the In SHAPE health-promotion program who lost at least 10 pounds or diminished their waist circumference by at least 10 cm. Interviews aimed to determine which aspects of the program were perceived to be most helpful in promoting physical health improvement. Among successful participants, three themes emerged, highlighting the importance of: (i) individualized interventions promoting engagement in the program; (ii) relationships with health-promotion program employees and (iii) self-confidence resulting from program participation. Health-promotion programs that target these areas may have better success in achieving health benefits for persons with SMI.     

Effects of a behavioural weight loss intervention in people with serious mental illness: Subgroup analyses from the ACHIEVE trial

BackgroundPersons with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of obesity and related chronic diseases and die 10–20 years earlier than the overall population, primarily due to cardiovascular disease. In the ACHIEVE trial, a behavioural weight loss intervention led to clinically significant weight loss in persons with SMI. As the field turns its attention to intervention scale-up, it is important to understand whether the effectiveness of behavioural weight loss interventions for people with SMI, like ACHIEVE, differ for specific subgroups.MethodsThis study examined whether the effectiveness of the ACHIEVE intervention differed by participant characteristics (e.g. age, sex, race, psychiatric diagnosis, body mass index) and/or their weight-related attitudes and behaviours (e.g. eating, food preparation, and shopping habits). We used likelihood-based mixed effects models to examine whether the baseline to 18 month effects of the ACHIEVE intervention differed across subgroups.ResultsNo statistically significant differences were found in the effectiveness of the ACHIEVE intervention across any of the subgroups examined.ConclusionsThese findings suggest that the ACHIEVE behavioural weight loss intervention is broadly applicable to the diverse population of individuals with SMI.     

Left behind by reform: the case for improving primary care and mental health system services for people with moderate mental illness

In this paper, we present a case for improving services to meet the needs of people with moderate mental illness (MMI). We begin by outlining the evolution of mental health reform and its current tendency toward excluding this population. We offer a working definition for MMI and systematically explain why individuals with moderate mental illnesses deserve increased attention and resources within both the mental health system and general medical settings. Some of the 'best practices' on a strategic programme level that can be used to serve people with MMI most effectively are discussed. Making MMI a priority involves reorienting clinical as well as programmatic approaches to address the needs of the population with these disorders. Systems-level financial, structural and manpower supply issues are crucial; challenging government to become a key player in developing a more collaborative model of physical and mental health care. Private health and mental health organisations, professional groups and individual users of services must also commit themselves to recognising the problem of MMI and respond to it more effectively.     

Twelve-month effect of chronic pain self-management intervention delivered in an easily accessible primary healthcare service - a randomised controlled trial

Background

To investigate the effects after twelve months related to patient activation and a range of secondary outcomes on persons with chronic pain of a chronic pain self-management course compared to a low-impact outdoor physical activity, delivered in an easily accessible healthcare service in public primary care.

Methods

An open, pragmatic, parallel group randomised controlled trial was conducted. The intervention group was offered a group-based chronic pain self-management course with 2.5-h weekly sessions for a period of six weeks comprising education that included cognitive and behavioural strategies for pain management, movement exercises, group discussions and sharing of experiences among participants. The control group was offered a drop-in, low-impact, outdoor physical activity in groups in one-hour weekly sessions that included walking and simple strength exercises for a period of six weeks. The primary outcome was patient activation assessed using the Patient Activation Measure (PAM-13). Secondary outcomes included assessments of pain, anxiety and depression, pain self-efficacy, sense of coherence, health-related quality of life, well-being and the 30-s Chair to Stand Test. Analyses were performed using a linear mixed model.

Results

After twelve months, there were no statistically significant differences between the intervention group (n?=?60) and the control group (n?=?61) for the primary or the secondary outcomes. The estimated mean difference between the groups for the primary outcome PAM was 4.0 (CI 95% -0.6 to 8.6, p?=?0.085). Within both of the groups, there were statistically significant improvements in pain experienced during the previous week, the global self-rated health measure and the 30-s Chair to Stand Test.

Conclusions

No long-term effect of the chronic pain self-management course was found in comparison with a low-impact physical activity intervention for the primary outcome patient activation or for any secondary outcome.

Trial registration

ClinicalTrials.gov: NCT02531282. Registered on August 212,015

     

Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older people in the Netherlands

Many chronically ill older patients in the Netherlands have a combination of more than one chronic disease. There is therefore a need for self-management programs that address general management problems, rather than the problems related to a specific disease. The Chronic Disease Self-Management Program (CDSMP) seems to be very suitable for this purpose. In evaluations of the program that have been carried out in the United States and China, positive effects were found on self-management behaviour and health status. However, the program has not yet been evaluated in the Netherlands. Therefore, the aim of this study was to evaluate the short-term and longer-term effects of the program among chronically ill older people in the Netherlands. One hundred and thirty-nine people aged 59 or older, with a lung disease, a heart disease, diabetes, or arthritis were randomly assigned to an intervention group (CDSMP) or a control group (care-as-usual). Demographic data and data on self-efficacy, self-management behaviour and health status were collected at three measurement moments (baseline, after 6 weeks, and after 6 months). The patients who participated rated the program with a mean of 8.5 points (range 0-10), and only one dropped out. However, our study did not yield any evidence for the effectiveness of the CDSMP on self-efficacy, self-management behaviour or health status of older patients in the Netherlands. Because the patients who participated were very enthusiastic, which was also indicated by very high mean attendance (5.6 out of 6 sessions) and only one dropout, it seems too early to conclude that the program is not beneficial for these patients.     

Moving on from paediatric to adult health care: an initial evaluation of a transition program for young people with cystic fibrosis

BACKGROUND AND OBJECTIVE: Although there are general guidelines for adolescents with chronic illnesses making the transition from paediatric to adult health care, there are few studies which evaluate transition programs. This cross-sectional study was a preliminary evaluation of a transition program for young people with cystic fibrosis. Study group and methods: A self-administered questionnaire was completed by a group of 'pre-transition' adolescents and their parents who had not moved on to adult health care and a 'post-transition' group who had moved on from the Children's Hospital at Westmead over a six year period. The questionnaire examined patient and parent concerns about adult health care, participation in steps of the transition process, satisfaction with transition and health related quality of life. Measures of disease severity (lung function tests and body mass index) were also included. RESULTS: 137 out of 220 (62%) eligible participants completed the questionnaire. In the pre-transition group, parents had more concerns compared to young people. There was no evidence of a significant difference between pre-transition and post-transition young people regarding degree of concern. Most people were satisfied with the transition program and posttransition patients and parents who completed more steps in the transition program described the overall transition process more positively. There was no evidence of a relationship between amount of participation in transition and measures of disease severity or quality of life.     

Interactive television for an urban adult mental health service: the Guy's Psychiatric Intensive Care Unit Telepsychiatry Project

We carried out a feasibility study of an interactive television (IATV) system to enhance the provision of psychiatric intensive care services to a remote adult acute psychiatric ward in the same National Health Service mental health trust. The system used videoconferencing equipment connected by ISDN at 128 kbit/s. The system was used for patient referral, assessment and monitoring by staff at the remote site 8 km away.     

卫生项目政策简报撰写的方法与技巧:以中英全球卫生支持项目(GHSP)为例

卫生项目是开展国际卫生合作、落实一国卫生发展目标、任务的重要载体和平台,在推进全球卫生战略、深化医药卫生体制改革中发挥着重要的作用。政策简报是一种相对较新的为决策人员提供打包研究证据的工具,能够实现快速传递信息、交流经验、促进实施等目的。本文以中英全球卫生支持项目(Global Health Support Program,GHSP)为例,就卫生项目政策简报的功能特点、撰写要求、写作技巧等进行阐述,以帮助各级卫生管理人员掌握政策简报撰写的一般程序和方法,促进政策简报这一有效工具在我国医药卫生各领域得到更好的应用和发展。