Cost estimation of a health-check intervention for adults with intellectual disabilities in the UK

Background   High rates of health needs among adults with intellectual disabilities flag the need for information about the economic consequences of strategies to identify and address unmet needs. Health-check interventions are one such strategy, and have been demonstrated to effect health gains over the following 12-month period. However, little is known about their effects on service use and costs, and hence how affordable such interventions are.
Methods   We examined service use patterns and costs over a 12-month period for 50 adult participants with intellectual disabilities who received a health-check intervention and 50 individually matched control participants who received standard care only.
Results   The health-check intervention was cheap, and it did not have associated higher costs in terms of service usage. Indeed, mean cost of care for the adults who received standard care only was greater than for the adults who received the health-check intervention. The higher costs were due to differences in unpaid carer support costs.
Conclusion   This is the first study to report the associated service use, and costs of a health-check intervention to improve the health of adults with intellectual disabilities and reduce health inequalities. Results suggest this intervention is cheap and affordable compared with standard care, supporting clinical outcome evidence for its introduction into health care policy and implementation. However, further research is needed to confirm this finding with a larger sample.     

Early intervention for psychosis in Hong Kong – the EASY programme

Aim: This article aims to describe the Hong Kong experience in developing and implementing an early psychosis programme. Methods: In 2001, the Early Assessment Service for Young People with Psychosis programme was launched in Hong Kong, providing both educational and service components. Public education includes promotion of timely help-seeking, accessible channels to service and knowledge of psychosis. The 2-year phase-specific intervention includes intensive medical follow-up and individualized psychosocial intervention. The programme has adopted the case-management approach, in which case managers provide protocol-based psychosocial intervention. The programme collaborates with non-governmental organizations and community networks in the provision of rehabilitation service. Results: An average of over 600 young patients enter the programme for intensive treatment each year. Based on preliminary data from a 3-year outcome study, patients in the programme have remarkable reductions in hospital stay accompanied by improvements in vocational functioning. Conclusions: The results suggested that the programme improved patients' outcome. Additional costs such as extra medical staff and medications may be offset by the shortened hospital stay. Further directions in early intervention are also discussed.     

Cost-effectiveness of an Internet-based aftercare intervention after inpatient treatment in a psychosomatic hospital

Abstract

Objective: The implementation of new interventions into routine care requires the demonstration of both their effectiveness and cost-effectiveness. Method: We explored the cost-effectiveness of an Internet-based aftercare program in addition to treatment as usual (CHAT) which was compared to treatment as usual (TAU) following inpatient treatment. Incremental cost-effectiveness ratios were calculated based on cost of the intervention, cost of outpatient treatment, and remission rates within 1 year after discharge from hospital. Results: Assuming a willingness-to-pay of an additional 14.87 € per treatment for every additional percent of remission, CHAT was cost-effective against TAU at a 95% level of certainty. Cost per remission equaled 2664.84 € in TAU and 1752.75 € in CHAT (34.2% savings). Conclusions: This is the first evidence that Internet-based aftercare may enhance long-term treatment outcome in a cost-effective way.     

地震灾区青少年心身健康分析及其干预性研究

目的探讨汶川地震灾区青少年心身健康特点及影响因素,并观察干预效果。方法采用随机整群取样法,对867名地震灾区青少年(研究组)和1016名非地震灾区青少年(对照组)使用简易心身健康调查表进行测试,对研究组有心身障碍者进行针对性心理和药物干预。结果研究组心理因子分、躯体因子分、躯体总分、心理总分及心身总分均显著高于对照组(P<0.01)。研究组女生在神经症状、焦虑状态、行为状态、其他情况、心理总分及心身总分上明显高于男生(P<0.01～0.05);高年龄段在骨骼肌肉症状、呼吸症状、心血管症状、神经症状、生殖泌尿症状、情绪状态、焦虑状态、行为状态、情感状态、其他情况、躯体总分、心理总分及心身总分上明显高于低年龄段(P<0.01～0.05)。研究组躯体症状与心理症状紧密相关(r为0.16～0.49,P<0.01);影响研究组心理总分的主要因素是年龄,其次是心理承受力;睡眠状态、年龄、行为状态则是躯体总分的主要影响因素。针对性心理和药物干预能有效缓解心身障碍者的心理和躯体症状。结论地震灾难对青少年心身健康损害明显,心理和药物干预效果明显。     

情感表达对农村社区精神分裂症患者预后的影响

目的探讨情感表达对农村社区精神分裂症患者预后的影响。方法将符合入组标准的300例农村社区精神分裂症患者分为研究组和对照组(每组各150例)。两组均服小剂量抗精神病药(折合氯丙嗪剂量<300mg/d),其中研究组同时接受家庭成员的情感表达干预;于入组时和随访时每年评定1次坎伯威家庭问卷(CFI)中文版(CFICV)、简明精神病评定量表(BPRS)、疾病严重程度量表(SI)、疾病总体进步量表(GI),连续3年共评定4次。结果(1)入组时研究组和对照组相比,CFICV、BPRS、SI、GI评分的差异均无显著性(P>0.05)。(2)干预1～3年时,研究组家属的批评、敌对和情感参与等因子分低于对照组(P<0.01～0.05),热情性、赞扬性等因子分高于对照组(P<0.01～0.05)。(3)干预1～3年时,研究组BPRS、SI、GI评分均低于对照组,差异均有显著性(P<0.01)。结论对农村社区精神分裂症患者家庭成员情感表达方式的干预,能有效降低患者的复发率。     

Matryoshka Project: lessons learned about early intervention in psychosis programme development

Aim: This part of the Matryoshka project sought to understand the processes with which early intervention in psychosis (EIP) programmes were implemented and developed. The goals were to understand the key influences of programme implementation in the context of rapid EIP service growth and lack of specific provincial guidelines. Methods: Sampling was purposive and data were collected with semi‐structured interviews. Five Matryoshka Project programmes were successfully contacted. All interviews were conducted by phone, recorded and transcribed verbatim. Emerging themes were analysed iteratively and discussed among authors. Key themes were validated with participants. Results: The new EIP services were significantly influenced by the provincial EIP network, advocacy groups and clinical mentors. EIP programme decision makers often relied on each other for guidance. Although the research evidence assisted programme decision makers to develop an effective EIP model for their region, implementation was often shaped by funding constraints. Programmes adapted their EIP models according to funding and local service characteristics. The lack of specific guidelines may have allowed innovation; programme creativity and diversity is consistent with EIP values. Despite the challenges related to geography and staffing, programmes experienced important successes such as partnerships across sectors, quality clinical service and the ability to engage hard‐to‐serve clientele. Conclusions: Although important, research evidence played only a secondary role. Relationships among providers and services, coupled with the dedication of front‐line staff, were more critical to knowledge exchange than written documents alone. These findings stress the importance of researcher–front‐line relationships to the adoption of evidence‐informed practice.     

心理干预对云南苦聪族人心理健康的影响

目的：探讨心理干预对苦聪族人心理健康的影响。方法：对679名云南省普洱市镇沅县苦聪族居民进行横断面调查,并随机分成研究组340人（给予心理干预）和对照组339人（不给予心理干预）,采用症状自评量表（SCL-90）于干预前和干预后1个月进行测评。结果：干预前研究组和对照组SCL-90总分平均分别为（58.14±38.45）分和（51.84±25.11）分（t=0.68,P〉0.05）,干预后研究组和对照组SCL-90总分平均分别为（32.84±25.11）分和（58.14±38.45）分（t=2.68,P〈0.01）;研究组除人际关系和敌对因子分外其他因子分均显著低于对照组（P〈0.01）。结论：心理干预可以显著提高苦聪族人的心理健康水平。     

Effectiveness of a brief stress management intervention in male college students

1 Purpose

This study aimed to examine the effects of a brief stress management intervention on depression, anxiety, suicidal ideation, and aggression among Korean male college students.

2 Design and Methods

In a repeated measures design, participants were assessed before, immediately after, and 3 months after the intervention. Data of 40 experimental and 32 control participants were analyzed using linear mixed models.

3 Findings

There were significant time‐by‐group interaction effects for depression and trait anxiety, but not for state anxiety, suicidal ideation, and aggression.

4 Practice Implications

The intervention has long‐term effects for depression and trait anxiety. Future research should involve a randomized controlled trial on a larger scale.     

综合干预对农村精神分裂症患者预后的影响

目的 探讨生物-心理-社会综合干预对农村社区精神分裂症患者预后的影响。方法 将符合入组标准的300例农村社区精神分裂症患者分为干撷组和对照组(每组各150例)。两组均服小剂量抗精神病药(折合氯丙嗪剂量为<300 mg/d),其中干预组同时接受生物-心理-社会综合干预及个案管理;于入组时和随访每半年时评定1次社会功能缺陷筛选量表(SDSS)、简明精神病评定量表(BPRS)、疾病严重程度量表(SI)、疾病总体进步量表(GI),3年共7次。结果 (1)入组时干预组与对照组相比,BPRS、SI、GI、SDSS评分的差异均无显著性(P>0.05);(2)综合干预1年时,干预组各量表的评分均低于对照组,差异有显著性(均P<0.01),并持续到随访结束。(3)随访结束时,干预组在掌握精神卫生知识、规律就医、接受精神科治疗、恢复工作能力等方面均好于对照组(均P<0.01)。结论 生物-心理-社会综合干预使农村社区精神分裂症患者的复发率明显降低。     

A Japanese perspective on crisis intervention

Abstract This paper describes the author's therapeutic team's general rules for crisis intervention that have been built up by gaining experience in therapy and crisis intervention for 'difficult cases to treat'. It discusses how the author's therapeutic team actually intervenes in the crisis, building a relationship as quickly as possible with the patient and/or family, and providing follow-up treatment with the family and others involved in the crisis. The paper then outlines recent trends in Japanese crisis intervention in comparison with the Western system of psychiatric emergency services. Finally, the paper concludes the necessity of establishing comprehensive and on-going community-care in order for a psychiatric emergency system to become successful in Japan.     

Project Connect: A community intervention for individuals with mental illness

ABSTRACT

Connection to community and a sense of belonging have been recognized as critical components of mental health recovery. However, few interventions that stress the importance of making community connections based on self-determination and personal interests have been developed. This article describes Project Connect, an innovative intervention through which people with mental illness can access support to make community connections on their own terms. It provides background on the design and implementation of the project, its connection to community organizing approaches, and initial findings.     

The outcomes of an intervention study to reduce the barriers experienced by people with intellectual disabilities accessing primary health care services

Background People with intellectual disabilities (IDs) experience significant health inequalities compared with the general population. The barriers people with IDs experience in accessing services contribute to these health inequalities. Professionals’ significant unmet training needs are an important barrier to people with IDs accessing appropriate services to meet their health needs. Method A three group, pre‐ and post‐intervention design was used to test the hypothesis that a training intervention for primary health care professionals would increase the knowledge and self‐efficacy of participants. The intervention had two components – a written training pack and a 3‐hour face‐to‐face training event. One group received the training pack and attended the training event, a second group received the training pack only, and a third group did not participate in the training intervention. Research measures were taken prior to the intervention and 3 months after the intervention. Statistical comparisons were made between the three groups. Results The participants in the training intervention reported that it had a positive impact upon their knowledge, skills and clinical practice. As a result of the intervention, 35 (81.4%) respondents agreed that they were more able to meet the needs of their clients with IDs, and 33 (66.6%) reported that they had made changes to their clinical practice. The research demonstrated that the intervention produced a statistically significant increase in the knowledge of participants (F = 5.6, P = 0.005), compared with the group that did not participate in the intervention. The self‐efficacy of the participants that received both components of the intervention was significantly greater than the group that did not participate in the training (t = 2.079, P = 0.04). Participation in the two components of the training intervention was associated with significantly greater change in knowledge and self‐efficacy than those receiving the training pack alone. Conclusion This intervention was effective in addressing the measured training needs of primary health care professionals. Future research should directly evaluate the positive benefits of interventions on the lives of people with IDs.     

Recruitment and consent of women with intellectual disabilities in a randomised control trial of a health promotion intervention

Background The need for evidence‐based health promotion interventions for women with intellectual and developmental disabilities is critical. However, significant barriers impede them from participating in research, including those related to recruitment and obtaining informed consent. Methods This study describes a procedure for the recruitment and consent of women with intellectual disabilities into a community‐based, multi‐site randomised controlled trial. Results Of 269 women who participated in information sessions, 203 (75%) enrolled in the study. While women with and without legal guardians consented at the same approximate rates (83% and 85%, respectively), those with legal guardians enrolled at significantly lower rates (61%) because of lower rates (74%) of guardian consent. Conclusions It is possible to recruit community‐dwelling women with intellectual disabilities into randomised controlled trials at relatively high participation rates. Recruiting women who have guardians poses additional challenges for researchers.     

综合干预对城乡重点中学学生心理健康的影响

目的探讨心理-社会综合方法对城乡重点中学学生心理健康的干预效果。方法以整群抽样的方法,从城市、农村两所重点中学初一年级选取8个班为研究对象,随机选取4个班(城乡各2个班)为实验组,4个班(城乡各2个班)为对照组。对实验组进行为期3年的心理社会干预,对照组为空白对照,干预前后分别应用中学生心理健康调查表、父母养育方式量表、EPQ儿童版进行测查。结果实验组经过3年的心理社会综合干预,心理健康水平明显提高,而对照组则明显下降。从心理健康总体来看,城乡间学生无差异。结论心理社会综合干预能有效提高城乡重点中学学生的心理健康水平。     

Pattern of therapeutic intervention and role of psychiatric settings: a survey in two regions of Italy

A survey of therapeutic intervention was conducted on 1513 patients treated in different psychiatric settings-psychiatric hospitals (PH), private facilities (PF), community mental health centers (CMHC) and psychiatric wards in general hospitals (PWGH). Psychotropic drugs, mainly neuroleptics and benzodiazepines, were widely prescribed irrespective of diagnosis, and 39% of patients treated with neuroleptics received two or more drugs. Psychotherapeutic intervention and social measures were administered in 21% and 20% of cases respectively, and 17% of patients received no treatment. The observed distribution of treatments over settings was compared with the expected one under the hypothesis that the two factors were independent. Differences between settings in therapeutic strategies, after adjustment for possible confounders (sex, age, education, diagnosis) were: no specific treatment was more than expected in PH and largely below unity in PF and PWGH, where treatment with psychotropic drugs alone was overrepresented; CMHC showed the most balanced therapeutic approach.