Building Economic Security Today: Making the Health–Wealth Connection in Contra Costa County’s Maternal and Child Health Programs

In recent years, maternal and child health professionals have been seeking approaches to integrating the Life Course Perspective and social determinants of health into their work. In this article, we describe how community input, staff feedback, and evidence from the field that the connection between wealth and health should be addressed compelled the Contra Costa Family, Maternal and Child Health (FMCH) Programs Life Course Initiative to launch Building Economic Security Today (BEST). BEST utilizes innovative strategies to reduce inequities in health outcomes for low-income Contra Costa families by improving their financial security and stability. FMCH Programs’ Women, Infants, and Children Program (WIC) conducted BEST financial education classes, and its Medically Vulnerable Infant Program (MVIP) instituted BEST financial assessments during public health nurse home visits. Educational and referral resources were also developed and distributed to all clients. The classes at WIC increased clients’ awareness of financial issues and confidence that they could improve their financial situations. WIC clients and staff also gained knowledge about financial resources in the community. MVIP’s financial assessments offered clients a new and needed perspective on their financial situations, as well as support around the financial and psychological stresses of caring for a child with special health care needs. BEST offered FMCH Programs staff opportunities to engage in non-traditional, cross-sector partnerships, and gain new knowledge and skills to address a pressing social determinant of health. We learned the value of flexible timelines, maintaining a long view for creating change, and challenging the traditional paradigm of maternal and child health.     

Withdrawal from methadone maintenance treatment: prognosis and participant perspectives

OBJECTIVE: To determine the proportion of clients engaged in methadone maintenance treatment who have favourable prognosis for withdrawal, and to examine client perceptions and expectations of withdrawal. METHODS: A broad cross-section of 856 methadone clients was sampled across Melbourne, Sydney and Brisbane. Self-complete surveys were developed for the clients, their clinic staff or pharmacists, and methadone prescribers. The client survey examined aspects of the clients' perspectives of withdrawal, and the surveys for the service providers collected information about each client's current treatment episode. Informed consent was provided by clients to obtain information from their clinic staff member or pharmacist, and their methadone prescriber. RESULTS: Most clients (70%) were at least very interested in methadone withdrawal. Clients were also more optimistic about their own post-withdrawal outcomes (in terms of opioid use) than both their clinic staff and prescribing doctors. Clinical criteria indicated that 31% of clients had a reasonable prognosis for withdrawal. However, when considering all factors, 17% had good withdrawal prognosis, were interested in methadone withdrawal, and believed it was very likely they would remain opioid-free for three months post-withdrawal. CONCLUSIONS: Despite the likely continued increase in client numbers in substitution maintenance treatment, the majority of methadone clients have a poor prognosis for withdrawal and should not be encouraged to cease treatment. IMPLICATIONS: Clients who do not meet key clinical criteria are likely to have poor clinical outcomes regardless of how withdrawal is attempted.     

Health professionals' knowledge, practice and opinions about fetal alcohol syndrome and alcohol consumption in pregnancy

OBJECTIVE: To measure the knowledge, attitudes and practices of health professionals regarding fetal alcohol syndrome (FAS) and alcohol use during pregnancy. METHOD: A postal survey of a representative random sample of health professionals was conducted in Western Australia (WA) in 2002/03. 1,143 (79%) of 1,443 eligible health professionals completed the survey (87 Aboriginal Health Workers, 286 allied health professionals, 537 community nurses, 170 general practitioners and 63 obstetricians). RESULTS: Of 1,143 health professionals, 12% identified all four essential diagnostic features of FAS. Most (95%) had never diagnosed FAS. Although 82% believed that making a diagnosis of FAS might improve treatment plans and 85% agreed FAS was preventable, 53% said the diagnosis might be stigmatising. Only 2% felt very prepared to deal with FAS and most wanted information for themselves and their clients. Of the 659 health professionals caring for pregnant women, only 45% routinely ask about alcohol use in pregnancy, only 25% routinely provide information on the consequences of alcohol use in pregnancy and only 13% provide advice consistent with NHMRC guidelines on alcohol consumption in pregnancy. CONCLUSION: Health professionals have identified the need for educational materials for themselves and their clients. IMPLICATIONS: FAS is likely to be under-ascertained in Australia due to a lack of knowledge of FAS by health professionals. Until this lack of knowledge is addressed, opportunities for diagnosis and prevention of FAS will be limited.     

An examination of the role of clinical psychology in meeting the needs of young disabled clients and their families/carers

This paper examines the views of clients with a physical disability, general practitioners and staff working in health and social work physical disability services about the needs of young disabled people. The most common area of disability seen by GPs was respiratory, followed by cardiac problems and stroke. With the exception of cardiac patients a third to over half of GPs felt that the needs of the identified groups were not being adequately met, in particular the needs of individuals with progressive neuromuscular problems. Over a quarter of clients felt that their needs were not being adequately met. Ninety-five percent of GPs and 100% of staff identified psychological needs of clients. For clients themselves, physical needs are ranked highest, with over 33 percent identifying psychological problems, 50 percent neuropsychological problems and 25 percent psychosexual difficulties as priority needs. In relation to carers, over 90 percent of GPs, 100% of staff and 50 percent of clients highlighted psychological needs. The majority of participants felt that clinical psychology had an important role to play in physical disability services. There was broad agreement on the areas of need which psychology would be seen to address. These were psychological needs, behavioural problems, neuropsychological problems and relationship/psychosexual difficulties. A high percentage of both staff and GPs also saw a role for clinical psychology in meeting the psychological, relationship and psychosexual needs of carers.     

The Practice of Compassion in Supervision in Residential Treatment Programs for Clients with Severe Mental Illness

ABSTRACT

Clinical supervision for residential care staff is essential and yet has rarely been studied. Drawing from the reflective practice tradition, we interviewed residential care supervisors about their clinical decision-making processes and analyzed the data qualitatively to identify common themes and distill their beliefs and reported practices. We found that supervisors prioritized a compassion-based model of supervision characterized by fostering staff self-care, developing staff's empathy and responsiveness to clients, helping staff with disappointments in their relationships with clients, accurately evaluating client progress, preserving safety, and nurturing teamwork. A supervisor's subjective experience of his caregiving of staff could be explained using a second-level analytic concept we termed a caregiving heuristic—one's beliefs, values, and guidelines for action as a caregiver—of which compassion was, for these supervisors, a foundational element. The supervisors envisioned compassion as a central means by which they could prevent compassion fatigue, develop their staff's caregiving heuristics, and improve job satisfaction and quality of client care.     

Factors influencing the willingness of community service organisation staff to provide smoking cessation support: a qualitative study

Objective : This study aimed to explore factors influencing community service organisation (CSO) staff members’ willingness to provide tobacco cessation support to clients experiencing disadvantage. Methods : Face‐to‐face semi‐structured interviews were conducted with 29 staff members from seven services in the alcohol and other drugs, homelessness, and mental health sectors in Western Australia. Results : The primary barriers to providing cessation support were believing that addressing smoking was not a priority relative to other issues, being a current smoker, and the lack of a formal tobacco cessation program within the organisation. Factors that appeared to be most influential in enabling the delivery of cessation support were organisational processes requiring staff to routinely ask clients about tobacco use, confidence to provide support, and being a past smoker. Conclusions : The introduction of organisational procedures that include routine cessation care should be of high priority in CSOs to help reduce smoking rates among clients. Staff may also benefit from receiving training in the provision of cessation support and education about the importance and feasibility of addressing smoking concurrently with other issues. Implications for public health : The results may inform future efforts to increase the delivery of cessation care to groups of people experiencing disadvantage and comorbidity.     

Barriers to the dissemination of four harm reduction strategies: a survey of addiction treatment providers in Ontario

A sample of service providers at addictions agencies' in Ontario were interviewed by telephone to assess attitudes toward, anticipated internal and external barriers to implementing, and expected benefits of four harm reduction strategies: needle exchange, moderate drinking goals, methadone treatment, and provision of free condoms to clients. Respondents were also asked to define harm reduction, list its most important elements, and describe what they find most troubling and most appealing about harm reduction. Attitudes toward harm reduction in general and the services provided at each agency were also assessed. Results indicated that the service providers surveyed had positive attitudes toward each of the four harm reduction strategies and harm reduction in general, and the majority of respondents were aware of the benefits associated with each strategy. Almost all of the agencies surveyed allowed for moderate drinking outcomes in the treatment of alcohol problems, and most agencies provided free condoms to clients. In terms of barriers, anticipated negative community reaction to needle exchange, methadone treatment, and free condoms was a major concern for the majority of respondents. Lack of staff, of funding, or anticipated staff resistance were also cited as potential barriers to introducing these strategies. In the case of methadone maintenance, the unavailability of a qualified physician was listed as the primary constraint. Implications for future efforts directed at encouraging the adoption of these strategies and suggestions for future research are discussed.     

Evaluation of patients'' knowledge about anticoagulant treatment.

OBJECTIVE--To develop a questionnaire to evaluate patients' knowledge of anticoagulation. DESIGN--Anonymous self completed questionnaire study based on hospital anticoagulant guidelines. SETTING--Anticoagulant clinic in a 580 bed district general hospital in London. SUBJECTS--70 consecutive patients newly referred to the anticoagulant clinic over six months. MAIN MEASURES--Information received by patients on six items of anticoagulation counselling (mode of action of warfarin, adverse effects of over or under anticoagulation, drugs to avoid, action if bleeding or bruising occurs, and alcohol consumption), the source of such information, and patients' knowledge about anticoagulation. RESULTS--Of the recruits, 36 (51%) were male; 38(54%) were aged below 46 years, 22(31%) 46-60, and 10(14%) over 75. 50 (71%) questionnaires were returned. In all, 40 respondents spoke English at home and six another language. Most patients reported being clearly advised on five of the six items, but knowledge about anticoagulation was poor. Few patients could correctly identify adverse conditions associated with poor control of anticoagulation: bleeding was identified by only 30(60%), bruising by 23(56%), and thrombosis by 18(36%). Only 26(52%) patients could identify an excessive level of alcohol consumption, and only seven (14%) could identify three or more self prescribed agents which may interfere with warfarin. CONCLUSION--The questionnaire provided a simple method of determining patients' knowledge of anticoagulation, and its results indicated that this requires improvement. IMPLICATIONS--Patients' responses suggested that advice was not always given by medical staff, and use of counselling checklists is recommended. Reinforcement of advice by non-medical counsellors and with educational guides such as posters or leaflets should be considered. Such initiatives are currently being evaluated in a repeat survey.     

A proposed intervention to improve knowledge of self-management of hypertension for Kenneth Young and C4 community mental health center staff in Cook County,Illinois

Purpose

Community mental health centers (CMHCs) provide psychiatric services and link Medicaid clients/members to both primary and specialty care within the community for people with serious mental illness (SMI), such as major depressive disorder, schizophrenia, and bipolar disorder. CMHCs help transition patients safely into the community from nursing facilities and rehabilitation centers. Patients diagnosed with an SMI have a higher incidence of cardiovascular diseases (CVDs), such as hypertension, and need management in the community to prevent further complications. CMHC staff lack knowledge to help their clients to manage medical conditions in the community, which can worsen hypertension management, potentially leading to complications for this population.

Methods

The conceptual framework used to guide this project is the health belief model. The planning model used to guide the intervention is the PRECEDE-PROCEED model. Twenty-two staff from two CMHCs participated in a one-hour educational session on hypertension management and accurate blood pressure demonstration, with pre and post session measures of hypertension knowledge and blood pressure skills checklist. Staff were re-evaluated for hypertension and blood pressure monitoring skills 8 weeks from the implementation of the intervention with a 30-min booster session, completing an additional post intervention hypertension knowledge questionnaire and blood pressure skills checklist. A hypertension management tool was developed for staff to use as a resource in the community for clients with hypertension. The tool covered accurate blood pressure measurement and documentation, red flag symptoms, medication, and physician appointment adherence.

Results

Ordinal data were evaluated from the Likert scale to compare the percentage score from baseline to post intervention measuring hypertension knowledge. Twenty-two staff participated from both agencies, comprising 17 females and 5 males, of which 38% had their Bachelors of Science degree and 62% had their Master’s degree. The pre and post assessment of knowledge increased by 33% from baseline after the intervention. Nominal data were used to collect responses from staff based on pre and post intervention blood pressure demonstration checklist and to capture staff attendance through the sign-in sheets at the intervention training. The results showed an improvement of 133% from baseline with the blood pressure demonstration checklist after the intervention and demonstration. There was a 14% decrease of blood pressure skills checklist at the 8-week booster session compared to the post intervention results.

Implications

The recommendations based on this project include addressing content missed from the knowledge test and the blood pressure skills checklist in the booster session, and reviewing the hypertension management information resource tool. Continually monitoring the use of the resource tools and incorporating booster sessions with the agencies can address any gaps in hypertension knowledge and changing guidelines in hypertension management. Recommendations to stakeholders of the agencies will include budgeting for training resources and participation incentives, monitoring sustainability of the intervention with use of the sustainability tool, and long-term monitoring of the impact of the intervention tool on blood pressure management outcomes in clients.

     

Attitudes to the use of videoconferencing in general and specialist psychiatric services

Mental health professionals and support staff were invited to complete a questionnaire about their experience of using videoconferencing. Our hypotheses were that mental health professionals in the UK do not have access to videoconferencing and do not believe that videoconferencing is appropriate for their work. Of the 134 people who completed and returned a questionnaire, 78 worked in deaf mental health services and 56 worked in general mental health services. The majority were nurses (n = 33) or psychologists (n = 30). A total of 109 respondents (81%) knew what videoconferencing was, but only 16 respondents (12%) had ever used it. The majority of the 32 respondents who knew the location of their nearest videoconferencing facility said that it could be accessed in less than 30 min. The 16 people who had previously used videoconferencing identified four different benefits of videoconferencing and eight different drawbacks. We conclude that mental health staff did not have adequate knowledge of, or access to, videoconferencing.     

The use of email in a child and adolescent mental health service: are staff ready?

All staff members of a child and adolescent mental health service were invited to participate in a survey about the use of email. Sixty-two of the 105 staff members responded to the survey, a participation rate of 59%. Of the respondents, 32 were allied health staff, 10 were nurses, seven were administrative staff, six were medical staff, three were operational staff and four were acting in a combination of these roles. The respondents reported extensive work-related email usage and considered that they were confident in using email despite low levels of training. However, they did not feel that they understood the legal and ethical issues involved. Furthermore, there was limited incorporation of email into standard record keeping. The majority of respondents thought that increased use of email would lead to a greater workload, a consequence they considered would probably increase over time. Many commented on the quick and practical use of this medium, but were wary about using email with individuals outside the service organization, especially if it were to contain clinical material. There was low use of email directly with clients, and clinicians were ambivalent about incorporating email into therapy. The results suggest that it is timely to consider the utility and appropriateness of email communication with clients and external service providers, and to formulate guidelines and procedures to ensure the confidentiality of client information and the safety of clients and staff.     

Community care staff attitudes towards delivering a falls prevention exercise intervention to community care clients

Millions of older people world-wide receive community care services in their home to assist them to live independently. These services often include personal care, domestic assistance and social support which are delivered by non-university trained staff, and are frequently long term. Older people receiving community care services fall 50% more often than individuals of similar age not receiving services. Yet, few ongoing community care services include exercise programs to reduce falls in this population. We conducted an earlier study to examine the feasibility of community care staff delivering a falls prevention program. A critical finding was that while some of the assessment and support staff responsible for service delivery delivered the falls prevention exercise program to one or two clients, others delivered to none. Therefore, the aim of this qualitative sub-study was to understand reasons for this variation. Semi-structured interviews were conducted with 25 participating support staff and assessors from 10 community care organisations. Staff who had successfully delivered the intervention to their clients perceived themselves as capable and that it would benefit their clients. Older clients who were positive, motivated and wanted to improve were perceived to be more likely to participate. Staff who had worked at their organisation for at least 5 years were also more likely to deliver the program compared to those that had only worked up to 2 years. Staff that did not deliver the intervention to anyone were more risk averse, did not feel confident enough to deliver the program and perceived their clients as not suitable due to age and frailty. Experienced staff who are confident and have positive ageing attitudes are most likely to deliver falls prevention programs in a home care organisation.     

Promoting uptake of the HPV vaccine: the knowledge and views of school staff

BACKGROUND: School‐based human papillomavirus (HPV)/cervical cancer vaccination programs have been implemented widely, but few studies have investigated the knowledge and views of school staff about this new vaccine. METHODS: Prior to the introduction of the HPV vaccine in 2009, we surveyed staff at 14 socioeconomically diverse schools to assess views toward this new program, including staff's information needs, ideas on promoting return of consent forms, and uptake of the vaccine among minority groups. RESULTS: Of 583 invited staff, 456 participated (78%). About 58% of the participants knew about the link between HPV and cervical cancer, and that HPV is passed on during sexual contact. When asked if vaccination would increase sexual activity at a younger age, 71% disagreed, 6% agreed, and 23% were unsure. The majority of staff agreed that vaccine uptake could be improved through provision of information and consent forms in indigenous and Pacific languages; ensuring parents are well informed and girls educated about the vaccine; involving community groups and by extending availability of the vaccine into community settings as well as school and primary care. Three fourths of the staff surveyed wanted more information about the program before and during its implementation. CONCLUSIONS: This important group of stakeholders requires appropriate information so that they can support girls and their parents in deciding whether to have the vaccine. School staff members are potential health advocates with whom consultation should occur before and during the implementation of such programs.     

Joanna Briggs Collaboration Aged Care Fellowship Project: implementing a smoking cessation program in a young, frail aged residential care facility

Background The subject site (Ian George Court) caters for clients from a socially disadvantaged background. All clients have been homeless or at risk of homelessness and have a history of alcohol and substance abuse often linked to mental health issues. This project was developed to examine if the site provided best practice in the promotion of smoking cessation. Objectives The first objective of this project was to improve client knowledge to make informed choice about smoking cessation, ensuring that client advice was given in line with best available evidence and assist the client in accessing community programs. The second objective was to fully review the current assessment tool used in relation to gathering baseline data about smoking habits and act on the information provided. Search strategy The search strategy sought to find published studies and papers. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of the text words contained in the title and abstract. A second extensive search was then undertaken using all identified keywords. Conclusion A smoking assessment tool was developed and is now in use across all Anglicare sites in South Australia. This provides staff with consistent baseline information and offers evidence-based health care in a package format to aid clients in smoking cessation.     

HIV related knowledge and prevention among Thai female commercial sex workers in Japan

A survey of 87 Thai female commercial sex workers (TCSW) was conducted in Tokyo and surrounding areas to investigate their: 1) living conditions, 2) knowledge about HIV/AIDS and sources of information, and 3) working conditions and dealings with clients. Data were mainly collected by “snowballing” with semi-structured interviews. The results showed a majority of participants knew HIV could be contracted through sexual intercourse and that condom use could protect against HIV infection. However, some TCSW reported failing to use condoms despite having requested clients to do so. Reasons for client compliance with condom use were discussed. Although a majority of the participants underwent HIV testing at least once every 3 months, they did not learn much about HIV prevention through public information and education. The results suggest that workers and clients need more detailed information concerning HIV prevention as well as a greater accessibility.     

HIV-related services for persons with severe mental illness: Policy and practice in new hampshire community mental health

Rates of HIV and HIV risk behaviors are elevated among people with severe mental illnesses (SMI). Little is known about the extent to which community mental health (CMH) centers screen, refer, and educate their clients regarding HIV and sexually transmitted diseases (STDs). The authors surveyed CMH administrators and clinicians in New Hampshire regarding HIV/STD policy, practices, knowledge, and attitudes. HIV/STD service availability varied, and the amount of services provided was unrelated to the prevalence of HIV and AIDS in that region. Clinicians were knowledgeable about general HIV information but lacked specific knowledge about HIV related to persons with SMI. CMH staff had positive attitudes about helping clients with HIV issues. Administrators were interested in receiving training. Policy leadership, CMH practice guidelines, and training are warranted in light of the pressing public health implications of HIV/STDs among people with SMI.     

上海市预防接种工作人员疑似预防接种异常反应监测认知和报告影响因素

目的了解上海市预防接种工作人员疑似预防接种异常反应(Adverse events following immunization,AEFI)监测的知识和态度以及影响AEFI报告的因素。方法采用方便抽样在上海市所有459个预防接种门诊选择预防接种工作人员开展问卷调查,分析AEFI监测知识得分(满分6分)和态度,采用多因素Logistic回归分析AEFI报告的影响因素。结果1379名调查对象的AEFI监测知识平均得分为3.30±1.31分;认为开展AEFI监测有必要、报告AEFI是自身职责、AEFI监测是额外工作负担的调查对象分别占98.84%、92.75%、30.38%。69.62%的调查对象近1年报告过AEFI;社区接种门诊、免疫规划专职人员、近1年接受过AEFI培训、AEFI监测知识得分高的调查对象报告AEFI的比例高[OR(95%CI):19.55(14.16-26.98)、1.95(1.45-2.64)、3.14(1.76-5.59)、1.91(1.38-2.63)]。结论上海市预防接种工作人员AEFI监测知识水平不高,对AEFI监测存在一定认识误区;需加强AEFI监测培训,进一步提高其AEFI报告意识。     

Pharmacy provision of medical abortifacients in a Latin American city

PURPOSE: Access to legal abortion services is restricted in Latin America. Nonetheless, previous research suggest that women frequently use misoprostol to self-induce abortion. In many settings, women obtain the medication from a pharmacy. This study was conducted to better understand pharmacy staff knowledge and provision practices of misoprostol and other medical abortifacients. METHODS: We first interviewed staff at a random sample of 102 pharmacies in a Latin American city. Mystery clients were subsequently sent to the same pharmacies to ascertain prescribing practices and counseling. RESULTS: Nearly half of the pharmacy staff interviewed reported that they were familiar with at least one abortifacient, and an abortifacient was recommended in 74% of the mystery client encounters. Hormonal injections were most frequently recommended as abortifacients in the survey (67%) and the mystery client encounters (71%), followed by misoprostol (60% and 39%, respectively). Few of the pharmacy staff (6% in the survey and 17% in the mystery client encounters) recommended a misoprostol dosing regimen that is potentially effective. CONCLUSION: Abortifacient provision is common at pharmacies but knowledge about medications is low among pharmacy staff.     

Children with Special Health Care Needs Program: Urban/Rural Comparisons

The purposes of this study were to: (1) describe both the urban and rural clients who received services from the Indiana Children with Special Health Care Needs program (CSHCN) including both demographic and clinical characteristics; (2) conduct a health care needs assessment of the CSHCN program clients in both urban and rural areas; and (3) measure the perceived quality and adequacy of the CSHCN program services. A survey instrument was developed and mailed to all 6,459 families who participated in the Indiana CSHCN program from July 1, 1990 to June 30, 1991. Of the 2,722 questionnaires used in the analysis, 1,624 clients (59.7%) resided in urban counties and 1,098 (40.3%) resided in rural counties. The most frequently noted conditions for program eligibility were asthma, ear infections, hearing impairments, heart defects, and convulsions and seizures. Asthma had greater prevalence among the urban clients while cleft lip/palate, epilepsy, and heart defects were more common among the rural clients. The majority of program clients perceived their medical needs as being met. However, significant numbers of clients perceived unmet needs for mental health services, support groups, information about community services, resources to pay for uncovered medical expenses, and respite care. Of the 23 listed services, five were reported at significantly lower rates by rural clients as not being met: regular medical care, recreation, child care/day care, parent support group services, and speech therapy. Quality of medical services was generally perceived as being "excellent or good," while services related to information about community programs, child's rights in school, resources available to pay for uncovered medical expenses, as well as communication between the treatment center and the child's school were more often rated as "fair or poor." A smaller proportion of rural clients rated physician care and availability of staff nurses as fair or poor. A larger percentage of the rural group reported that access to treatment center location was fair or poor, compared to the urban group. Overall, the evaluation of the Indiana CSHCN program has shown that the non-medical care component seems to be in need of change, especially in the area of information and communication. Attention needs to be focused on providing more family support such as respite or child care and support groups, better information and communications, and improved availability of mental health services to better enable the CSHCN program to meet its objectives.