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Daniel Goldstone Jason Bantjes Lisa Dannatt 《Substance abuse treatment, prevention, and policy》2018,13(1):47
Background
People with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. Expert consensus is that suicide prevention strategies should be culturally sensitive and specific to particular populations and socio-cultural and economic contexts. The aim of this study was to explore mental health care providers' context- and population-specific suggestions for suicide prevention when providing services for PWSUDs in the Western Cape, South Africa.Methods
Qualitative data were collected via in-depth, semi-structured interviews with 18 mental health care providers providing services to PWSUDs in the public and private health care sectors of the Western Cape, South Africa. Data were analysed inductively using thematic analysis.Results
Participants highlighted the importance of providing effective mental health care, transforming the mental health care system, community interventions, and early intervention, in order to prevent suicide amongst PWSUDs. Many of their suggestions reflected basic principles of effective mental health care provision. However, participants also suggested further training in suicide prevention for mental health care providers, optimising the use of existing health care resources, expanding service provision for suicidal PWSUDs, improving policies and regulations for the treatment of substance use disorders, provision of integrated health care, and focusing on early intervention to prevent suicide.Conclusions
Training mental health care providers in suicide prevention must be augmented by addressing systemic problems in the provision of mental health care and contextual problems that make suicide prevention challenging. Many of the suggestions offered by these participants depart from individualist, biomedical approaches to suicide prevention to include a more contextual view of suicide prevention. A re-thinking of traditional bio-medical approaches to suicide prevention may be warranted in order to reduce suicide among PWSUDs.4.
Meliha Salahuddin Sarah E. Barlow Stephen J. Pont Nancy F. Butte Deanna M. Hoelscher 《BMC family practice》2018,19(1):191
Background
The Texas Childhood Obesity Research Demonstration study was an integrated, systems-oriented intervention that incorporated primary and secondary obesity prevention approaches targeting multiple sectors, including primary care clinics, to address childhood obesity. The primary care clinic component included the American Academy of Pediatrics’ Next Steps weight management counseling materials that support brief healthy lifestyle-focused visits. The current study describes the methodology and assesses the implementation of the Next Steps program in the participating primary care clinics, as well as the association of implementation with enrollment of children with overweight and obesity in the secondary prevention intervention.Methods
The study used a serial cross-sectional study design to collect data from 11 primary care clinics in Houston (n?=?5) and Austin (n?=?6), Texas, in 2013–2014. Responses of primary care providers on 42 self-reported survey questions assessing acceptability, adoption, appropriateness, and feasibility of the program were utilized to create a mean standardized clinic implementation index score. Provider scores were aggregated to represent Next Steps implementation scores at the clinic level. A mixed effects logistic regression test was conducted to determine the association between program implementation and the enrollment of children in the secondary prevention.Results
Mean implementation index score was lower at Year 2 of implementation (2014) than Year 1 (2013) although the decrease was not significant [63.2% (12.2%) in 2013 vs. 55.3% (16.5%) in 2014]. There were no significant associations between levels of implementation of Next Steps and enrollment into TX CORD secondary prevention study.Conclusions
The development of an index using process evaluation measures can be used to assess the implementation and evaluation of provider-based obesity prevention tools in primary care clinics.5.
Erika Berggren Y. Orrevall A. Ödlund Olin P. Strang R. Szulkin L. Törnkvist 《The journal of nutrition, health & aging》2016,20(4):428-438
Objective
Evaluate the effectiveness of a continuing educational intervention on primary health care professionals’ familiarity with information important to nutritional care in a palliative phase, their collaboration with other caregivers, and their level of knowledge about important aspects of nutritional care.Design
Observational cohort study.Setting
10 primary health care centers in Stockholm County, Sweden.Participants
140 district nurses/registered nurses and general practitioners/physicians working with home care.Intervention
87 professionals participated in the intervention group (IG) and 53 in the control group (CG). The intervention consisted of a web-based program offering factual knowledge; a practical exercise linking existing and new knowledge, abilities, and skills; and a case seminar facilitating reflection.Measurements
The intervention’s effects were measured by a computer-based study-specific questionnaire before and after the intervention, which took approximately 1 month. The CG completed the questionnaire twice (1 month between response occasions). The intervention effects, odds ratios, were estimated by an ordinal logistic regression.Results
In the intra-group analyses, statistically significant changes occurred in the IG’s responses to 28 of 32 items and the CG’s responses to 4 of 32 items. In the inter-group analyses, statistically significant effects occurred in 20 of 32 statements: all 14 statements that assessed familiarity with important concepts and all 4 statements about collaboration with other caregivers but only 2 of the 14 statements concerning level of knowledge. The intervention effect varied between 2.5 and 12.0.Conclusion
The intervention was effective in increasing familiarity with information important to nutritional care in a palliative phase and collaboration with other caregivers, both of which may create prerequisites for better nutritional care. However, the intervention needs to be revised to better increase the professionals’ level of knowledge about important aspects of nutritional care.6.
Shamra Boel-Studt Lisa Schelbe Megan Deichen Hansen Lauren Tobia 《Child & youth care forum》2018,47(6):863-880
Background
Lack of engagement in child welfare services is a salient issue impeding client outcomes. Research findings indicate that providing incentives may be a promising strategy for enhancing client engagement.Objective
In response to low youth engagement and repeated re-entry into care, a Southeastern child welfare agency developed an incentive program aimed at increasing youths’ participation and success in meeting treatment goals. This mixed methods study examined elements of effective implementation and the effectiveness of the incentive program piloted in a group home serving adolescent boys (n?=?16).Method
A semi-structured focus group with service providers (n?=?7) was used to inform the development of the pilot incentive program. We used a time-series design to measure youth perceptions of the therapeutic alliance with their therapists and weekly goal attainment. Baseline data was collected for 6 weeks (phase one) followed by 6 weeks of the incentive program (phase two).Results
Results of qualitative analyses revealed four themes related to therapeutic engagement, and two themes related to intervention implementation. Providers emphasized the importance of youth-driven care and building a strong therapeutic alliance. Findings also suggest that staff buy-in is critical to the success of intervention implementation. These results, along with suggested strategies for effective implementation, informed the development of the piloted incentive program. Results of simulation modeling analyses of time series data showed significant increases in therapeutic alliances and goal attainment following the incentive program.Conclusions
This study provides preliminary support for the use of incentive programs to facilitate youth engagement in residential programs.7.
A.‑L. Bartsch M. Härter A. L. Brütt A. Buchholz 《Pr?vention und Gesundheitsf?rderung》2018,13(3):237-247
Background
The study “ENTER: Evaluation of a collaborative smoking cessation intervention” is a cluster-randomized controlled trial to assess the effectiveness of a smoking cessation intervention implemented in the German primary care setting in collaboration with AOK NORDWEST in Westphalia-Lippe and Schleswig-Holstein.Objectives
A process evaluation was performed with the aim of investigating barriers and facilitators to intervention implementation and giving recommendations for future interventions.Materials and methods
Between November 2015 and January 2016 semistructured qualitative interviews were conducted with AOK employees and general practitioners of the intervention group. Interviews focused on contextual factors (e.?g. responsibilities for implementing the intervention), the communication between network partners and the process of referring patients to smoking cessation courses.Results
Overall, 21 interviews were completed (8 AOK employees, 13 general practitioners). Intervention implementation was facilitated because physicians perceived smoking cessation counseling to be important and were supported by their office staff. Challenges were seen in patients’ motivation for participation in smoking cessation courses and meeting the minimum number of course participants.Conclusions
Successful intervention implementation would be facilitated by motivating patients to participate in smoking cessation courses and informing them about the effectiveness of the courses. Patient’s preferences for different smoking cessation aids should be investigated in order to increase the use of effective aids.8.
Lisanne Warmerdam Marko Barendregt Edwin de Beurs 《Zeitschrift fur Gesundheitswissenschaften》2017,25(3):311-319
Aim
A meaningful comparison of clinical outcomes of mental health care providers requires risk adjustment of case mix variables that affect treatment outcome. The first goal of the present study was to describe the risk adjustment method we applied to routine outcome monitoring data in The Netherlands. Second, the consequences of risk adjustment for the ranking of providers were investigated.Subject and methods
Using an observational study design, pre- and posttest self-report assessments of symptoms were obtained for 31,849 adults with common mental health problems, such as mood and anxiety disorders. Regression analyses were performed to predict the posttest symptom level using socio-demographics and clinical characteristics as predictors.Results
Results showed that the posttest level of symptoms was best predicted by the symptom level at baseline, followed by the baseline level of functioning, age, socioeconomic status and some diagnoses. For the majority of the providers, risk adjustment did not markedly change their ranking.Conclusion
The baseline level of symptoms is the best predictor of the posttest level. The other investigated case mix variables only have a modest influence on the performance of providers. Risk adjustment is particularly necessary when consequences are related to the performance of an individual provider. These results contribute to the limited literature on risk adjustment in mental health care by using a large national data set.9.
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Background
Readiness for change, defined as “the cognitive precursor to the behaviors of either resistance to, or support for, a change effort” (Armenakis et al. in Hum Relat, 1993, p. 682), can serve as a facilitator or barrier to dissemination of evidence-based services. There is limited research on the role of readiness for change in educational contexts and its relationship to the success of school mental health (SMH) initiatives.Objective
The goal of this study was to examine readiness in three communities (i.e., teachers, SMH staff, and principals) from the perspective of three key informant groups and assess the association between readiness scores and use of SMH initiatives.Method
Participants were recruited from 11 elementary schools and included administrators (n?=?13), teachers (n?=?194), and SMH staff (n?=?47). Participants completed a modified Change Orientation Scale (COS; Kearney and Smith in: Hoy and DiPaola (eds) Studies in school improvement, Information Age, Greenwich, 2009), and answered questions about participation in recent SMH initiatives.Results
Differences were detected between informant’s perceptions of readiness, between community readiness levels, and across schools (when communities were aggregated). Building administrators rated readiness the highest and the teacher community was consistently rated as the least ready. Positive correlations between teacher readiness and teachers’ reported use of a positive behavior support strategy (rs range from .19 to .62) were found.Conclusions
The variability in COS scores across schools, suggests that this brief measure may be sensitive to small, but meaningful differences between schools. Findings provide initial evidence for the utility of the COS in assessing readiness in schools and its relation to implementation of SMH initiatives.11.
Background
There has been increasing interest in measuring the productive performance of healthcare services since the mid-1980s.Objective
By applying bootstrapped data envelopment analysis across the 20 Italian Regional Health Systems (RHSs) for the period 2008–2012, we employed a two-stage procedure to investigate the relationship between care appropriateness and productivity evolution in public hospital services.Methods
In the first stage, we estimated the Malmquist index and decomposed this overall measure of productivity into efficiency and technological change. In the second stage, the two components of the Malmquist index were regressed on a set of variables measuring per capita health expenditure, care appropriateness, and clinical appropriateness.Results
Malmquist analysis shows that no gains in productivity in the health industry have been achieved in Italy despite the sequence of reforms that took place during the 1990s, which were devoted to increasing efficiency and reducing costs. Analysis of the efficiency change index clearly indicates that the source of productivity gain relies on a rationalization of the employed inputs in the Italian RHSs. At the same time, the trend of the technological change index reveals that the health systems in the three macro-areas (North, Central, and South) are characterized by technological regress.Conclusion
Overall, our results suggest that productivity increases could be achieved in the Italian health system by reducing the level of inputs, improving care and clinical appropriateness, and by counteracting the ‘DRG (diagnosis-related group) creep’ phenomenon.12.
Individually tailored dietary counseling among old home care clients - Effects on nutritional status
S. Pölönen M. Tiihonen S. Hartikainen Irma Nykänen 《The journal of nutrition, health & aging》2017,21(5):567-572
Objective
To evaluate the effect of individually tailored dietary counseling on nutritional status among home care clients aged 75 years or older.Design
Non-randomised controlled study.Setting and participants
The study sample consisted of 224 home care clients (≥ 75 years) (intervention group, n = 127; control group, n = 100) who were at protein-energy malnutrition (PEM) or risk of PEM (MNA score <24 and plasma albumin <35 g/L).Intervention
Individually tailored dietary counseling; the persons were instructed to increase their food intake with energy-dense food items, the number of meals they ate and their consumption of energy-, protein- and nutrient-rich snacks for six months.Measurements
The Mini Nutritional Assessment (MNA), Body Mass Index (BMI) and plasma albumin were used to determine nutritional status at the baseline and after the six-month intervention.Results
The mean age of the home care clients was 84.3 (SD 5.5) in the intervention group and 84.4 (SD 5.3) in the control group, and 70 percent were women in both groups. After the six-month nutritional intervention, the MNA score increased 2.3 points and plasma albumin 1.6 g/L in the intervention group, against MNA score decreased -0.2 points and plasma albumin -0.1 g/L in the control group.Conclusions
Individually tailored dietary counseling may improve nutritional status among older home care clients.13.
14.
Background
Providing enriched learning environments is important to stimulating children’s development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children’s school readiness.Objective
The purpose of this study was to examine associations between QRIS, a statewide government-funded early childhood care and education policy which integrates structural quality of child-care, and children’s cognitive skills.Methods
A sample of randomly selected 313 children (mean age = 54.9 months, SD = 6.7) from 36 QRIS-participating early child-care programs was included in this study.Results
Multilevel analysis with a latent variable (i.e., observed cognitive skills consisting of vocabulary, phonological awareness, and mathematical skills) revealed that children in the highest level of QRIS programs demonstrated better cognitive skills after controlling for child demographics, and home and neighborhood environments. In addition, QRIS moderated a negative association between family socioeconomic risk and children’s cognitive skills.Conclusions
The results suggest that policymakers may expect positive returns on QRIS investments in terms of children’s early cognitive achievements that support their school readiness in later life.15.
16.
T. Lehnert O. H. Günther A. Hajek S. G. Riedel-Heller H. H. König 《The European journal of health economics》2018,19(9):1213-1223
Background
Most people prefer to “age in place” and to remain in their homes for as long as possible even in case they require long-term care. While informal care is projected to decrease in Germany, the use of home- and community-based services (HCBS) can be expected to increase in the future. Preference-based data on aspects of HCBS is needed to optimize person-centered care.Objective
To investigate preferences for home- and community-based long-term care services packages.Design
Discrete choice experiment conducted in mailed survey.Setting and participants
Randomly selected sample of the general population aged 45–64 years in Germany (n?=?1.209).Main variables studied
Preferences and marginal willingness to pay (WTP) for HCBS were assessed with respect to five HCBS attributes (with 2–4 levels): care time per day, service level of the HCBS provider, quality of care, number of different caregivers per month, co-payment.Results
Quality of care was the most important attribute to respondents and small teams of regular caregivers (1–2) were preferred over larger teams. Yet, an extended range of services of the HCBS provider was not preferred over a more narrow range. WTP per hour of HCBS was €8.98.Conclusions
Our findings on preferences for HCBS in the general population in Germany add to the growing international evidence of preferences for LTC. In light of the great importance of high care quality to respondents, reimbursement for services by HCBS providers could be more strongly linked to the quality of services.17.
Anita L. Hansen G. Ambroziak D. Thornton L. Dahl B. Grung 《The journal of nutrition, health & aging》2018,22(4):513-518
Objectives
To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ.Design
A randomized controlled trial.Setting
A forensic facility.Participants
Eighty-four young to middle aged male forensic inpatients with psychiatric disorders.Intervention
Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks.Measurement
Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention.Results
Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ.Conclusion
Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.18.
Background
Collaborative pediatric mental health and primary care is increasingly recognized as optimal for meeting the needs of children with mental health problems. This paper describes the challenges faced by freestanding specialty mental health clinics and pediatric health practices to provide such coordinated mind-and-body treatment. It describes critical elements of a proactive approach to achieving collaborative pediatric care under real-world circumstances using the patient-centered medical home neighborhood (PCMH-N) model.Objective
The current study evaluates the field test of the practitioner-informed model to facilitate interdisciplinary collaboration (PIM-FIC), a systematic approach to improving inter-professional collaboration by building relationships and enhancing communication between pediatric mental health and primary care practices.Methods
Thirty-nine providers at two mental health and two pediatric primary care practices participated in a pilot project and completed surveys prior to and following their participation. Key informant interviews were also conducted prior to the project.Results
Participating practitioners’ survey and interview responses indicate that the quantity and quality of communication between pediatric mental and medical health care providers increased post-project, as did satisfaction with overall collaboration.Conclusions
Improving relationships and communication are first steps in building the infrastructure to support effective coordinated care. Project results highlight practical and easily implemented strategies that pediatric mental health and primary care practices can take to strengthen their collaboration. Findings also suggest a need for collaborative care policies and competencies for child mental health providers working in freestanding practices within the PCMH-N.19.
Rebecca Anne Swartz Angela R. Wiley Natalie A. Koziol Katherine A. Magerko 《Child & youth care forum》2016,45(5):781-805
Background
Family child care is commonly used in the US by families, including by those receiving child care subsidies. Psychosocial influences upon the workforce and professional development participation of family child care providers (FCCPs) have implications for the investment of public dollars that aim to improve quality and stability of child care.Objective
We examined psychosocial influences upon workforce and professional development participation of FCCPs. We hypothesized lower levels of psychosocial stress and higher levels of peer support would be associated with less consideration of exit. We hypothesized that those providers embracing a greater sense of themselves as ECE professionals and reporting the support of professional peers would have greater participation in professional development.Methods
This study employed the use of administrative survey data in path modeling.Results
Multivariate analyses of survey data indicated that psychosocial stress had a significant, positive association with consideration of exit. In contrast, perceived peer support had a significant, negative association with consideration of exit. A stronger sense of identity as an early care and education professional had a significant, positive association with professional development participation as measured by training hours completed in the past year. The support of professional peers was not observed to have a significant association with professional development participation.Conclusion
Results suggest the importance of considering psychosocial factors in planning workforce development and educational programs for FCCPs. This may include developing supports to help FCCPs cope with the psychosocial stress of care work, build professional identities, and connect with peer providers to promote stability and quality caregiving in the ECE workforce. We propose additional qualitative research aimed at understanding the context of FCC care as a mechanism for informing the development of these supports.20.
Janne Beelen N. M. de Roos L. C. P. G. M. de Groot 《The journal of nutrition, health & aging》2017,21(2):173-179