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Tomassone, Joseph. "Trauma-Responsive Engagement and Treatment (TREAT)." Journal of Child and Youth Care Work 25 (November 17, 2020): 92–105. http://dx.doi.org/10.5195/jcycw.2015.74.
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This article will outline a conceptual framework for Trauma-Responsive Engagement and Treatment (TREAT), which can be implemented as a model for organizational and programmatic transformation in a juvenile justice system. The proposed TREAT framework is designed to create juvenile justice programming that is not only trauma-informed, but is actually trauma-responsive with respect to all of the members of its community. That is, TREAT staff identify and respond to the outcomes of traumatic experiences in order to help people recover. They work to increase emotional and behavioral self-regulation of participants and help them to achieve self-identified goals. The article will discuss the evolution of this model in the context of recent and historical forces that have fueled juvenile justice reform efforts nationwide. The article will also describe how systemic changes in reaction to those forces should include a clear understanding of, and response to, the impacts of trauma on youth, staff, and systems, and will emphasize that true systemic transformation requires a model which engages, motivates, and benefits all members of a juvenile justice service delivery system—staff and youth alike.
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Warnick, Erin M., Karen Bearss, V. Robin Weersing, Lawrence Scahill, and Joseph Woolston. "Shifting the Treatment Model: Impact on Engagement in Outpatient Therapy." Administration and Policy in Mental Health and Mental Health Services Research 41, no. 1 (September 12, 2012): 93–103. http://dx.doi.org/10.1007/s10488-012-0439-3.
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Geliukh, Evgenia, Dilyara Nabirova, Karapet Davtyan, Svetlana Yesypenko, and Rony Zachariah. "Primary healthcare centers engagement in tuberculosis treatment in Ukraine." Journal of Infection in Developing Countries 13, no. 07.1 (July 31, 2019): 83S—88S. http://dx.doi.org/10.3855/jidc.11292.
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Introduction: We assessed the influence of a result-based financing (RBF) model, which included incentives for Primary Healthcare facilities on TB treatment outcomes.
Methodology: We compared TB patients > 17 years and their treatment outcomes among those who did and did not benefit from RBF-model in 14 districts of Odeska oblast, Ukraine in 2017. Log-binomial regression was used to examine factors associated with being included in RBF-model.
Results: Of 2,269 reported TB patients, 308 (14%) were included in RBF-model. Most patients in the RBF-model were from rural areas 229 (74%), unemployed 218 (71%), and HIV-infected 131 (43%). Individuals from urban areas (Adjusted risk ratio, ARR =0.9, 95% Confidence Interval, CI:0.89-0.94), having drug-resistant TB (ARR = 0.3, 95% CI: 0.18-0.45), and relapse TB (ARR = 0.6, 95% CI:0.40-0.83) were less likely to be included in RBF-model. Favorable outcomes in new/relapse cases with RBF-model was 89% compared with 41% (p < 0.001) without RBF. Similarly, for other retreatment this was 83% versus 40% (p < 0.001). Failures in the no-RBF group was 29% for new and relapse cases while for other retreatment cases, it was 26% (significantly higher than in the RBF-model).
Conclusion: RBF-model is effective in achieving high levels of favorable TB treatment outcomes. Almost three-in-ten TB patients in non-RBF category failed TB treatment despite having drug-susceptible TB. Efforts are now needed to include it within ongoing public health reforms and assess the feasibility of scaling-up this intervention through implementation research and dedicated funding.
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King, Van Lewis, and Robert K. Brooner. "Improving Treatment Engagement in Opioid-Dependent Outpatients with a Motivated Stepped-Care Adaptive Treatment Model." Joint Commission Journal on Quality and Patient Safety 34, no. 4 (April 2008): 209–13. http://dx.doi.org/10.1016/s1553-7250(08)34027-6.
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Nelson, Danielle, Geoffrey Walcott, Christine Walters, and Frederick W. Hickling. "Community Engagement Mental Health Model for Home Treatment of Psychosis in Jamaica." Psychiatric Services 71, no. 5 (May 1, 2020): 522–24. http://dx.doi.org/10.1176/appi.ps.201900063.
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Sturgess, Danielle, Jessica Woodhams, and Matthew Tonkin. "Treatment Engagement From the Perspective of the Offender." International Journal of Offender Therapy and Comparative Criminology 60, no. 16 (July 28, 2016): 1873–96. http://dx.doi.org/10.1177/0306624x15586038.
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A systematic review of the reasons why detained adult offenders fail to attend or successfully complete treatment programme(s) was conducted. An initial search of the literature identified 2,827 articles, which following evaluation against explicit inclusion/exclusion criteria and a quality assessment was reduced to 13 studies. Extracted data from the 13 studies were synthesised using a qualitative approach. Despite the 13 studies being heterogeneous in design, there was consensus on the reasons offenders gave for completion/noncompletion of treatment. The majority were consistent with the factors outlined in the Multifactor Offender Readiness Model (MORM) and included a perceived lack of self-efficacy, negative perceptions of treatment, staff and peers, an inability to regulate emotions, and a lack of perceived choice and control. A lack of opportunity to engage in established, professionally run, groups, as well as perceived inadequate support from members of staff, was also associated with poor engagement and noncompletion of treatment.
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Macoveanu, Julian, Kirsa M. Demant, Maj Vinberg, Hartwig R. Siebner, Lars V. Kessing, and Kamilla W. Miskowiak. "Towards a biomarker model for cognitive improvement: No change in memory-related prefrontal engagement following a negative cognitive remediation trial in bipolar disorder." Journal of Psychopharmacology 32, no. 10 (July 4, 2018): 1075–85. http://dx.doi.org/10.1177/0269881118783334.
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Background: Cognitive deficits are prevalent in bipolar disorder during remission but effective cognition treatments are lacking due to insufficient insight into the neurobiological targets of cognitive improvement. Emerging data suggest that dorsal prefrontal cortex target engagement is a key neurocircuitry biomarker of pro-cognitive treatment effects. Aims: In this randomized controlled functional magnetic resonance imaging study, we test this hypothesis by investigating the effects of an ineffective cognitive remediation intervention on dorsal prefrontal response during strategic memory encoding and working memory engagement. Methods: Bipolar disorder patients in partial remission with subjective cognitive difficulties were randomized to receive 12-week group-based cognitive remediation ( n = 13) or to continue their standard treatment ( n = 14). The patients performed a strategic episodic picture encoding task and a spatial n-back working memory task under functional magnetic resonance imaging at baseline and following cognitive remediation or standard treatment. Results: The right dorsolateral prefrontal cortex was commonly activated by both strategic memory tasks across all patients. The task-related prefrontal engagement was not altered by cognitive remediation relative to standard treatment. The dorsolateral prefrontal cortex response was not significantly associated with recall accuracy or working memory performance. Conclusions: As hypothesized, no task-related change in prefrontal activity was observed in a negative cognitive remediation trial in remitted bipolar disorder patients. By complementing previous findings linking cognitive improvement with increased dorsolateral prefrontal cortex engagement, our negative findings provide additional validity evidence to the dorsal prefrontal target engagement biomarker model of cognitive improvement by strengthening the proposed causality between modulation of dorsolateral prefrontal cortex engagement and pro-cognitive effects.
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Laracuente, M. S. "Therapeutic Engagement With Partner-Abusive Fathers." Family Journal 25, no. 4 (September 12, 2017): 383–88. http://dx.doi.org/10.1177/1066480717731221.
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Excluding partner-abusive fathers from an intimate partner violence (IPV)-exposed child’s mental health treatment without exercising due diligence may be contraindicated. It is known that fathers with antisocial characteristics can be detrimental to a child’s development; however, research also shows that fathers are as important as mothers to the healthy development of children. Due to this dichotomy, working with IPV-exposed children and their families deserves an idiographic approach. By using a case vignette, steps are delineated and recommendations offered to develop a model for the safe engagement of partner-abusive fathers into an IPV-exposed child’s treatment.
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Wilkinson, Brett D., and Fred J. Hanna. "Using the Precursors Model of Change to Facilitate Engagement Practices in Family Counseling." Family Journal 26, no. 3 (July 2018): 306–14. http://dx.doi.org/10.1177/1066480718795502.
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Many evidence-based family counseling approaches include an engagement phase of treatment. Such motivation-focused treatment practices may benefit from a conceptual model that highlights common client change mechanisms and relevant interventions. Addressing seven empirically validated change factors, the precursors model provides counselors with a relevant taxonomy for further understanding, addressing, and enhancing family engagement in counseling. It is suggested that exposing practitioners to the precursors model of change may serve to improve treatment outcomes, thereby benefiting both clients and the evidence-based practice movement in family counseling. The precursors model taxonomy is explained, and corresponding interventions are explored in the context of a case vignette.
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Carl, Lena C., Martin Schmucker, and Friedrich Lösel. "Predicting Attrition and Engagement in the Treatment of Young Offenders." International Journal of Offender Therapy and Comparative Criminology 64, no. 4 (September 27, 2019): 355–74. http://dx.doi.org/10.1177/0306624x19877593.
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Premature treatment termination in offender treatment is linked to negative consequences for clients, practitioners, and the criminal justice system. Therefore, identifying predictors of treatment attrition is a crucial issue in offender rehabilitation. Most studies on this topic focus on adult offenders; less is known about adolescent offenders. In our study, therapy attrition and engagement were predicted via logistic and linear regression to examine the link between pretreatment variables, engagement, and treatment failure in 161 young offenders treated in a social-therapeutic unit in Germany. Engagement could be predicted by motivation, disruptive childhood behavior, low aggressiveness, and higher age. In turn, low motivation, substance abuse, and young age predicted attrition, but their impact diminished when engagement was added to the model with only substance abuse remaining significant. The effect of substance abuse on attrition disappeared, when the offender’s initial motivation was high. Implications for assessment and treatment planning are discussed.
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Frost, Andrew, Randolph C. Grace, and Anthony P. McLean. "Therapeutic Engagement and Treatment Progress: Developing and Testing an In-Treatment Measure of Client Engagement Among Sex Offenders in a Group Program." Sexual Abuse 31, no. 8 (July 27, 2018): 952–71. http://dx.doi.org/10.1177/1079063218791178.
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The engagement process of sexual offenders in group-based cognitive-behavioral treatment is an important area of study. Disclosure management style (DMS), a model developed from grounded-theory research of men undertaking a prototypical program, provides a framework to assess engagement in treatment. Our goal was to develop a quantitative measure of DMS, to test its reliability and validity, and to evaluate its utility as a measure of treatment progress by examining relationships between DMS and established measures of treatment change. We studied a sample of men ( N = 93) who undertook an intensive prison-based treatment program in New Zealand. Variables included DMS measures, psychometric measures of dynamic risk and treatment change, static risk, clinician rating of treatment progress, and recidivism outcomes. We found that (a) DMS shows an acceptable level of agreement between independent raters, (b) DMS-based ratings of engagement changed over the course of treatment and were correlated with measures of change based on offender self-reports, and (c) offenders showed heterogeneity in terms of their trajectories of change as assessed by DMS ratings.
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Shah, Syed Iftikhar Hussain, Muhammad Iqbal Majoka, and Shaista Irshad Khan. "Learning Engagement in Mathematics: A Test of an Active Learning Model." Global Social Sciences Review IV, no. II (June 30, 2019): 143–50. http://dx.doi.org/10.31703/gssr.2019(iv-ii).19.
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This experimental study explored the effect of the 4WsHs active learning model on learning engagement in mathematics classes. The research design used for conducting this study was true experimental research design (pre-test post-test equivalent group design). A sample comprising 190 students selected from two public sector schools was divided into experimental and control groups using a matched random sampling technique. The newly developed active learning model was used as treatment for an experimental group while the same contents of mathematics were taught to the control group using a traditional method. After practice of three months, learning engagement of both groups was measured using a classroom observation checklist. The analyzed data revealed a significant superiority of students belonging to the experimental group over their counterparts in learning engagement. Hence, the newly developed active learning model proved to be effective for developing learning engagement among students.
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Jena, Lalatendu Kesari, and Sajeet Pradhan. "Research and recommendations for employee engagement: revisiting the employee-organization linkage." Development and Learning in Organizations: An International Journal 31, no. 5 (September 4, 2017): 17–19. http://dx.doi.org/10.1108/dlo-02-2017-0012.
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Purpose The aim of this paper is to propose a conceptual model of employee engagement that will help employees to contribute toward organizational and societal goals in meaningful ways. Design/methodology/approach This study takes an exploratory viewpoint of employee engagement based on the extant literature and offers a conceptual model of employee engagement and its possible merits. Findings The paper strives to expand our understanding of employee engagement and addresses concerns regarding an apathetic treatment by practitioners. Originality/value The paper draws the attention of both academicians and practitioners by offering a conceptual model that will compel them to rethink the ways employee engagement is considered.
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Davidson, Kimberly M. "Testing an Interactionist Theory of Treatment Engagement in a Pennsylvania Prison-Based Therapeutic Community." Criminal Justice and Behavior 47, no. 10 (May 26, 2020): 1282–98. http://dx.doi.org/10.1177/0093854820919782.
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The prison-based Therapeutic Community (TC) is a promising substance use treatment program that emphasizes peer influence. Although program evaluations demonstrate positive results, the cognitive, behavioral, and social processes that define the prison-based TC are largely unknown. The TC model presumes that residents increase their treatment engagement and willingness to change through peer interactions and role modeling, but this process has received virtually no research attention. This study explores these peer-driven mechanisms by examining self, reflected, and peer appraisals of willingness to change of 177 male TC residents, predicting within-person changes in treatment engagement by changes in appraisal measures. Results suggest that self, peer, and reflected appraisals converge over time in treatment. In addition, fixed effects models demonstrate that changes in reflected appraisals are most predictive of changes in treatment engagement. Such results, consistent with symbolic interactionist perspectives, inform prison-based programming and contribute to research on individual-level trajectories of desistance and recovery.
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Clark, Arthur J., and Carrie M. Butler. "Empathy: An Integral Model in Clinical Social Work." Social Work 65, no. 2 (April 1, 2020): 169–77. http://dx.doi.org/10.1093/sw/swaa009.
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Abstract Empathy has held a vital and enduring standing in the theory and practice of clinical social work. Defining and conceptualizing empathy is a continuing challenge in social work and across the human services. A multitude of definitions of empathy exist in the therapeutic literature, creating confusion relating to research findings and treatment processes. Recent trends emphasize an overarching and expansive way of conceiving empathic understanding in the therapeutic relationship and informing treatment practice. Multiple perspectives of empathy facilitate a broad and wide-ranging engagement of the practitioner and the client in the therapeutic process. With significant implications for clinical social workers, an integral model capitalizes on the engagement of empathy from multiple ways of knowing: subjective, objective, and interpersonal. Numerous clinical examples illustrate applications of the tripartite model in social work practice. The integral empathy model is amenable to research and training across therapeutic contexts in social work and related fields.
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Marchand, William R., Julie Beckstrom, Elena Nazarenko, Renn U. Sweeny, Tracy Herrmann, McKenzi R. Yocus, Jennifer Romesser, Jeremy Roper, Brandon Yabko, and Ashley Parker. "The Veterans Health Administration Whole Health Model of Care: Early Implementation and Utilization at a Large Healthcare System." Military Medicine 185, no. 11-12 (November 1, 2020): e2150-e2157. http://dx.doi.org/10.1093/milmed/usaa198.
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Abstract Introduction The U.S. Veterans Health Administration (VHA) is changing the way it provides healthcare to a model known as Whole Health (WH). The aim is to shift from a primarily medical/disease-oriented system to a model that focuses on health promotion and disease prevention; utilizes personalized, proactive, and patient-driven care; and emphasizes the use of complementary and integrative health. This investigation aimed to examine referral and utilization patterns in early implementation at tertiary care VHA medical care system. Specific aims were to evaluate (1) referral patterns, (2) initial treatment engagement, and (3) continuity of treatment engagement. Materials and methods This is an institutional review board-approved, retrospective study of the first 561 veterans referred to WH programming in the first 20 months of implementation. Data analyses included a chi-square goodness of fit to compare demographics of veterans who were referred to WH Services with those of local patient population. At this facility, WH offers services in three tracks (General WH, Mindfulness Center [MC], and WH Nutrition), which offer unique services to veterans. A chi-square test for independence was conducted to analyze differences in initial engagement among the WH components, in referrals and retention among WH components by time period, and in demographics or diagnoses among self-referred or veterans referred by a consult. Finally, a regression model was used to assess for predictive factors that might influence continuity of treatment engagement across all the WH tracks. Results Key findings indicated potential implementation challenges including disproportionate numbers of referrals from clinical services; poor initial and ongoing treatment engagement; and older, male, and non-service-connected Veterans being less likely to be referred. Conclusion Implementation of the WH model of care has the potential to transform the way VHA delivers healthcare and improve the health and lives of veterans. However, a shift of this magnitude is likely to face challenges during implementation. This article reports on initial barriers to implementation, which can guide implementation at other sites as well as future investigations. Further research is needed to replicate these results as well as to determine underlying causal factors. However, if replicated, these results indicate that successful implementation of WH, or similar models of care, will require extensive efforts focused on outreach to, and education of, facility providers and certain patient demographic groups. Finally, efforts will be required to enhance treatment engagement.
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Carleton, Kelly E., Urvashi B. Patel, Dana Stein, David Mou, Alissa Mallow, and Michelle A. Blackmore. "Enhancing the scalability of the collaborative care model for depression using mobile technology." Translational Behavioral Medicine 10, no. 3 (June 2020): 573–79. http://dx.doi.org/10.1093/tbm/ibz146.
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Abstract The collaborative care model (CoCM) has substantial support for improving behavioral health care in primary care. However, large-scale CoCM adoption relies on addressing operational and financial implementation challenges across health care settings with varying resources. An academic medical center serving socioeconomically and racially diverse patients implemented the CoCM in seven practices. A smartphone application was introduced to facilitate CoCM care management during depression treatment (app-augmented CoCM). App features included secure texting, goal/appointment reminders, symptom monitoring, and health education material. A nonrandomized convenience patient sample (N = 807) was enrolled in app-augmented CoCM and compared with patients in standard CoCM (N = 3,975). Data were collected on clinical contact frequency, engagement, and clinical outcomes. App-augmented CoCM patients received more health care team contacts (7.9 vs. 4.9, p < .001) and shorter time to follow up compared with the standard CoCM sample (mean = 11 vs. 19 days, p < .001). App-augmented CoCM patients had clinical outcomes similar to the standard CoCM group (47% vs. 46% with ≥50% depression improvement or score <10), despite app-augmented patients having more prior depression treatment episodes. Further, the app-augmented group with greater app engagement demonstrated increased behavioral health appointment compliance, including more completed appointments and fewer no shows, and greater depression symptom improvement than those with less app engagement. App-augmented CoCM may improve patient engagement in treatment and provide opportunities to implement key CoCM elements without overburdening practice resources. CoCM sustainability and scalability in primary care may be enhanced by using this technology.
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Christon, Lillian M., Bryce D. McLeod, Emily Wheat, Rosalie Corona, and Nadia Y. Islam. "Using a Health Behavior Model to Inform Understanding of Therapy Engagement in Child Therapy: A Qualitative Study." Journal of Emotional and Behavioral Disorders 25, no. 3 (March 25, 2016): 157–69. http://dx.doi.org/10.1177/1063426616641401.
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The present study assessed the potential of a health behavior model used to explain adherence to treatment for chronic illnesses, the Integrative Behavioral Prediction Model (IBPM), to better understand therapy engagement (e.g., low participation) for child therapy in community-based service settings. Qualitative interview methods were used to assess the fit of the IBPM to therapy engagement. Caregivers of children ( n = 17) who had successfully completed therapy, were at risk of dropping out, or terminated prematurely at a community mental health clinic were interviewed. Clinic therapists and administrative staff were also interviewed ( n = 8). From the perspective of caregivers, therapists, and administrative staff, most IBPM elements—cognitions, intentions, and environmental/contextual factors—appear to be relevant to therapy engagement. Other factors, such as personal and psychological barriers (e.g., poor fit with therapist), not found in the IBPM also may influence therapy engagement. It appears that the core elements of the IBPM may translate to child therapy, though future research is needed to evaluate the generalizability of the study findings. Thus, health behavior models (e.g., IBPM) may improve our understanding of factors contributing to poor therapy engagement for children receiving psychosocial therapy in community-based service settings.
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Yeager, Carolyn M., Kotaro Shoji, Aleksandra Luszczynska, and Charles C. Benight. "Engagement With a Trauma Recovery Internet Intervention Explained With the Health Action Process Approach (HAPA): Longitudinal Study." JMIR Mental Health 5, no. 2 (April 10, 2018): e29. http://dx.doi.org/10.2196/mental.9449.
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Background There has been a growing trend in the delivery of mental health treatment via technology (ie, electronic health, eHealth). However, engagement with eHealth interventions is a concern, and theoretically based research in this area is sparse. Factors that influence engagement are poorly understood, especially in trauma survivors with symptoms of posttraumatic stress. Objective The aim of this study was to examine engagement with a trauma recovery eHealth intervention using the Health Action Process Approach theoretical model. Outcome expectancy, perceived need, pretreatment self-efficacy, and trauma symptoms influence the formation of intentions (motivational phase), followed by planning, which mediates the translation of intentions into engagement (volitional phase). We hypothesized the mediational effect of planning would be moderated by level of treatment self-efficacy. Methods Trauma survivors from around the United States used the eHealth intervention for 2 weeks. We collected baseline demographic, social cognitive predictors, and distress symptoms and measured engagement subjectively and objectively throughout the intervention. Results The motivational phase model explained 48% of the variance, and outcome expectations (beta=.36), perceived need (beta=.32), pretreatment self-efficacy (beta=.13), and trauma symptoms (beta=.21) were significant predictors of intention (N=440). In the volitional phase, results of the moderated mediation model indicated for low levels of treatment self-efficacy, planning mediated the effects of intention on levels of engagement (B=0.89, 95% CI 0.143-2.605; N=115). Conclusions Though many factors can affect engagement, these results offer a theoretical framework for understanding engagement with an eHealth intervention. This study highlighted the importance of perceived need, outcome expectations, self-efficacy, and baseline distress symptoms in the formation of intentions to use the intervention. For those low in treatment self-efficacy, planning may play an important role in the translation of intentions into engagement. Results of this study may help bring some clarification to the question of what makes eHealth interventions work.
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Tyler, Tom R., and Steven L. Blader. "The Group Engagement Model: Procedural Justice, Social Identity, and Cooperative Behavior." Personality and Social Psychology Review 7, no. 4 (November 2003): 349–61. http://dx.doi.org/10.1207/s15327957pspr0704_07.
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The group engagement model expands the insights of the group-value model of procedural justice and the relational model of authority into an explanation for why procedural justice shapes cooperation in groups, organizations, and societies. It hypothesizes that procedures are important because they shape people's social identity within groups, and social identity in turn influences attitudes, values, and behaviors. The model further hypothesizes that resource judgments exercise their influence indirectly by shaping social identity. This social identity mediation hypothesis explains why people focus on procedural justice, and in particular on procedural elements related to the quality of their interpersonal treatment, because those elements carry the most social identity-relevant information. In this article, we review several key insights of the group engagement model, relate these insights to important trends in psychological research on justice, and discuss implications of the model for the future of procedural justice research.
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Guess, Pamela E. "The Power of Client Engagement: “Contextual Healing” Research and Implications for Treatment of Depression." Ethical Human Psychology and Psychiatry 15, no. 2 (2013): 109–19. http://dx.doi.org/10.1891/1559-4343.15.2.109.
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The pervasive incidence of depression is predicted to increase even more exponentially over the next 2 decades; by 2030, depression will likely be among the most common causes of disability (Mathers & Loncar, 2006). Although efficacious interventions for depression have been established, these treatments are, paradoxically, accessed by and/or available to only a small percentage of affected individuals. Furthermore, the most frequently used interventions—traditional psychotherapy and antidepressant medications—are conceptually based within an external control model as opposed to a holistic model of care. Interventions are reactive as opposed to proactive, and they highlight the role of agents external to the individual. This conceptualization opposes a more expansive approach that incorporates medical, psychological, and social factors as equivalent contributors to health. An alternative lens through which prevention and management of depression can be viewed emphasizing the influence of client participation is described. Citing results from research in which outcomes from use of antidepressant medications only slightly exceeded the influence of placebos (Kirsch, 2010), an often overlooked intervention resource, the influence of the patient himself/herself and the “contextual healing” suggested through placebo research is highlighted. Presenting literature on hope models (Jacoby, 2003) and positive psychology (Seligman & Csikszentmihalyi, 2000), the role of the individual as a powerful resource for depression intervention, is emphasized. Examples of therapeutic strategies that capitalize on this resource are described along with a discussion regarding the ethical responsibility of health care providers to include such strategies in practice.
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Williams, Katie, and Hannah Steer. "Illness Perceptions: Are Beliefs About Mental Health Problems Associated with Self-Perceptions of Engagement in People with Psychosis?" Behavioural and Cognitive Psychotherapy 39, no. 2 (November 10, 2010): 151–63. http://dx.doi.org/10.1017/s1352465810000627.
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Background: The Self-Regulation Model (SRM) has been presented as a framework for assessing the perceptions people hold about their mental health problem. Currently no direct attempts have been made to assess the association between illness perceptions and engagement in psychosis. Engagement is an important issue for health professionals providing support to people with psychosis; therefore, research demonstrating a link between illness perceptions and engagement may enable targeted interventions to facilitate engagement and enhance outcome. Aim: To assess whether beliefs about mental health are associated with self-perceptions of engagement in people with psychosis. Method: Participants with psychosis completed two questionnaires; beliefs about mental health and self-perceptions of engagement with mental health services. Results: A belief that the mental health difficulty has fewer negative consequences, increased perceptions of personal ability to control the mental health difficulty, a belief that treatment is helpful in controlling symptoms and a more coherent understanding of the mental health difficulty were all associated with higher self-perception engagement scores. Multivariate analyses indicated that a more coherent understanding and a belief that treatment is helpful were the strongest and most consistent predictors of higher self-perception engagement scores. However, the direction of the associations cannot be established. Conclusions: This study suggests that the SRM is a promising model for mental health problems and that beliefs about mental health are associated with self-perceptions of engagement in people with psychosis. The importance of further intervention-based research studies that examines causality is highlighted.
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Dillon, Patrick J., Satish K. Kedia, Oluwaseyi O. Isehunwa, and Manoj Sharma. "Motivations for Treatment Engagement in a Residential Substance Use Disorder Treatment Program: A Qualitative Study." Substance Abuse: Research and Treatment 14 (January 2020): 117822182094068. http://dx.doi.org/10.1177/1178221820940682.
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Aims: The aim of this study was to explore perspectives on motivations for treatment engagement from substance use disorder (SUD) clients in a long-term residential rehabilitation program. Design and Methods: A convenience sample of 30 clients who were enrolled in a year-long SUD treatment program at a residential rehabilitation facility took part in in-depth interviews. Interview transcripts were analyzed using the directed content analysis approach. Results: Participant accounts indicated that their treatment engagement was motivated by factors that aligned with the six primary constructs of the Health Belief Model: (i) perceived susceptibility (eg, believing that their substance use required intervention and that they were prone to relapse), (ii) perceived severity (eg, substance use negatively impacted their health and harmed their close relationships), (iii) perceived benefits (eg, opportunities for a better life, reconnecting with family members and close friends, & avoiding legal consequences), (iv) perceived barriers (eg, the length of the treatment program), (v) cues to actions (eg, decisive moments, elements of the treatment program, & faith and spirituality), and (vi) self-efficacy in remaining abstinent (eg, treatment program provided them with skills and experiences to maintain long-term sobriety). Discussion: Our analysis indicates that participants’ treatment engagement was linked to their beliefs regarding the severity of their substance use disorder, their treatment program’s ability to help them avoid future relapse, and their own capability to act upon the strategies and resources provided by the treatment program. A theoretical understanding of these aspects can contribute to the future planning of precision interventions.
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Drake, R. E., G. Morse, M. F. Brunette, and W. C. Torrey. "Evolving U.S. service model for patients with severe mental illness and co-occurring substance use disorder." Acta Neuropsychiatrica 16, no. 1 (February 2004): 36–40. http://dx.doi.org/10.1111/j.1601-5215.2004.0059.x.
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Co-occurring severe mental illness and substance use disorder has been recognized as a common problem in the U.S. since the early 1980s (1–3). For these individuals with co-occurring disorders, research demonstrates the effectiveness of various forms of combining, blending, or integrating mental health and substance abuse treatments (4). The evolving U.S. service model for integrated dual disorders treatment emphasizes several key elements: implementation, leadership, training, engagement, assessment, counseling for all patients, ancillary treatments for those with multiple needs, secondary treatments for patients who are nonresponders, and quality assurance regarding process and outcomes.
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Praphatthanakunwong, Nattakit, Komsan Kiatrungrit, Sirichai Hongsanguansri, and Kaewta Nopmaneejumruslers. "Factors associated with parent engagement in DIR/Floortime for treatment of children with autism spectrum disorder." General Psychiatry 31, no. 2 (October 2018): e000009. http://dx.doi.org/10.1136/gpsych-2018-000009.
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BackgroundThe Developmental, Individual-differences, Relationship-based model (DIR/Floortime) is one of the well-known therapies for autism spectrum disorder (ASD), in which its main principle is to promote holistic development of an individual and relationships between the caregivers and children. Parental engagement is an essential element to DIR/Floortime treatment and involved with various factors. Finding those supporting factors and eliminating factors that might be an obstacle for parental engagement are essential for children with ASD to receive the full benefits of treatment.AimTo examine the association between parents, children and provider and service factors with parental engagement in DIR/Floortime treatment.MethodsThis is a cross-sectional study of parents with children aged 2–12 years who were diagnosed with ASD. Data were collected using a parent, child, provider and service factors questionnaire. Patient Health Questionaire-9, Clinical Global Impressions-Severity and Childhood Autism Rating Scale were also used to collect data. For parent engagement in DIR/Floortime, we evaluated quality of parental engagement in DIR/Floortime and parent application of DIR/Floortime techniques at home. Finally, Clinical Global Impressions-Improvement and Functional Emotional Developmental Level were used to assess child development.ResultsParents who were married, had lower income and higher knowledge of DIR/Floortime theory were more likely to have higher parent engagement (χ2=4.43, p=0.035; χ2=13.1, p<0.001 and χ2=4.06, p=0.044 respectively). Furthermore, severity of the diagnosis and the continuation of the treatment significantly correlated with parent engagement (χ2=5.83, p=0.016 and χ2=4.72, p=0.030 respectively). It was found that parents who applied the techniques for more than 1 hour/day, or had a high-quality parent engagement, significantly correlated with better improvement in child development (t=−2.03, p=0.049; t=−2.00, p=0.053, respectively).ConclusionFactors associated with parents, children, and provider and service factors had a significant correlation with parent engagement in DIR/Floortime in which children whose parents had more engagement in DIR/Floortime techniques had better improvement in child development.
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Moskal, Dezarie, Stephen A. Maisto, Kyle Possemato, Kevin G. Lynch, and David W. Oslin. "Testing Mediators of Reduced Drinking for Veterans in Alcohol Care Management." Military Medicine 183, no. 9-10 (March 26, 2018): e594-e602. http://dx.doi.org/10.1093/milmed/usy024.
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Abstract Introduction Alcohol Care Management (ACM) is a manualized treatment provided by behavioral health providers working in a primary care team aimed at increasing patients’ treatment engagement and decreasing their alcohol use. Research has shown that ACM is effective in reducing alcohol consumption; however, the mechanisms of ACM are unknown. Therefore, the purpose of this study is to examine the mechanisms of change in ACM in the context of a randomized clinical trial evaluating the effectiveness of ACM. Materials and Methods This study performed secondary data analysis of existing data from a larger study that involved a sample of U.S. veterans (N = 163) who met criteria for current alcohol dependence. Upon enrollment into the study, participants were randomized to receive either ACM or standard care. ACM was delivered in-person or by telephone within the primary care clinic and focused on the use of oral naltrexone and manualized psychosocial support. According to theory, we hypothesized several ACM treatment components that would mediate alcohol consumption outcomes: engagement in addiction treatment, reduced craving, and increased readiness to change. Parallel mediation models were performed by the PROCESS macro Model 4 in SPSS to test study hypotheses. The institutional review boards at each of the participating facilities approved all study procedures before data collection. Results As hypothesized, results showed that treatment engagement mediated the relation between treatment and both measures of alcohol consumption outcomes, the percentage of alcohol abstinent days, and the percentage of heavy drinking days. Neither craving nor readiness to change mediated the treatment effect on either alcohol consumption outcome. Conclusions Findings suggest that ACM may be effective in changing drinking patterns partially due to an increase in treatment engagement. Future research may benefit from evaluating the specific factors that underlie increased treatment engagement. The current study provides evidence that alcohol use disorder interventions should aim to increase treatment engagement and reduce barriers to care.
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Griffith, James D., Danica K. Knight, George W. Joe, and D. Dwayne Simpson. "Implications of family and peer relations for treatment engagement and follow-up outcomes: An integrative model." Psychology of Addictive Behaviors 12, no. 2 (June 1998): 113–26. http://dx.doi.org/10.1037/0893-164x.12.2.113.
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McSweeney, Tim, Caitlin Hughes, and Alison Ritter. "The impact of compliance with a compulsory model of drug diversion on treatment engagement and reoffending." Drugs: Education, Prevention and Policy 25, no. 1 (November 6, 2016): 56–66. http://dx.doi.org/10.1080/09687637.2016.1219695.
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McKenna, Brian, Jeremy Skipworth, Rees Tapsell, Krishna Pillai, Dominic Madell, Alexander Simpson, James Cavney, and Paul Rouse. "Impact of an assertive community treatment model of care on the treatment of prisoners with a serious mental illness." Australasian Psychiatry 26, no. 3 (January 15, 2018): 285–89. http://dx.doi.org/10.1177/1039856217748247.
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Objectives: This study aims to describe the impact of a mental health assertive community treatment prison model of care (PMOC) on improving the ability to identify prisoner needs, provide interventions and monitor their efficacy. Methods: We carried out a file review across five prisons of referrals in the year before the implementation of the PMOC in 2010 ( n = 423) compared with referrals in the year after ( n = 477). Results: Some improvements in the identification of needs and providing interventions were detected. There was increased use of medication management and clinically significant improvement in addressing engagement with families. Monthly multi-disciplinary team face-to-face contact improved. Conclusions: Meeting the needs of mentally ill prisoners is challenged by the complexity of the custodial environment. Improvements made resulted from changing the model of care, rather than adding new resources.
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Sagar, Mark, and Elizabeth Broadbent. "Participatory medicine: model based tools for engaging and empowering the individual." Interface Focus 6, no. 2 (April 6, 2016): 20150092. http://dx.doi.org/10.1098/rsfs.2015.0092.
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The long-term goal of the Virtual Physiological Human and Digital Patient projects is to run 'simulations’ of health and disease processes on the virtual or 'digital' patient, and use the results to make predictions about real health and determine the best treatment specifically for an individual. This is termed 'personalized medicine', and is intended to be the future of healthcare. How will people interact and engage with their virtual selves, and how can virtual models be used to motivate people to actively participate in their own healthcare? We discuss these questions, and describe our current efforts to integrate and realistically embody psychobiological models of face-to-face interaction to enliven and increase engagement of virtual humans in healthcare. Overall, this paper highlights the need for attention to the design of human–machine interfaces to address patient engagement in healthcare.
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O'Hara, Nathan N., Alisha Garibaldi, Sheila Sprague, Joshua Jackson, Alyson K. Kwok, Dorcas E. Beaton, Mohit Bhandari, and Gerard P. Slobogean. "Rehabilitation, not injury or treatment details, dominate proximal humeral fracture patient concerns: a thematic analysis." European Journal for Person Centered Healthcare 5, no. 3 (September 26, 2017): 351. http://dx.doi.org/10.5750/ejpch.v5i3.1328.
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Background, objectives, and aims: To provide treatment using a patient-centered care model, the provider must understand the needs and wants of the patient and ensure the patient has access to appropriate and necessary health information. The objective of this study was to determine what information is most desired by proximal humeral fracture patients following their injury.Methods: This qualitative study enrolled patients aged 60 years or older presenting with a proximal humeral fracture. Semi-structured interviews were conducted within one-month of injury and at 6-months post-injury. The interviews were transcribed, coded and analyzed using thematic analysis.Results: Four themes (biomedical information, recovery, engagement opportunities and support available) emerged from the coded data. Within one-month post-injury, the most commonly identified themes were rehabilitation and support available. Six-months after the injury, the most commonly identified theme remained rehabilitation, while the second most frequently identified theme shifted to engagement opportunities. The biomedical information theme emerged infrequently at both interviews. Conclusions: Patient-centered care models for proximal humeral fracture patients could be improved by adapting to dynamic information concerns. While the effect of the injury on the patient’s rehabilitation remained the leading concern for the duration of the study period, secondary concerns did change over time. Providing germane information to patients at timely intervals supports patient-centered care, patient engagement and ultimately may improve patient care.
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Lal, S., K. Goldberg, R. Joober, N. Vracotas, and A. Malla. "0464 REDUCING DELAY IN TREATMENT OF PSYCHOSIS: A SERVICE MODEL FACILITATING EARLY CASE IDENTIFICATION, ENGAGEMENT AND ASSESSMENT." Schizophrenia Research 86 (October 2006): S124. http://dx.doi.org/10.1016/s0920-9964(06)70371-1.
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Ho, Szu‐Szu, Rosie Stenhouse, and Aisha Holloway. "Understanding HIV‐positive drug users’ experiences of taking highly active antiretroviral treatment: Identity–Values–Conscious engagement model." Journal of Clinical Nursing 29, no. 9-10 (May 2020): 1561–75. http://dx.doi.org/10.1111/jocn.15228.
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Mulder, Roger, Debbie Sorensen, Staverton Kautoke, and Seini Jensen. "Part II: using an integrated case model for delivering mental health services in general practice for Pacific people." Australasian Psychiatry 28, no. 1 (September 16, 2019): 21–23. http://dx.doi.org/10.1177/1039856219871871.
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Objective: To discuss an alternative model for delivering mental health services to Pacific people in general practice. Methods: Review of primary healthcare models which attempt to integrate behavioural healthcare with general practice. Results: There is some evidence that relationship-based collaborative models may improve both mental and physical health. Such a model has been implemented successfully by Alaskan Native Americans. Conclusion: An integrated model of healthcare incorporating Pacific cultural values may reduce stigma and improve engagement and efficacy in delivering mental health treatment to Pacific people, their families and communities.
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Singleton, Alyson L., Brandon D. Marshall, Xiao Zang, Amy S. Nunn, and William C. Goedel. "1701. Added Benefits of Pre-exposure Prophylaxis Use on HIV Incidence with Minimal Changes in Efficiency in the Context of High Treatment Engagement among Men Who Have Sex with Men." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S833. http://dx.doi.org/10.1093/ofid/ofaa439.1879.
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Abstract Background Although there is ongoing debate over the need for substantial increases in PrEP use when antiretroviral treatment confers the dual benefits of reducing HIV-related morbidity and mortality and the risk of HIV transmission, no studies to date have quantified the potential added benefits of PrEP use in settings with high treatment engagement across variable sub-epidemics in the United States. Methods We used a previously published agent-based network model to simulate HIV transmission in a dynamic network of 17,440 Black/African American and White MSM in Atlanta, Georgia from 2015 to 2024 to understand how the magnitude of reductions in HIV incidence attributable to varying levels of PrEP use (0–90%) changes in potential futures where high levels of treatment engagement (i.e. the UNAIDS ‘90-90-90’ goals and eventual ‘95-95-95’ goals) are achieved and maintained, as compared to current levels of treatment engagement in Atlanta (Figure 1). Model inputs related to HIV treatment engagement among Black/African American and White men who have sex with men in Atlanta. A comparison of current levels of treatment engagement (Panel A) to treatment engagement at ‘90-90-90’ (Panel B) and ‘95-95-95’ goals (Panel C). Results Even at achievement and maintenance of ‘90-90-90’ goals, 75% PrEP coverage reduced incidence rates by an additional 67.9% and 74.2% to 1.53 (SI: 1.39, 1.70) and 0.355 (SI: 0.316, 0.391) per 100 person-years for Black/African American and White MSM, respectively (Figure 2), compared to the same scenario with no PrEP use. Additionally, an increase from 15% PrEP coverage to 75% under ‘90-90-90’ goals only increased person-years of PrEP use per HIV infection averted, a measure of efficiency of PrEP, by 8.1% and 10.5% to 26.7 (SI: 25.6, 28.0) and 73.3 (SI: 70.6, 75.7) among Black/African American MSM and White MSM, respectively (Figure 3). Overall (Panel A) and race-stratified (Panel B and Panel C) marginal changes in HIV incidence over ten years among Black/African American and White men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: All changes are calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Person-years of pre-exposure prophylaxis use per HIV infection averted among Black/African American (Panel A) and White (Panel B) men who have sex with men in Atlanta across scenarios of varied levels of treatment engagement among agents living with HIV infection and levels of pre-exposure prophylaxis use among HIV-uninfected agents. Note: The number of HIV infections averted is calculated within each set of treatment scenarios relative to a scenario where no agents use pre-exposure prophylaxis. Conclusion Even in the context of high treatment engagement, substantial expansion of PrEP use still contributes to meaningful decreases in HIV incidence among MSM with minimal changes in person-years of PrEP use per HIV infection averted, particularly for Black/African American MSM. Disclosures All Authors: No reported disclosures
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Croft, Alison, and Ann Hackmann. "Agoraphobia: An Outreach Treatment Programme." Behavioural and Cognitive Psychotherapy 41, no. 3 (September 28, 2012): 359–64. http://dx.doi.org/10.1017/s135246581200077x.
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Background: Agoraphobia is disabling and clients find it hard to access effective treatment. Aims: This paper describes the development of an inexpensive service, delivered by trained volunteers in or near the client's own home. Method: We describe the development of the service, including selection, training and supervision. Outcomes were evaluated over 5 years, and compared with those available from the local psychology service. Results: Effect sizes on all measures were high. Benchmarking indicated that results on comparable measures were not significantly different from the local psychology service. As in many previous studies drop-out rate was fairly high. Conclusions: This model worked well, and was inexpensive and effective. Further research on long term outcome and methods of enhancing engagement is needed.
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Wilson, Mackenzie, Kednapa Thavorn, Terry Hawrysh, Ian D. Graham, Harold Atkins, Natasha Kekre, Doug Coyle, et al. "Stakeholder engagement in economic evaluation: Protocol for using the nominal group technique to elicit patient, healthcare provider, and health system stakeholder input in the development of an early economic evaluation model of chimeric antigen receptor T-cell therapy." BMJ Open 11, no. 8 (August 2021): e046707. http://dx.doi.org/10.1136/bmjopen-2020-046707.
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IntroductionChimeric antigen receptor T-cell (CAR-T) therapy is a class of immunotherapy. An economic evaluation conducted at an early stage of development of CAR-T therapy for treatment of adult relapsed or refractory acute lymphoblastic leukaemia could provide insight into factors contributing to the cost of treatment, the potential clinical benefits, and what the health system can afford. Traditionally, stakeholders are engaged in certain parts of health technology assessment processes, such as in the identification and selection of technologies, formulation of recommendations, and implementation of recommendations; however, little is known about processes for stakeholder engagement during the conduct of the assessment. This is especially the case for economic evaluations. Stakeholders, such as clinicians, policy-makers, patients, and their support networks, have insight into factors that can enhance the validity of an economic evaluation model. This research outlines a specific methodology for stakeholder engagement and represents an avenue to enhance health economic evaluations and support the use of these models to inform decision making for resource allocation. This protocol may inform a tailored framework for stakeholder engagement processes in future economic evaluation model development.Methods and analysisWe will involve clinicians, healthcare researchers, payers, and policy-makers, as well as patients and their support networks in the conduct and verification of an early economic evaluation of a novel health technology to incorporate stakeholder-generated knowledge. Three stakeholder-specific focus groups will be conducted using an online adaptation of the nominal group technique to elicit considerations from each. This study will use CAR-T therapy for adults with relapsed or refractory B-cell acute lymphoblastic leukaemia as a basis for investigating broader stakeholder engagement processes.Ethics and disseminationThis study received ethics approval from the Ottawa Hospital Research Institute Research Ethics Board (REB 20200320-01HT) and the results will be shared via conference presentations, peer-reviewed publications, and ongoing stakeholder engagement.
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Jahandideh, Sepideh, Elizabeth Kendall, Samantha Low-Choy, Kenneth Donald, Rohan Jayasinghe, and Ebrahim Barzegari. "The Process of Patient Engagement in Outpatient Cardiac Rehabilitation Programs." Behaviour Change 36, no. 4 (August 22, 2019): 233–51. http://dx.doi.org/10.1017/bec.2019.14.
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AbstractThe primary aim of this study was to test the causal structure of the model of therapeutic engagement (MTE) for the first time, to examine whether the model assists in understanding the process of patient engagement in cardiac rehabilitation (CR) programs. This study used a prospective design, following up patients from the Gold Coast University Hospital Cardiology ward who attended Robina Cardiac Rehabilitation Clinic. A structural equation model of the interactions among the proposed variables within the three stages of the MTE (intention to engage in CR programs, CR initiation, and sustained engagement) revealed significant relationships among these variables in a dataset of 101 patients who attended a CR program. However, no relationship was discerned between outcome expectancies and patient intention to engage in CR. Patients’ willingness to consider the treatment also mediated the relationship between perceived self-efficacy and patient intention to engage in CR. These findings help clarify the process proposed by Lequerica and Kortte (2010) in the context of patient engagement in CR programs. The findings also reveal information on how patients engage in CR programs. Importantly, this provides new information for healthcare providers, enabling them to more effectively engage patients according to their stage of engagement.
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Jasoliya, Mittal, Heather Bowling, Ignacio Cortina Petrasic, Blythe Durbin-Johnson, Eric Klann, Aditi Bhattacharya, Randi Hagerman, and Flora Tassone. "Blood-Based Biomarkers Predictive of Metformin Target Engagement in Fragile X Syndrome." Brain Sciences 10, no. 6 (June 10, 2020): 361. http://dx.doi.org/10.3390/brainsci10060361.
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Recent advances in neurobiology have provided several molecular entrees for targeted treatments for Fragile X syndrome (FXS). However, the efficacy of these treatments has been demonstrated mainly in animal models and has not been consistently predictive of targeted drugs’ response in the preponderance of human clinical trials. Because of the heterogeneity of FXS at various levels, including the molecular level, phenotypic manifestation, and drug response, it is critically important to identify biomarkers that can help in patient stratification and prediction of therapeutic efficacy. The primary objective of this study was to assess the ability of molecular biomarkers to predict phenotypic subgroups, symptom severity, and treatment response to metformin in clinically treated patients with FXS. We specifically tested a triplex protein array comprising of hexokinase 1 (HK1), RAS (all isoforms), and Matrix Metalloproteinase 9 (MMP9) that we previously demonstrated were dysregulated in the FXS mouse model and in blood samples from patient with FXS. Seventeen participants with FXS, 12 males and 5 females, treated clinically with metformin were included in this study. The disruption in expression abundance of these proteins was normalized and associated with significant self-reported improvement in clinical phenotypes (CGI-I in addition to BMI) in a subset of participants with FXS. Our preliminary findings suggest that these proteins are of strong molecular relevance to the FXS pathology that could make them useful molecular biomarkers for this syndrome.
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Bar-Gill, Sagit, and Shachar Reichman. "Stuck Online: When Online Engagement Gets in the Way of Offline Sales." MIS Quarterly 45, no. 2 (June 1, 2021): 755–88. http://dx.doi.org/10.25300/misq/2021/15267.
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In recent years, billions of dollars have been spent by both online and offline retailers on website design aimed at increasing consumers’ online engagement. We study the relationship between online engagement and offline sales, utilizing a quasi-experimental setting in which a leading premium automobile brand gradually launched a new interactive website across markets, allowing for a treatment-control comparison. This paper offers evidence of a causal effect of online engagement on offline sales, with the high-engagement website leading to a decline of approximately 12% in car sales. This negative effect is due to substitution between online and offline engagement; users of the high-engagement website exhibited a decreased tendency to seek out personal contact with a car dealer and proceed to offline engagement—a necessary stage in the car purchase funnel. We develop an analytical model of the online-to-offline sales funnel to generalize our findings and highlight the conditions under which online engagement substitutes for offline engagement and potentially decreases offline sales. Taken together, our findings suggest that while online engagement serves as a means for both product information provision and consumer persuasion, it may fall short in achieving the latter goal, as compared to the offline channel. For purely offline products, hands-on engagement is a necessary step toward purchase. Thus, increasing consumers’ online engagement may not be an optimal strategy if it has the potential to halt progression down the sales funnel and reduce offline engagement.
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McHale, Ciaran, Mark Hayward, and Fergal W. Jones. "Building a Grounded Theory of Engagement in Mindfulness-Based Group Therapy for Distressing Voices." Qualitative Health Research 28, no. 14 (August 10, 2018): 2169–82. http://dx.doi.org/10.1177/1049732318789897.
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Mindfulness-based group therapy shows promise as a treatment for distressing voice hearing. However, fostering engagement in groups can be challenging, and no theory of engagement in group therapy for distressing voices exists to guide practice or research. This study employed Grounded Theory Method to build a theory of engagement in mindfulness-based groups for distressing voices. Ten service-users and three therapists were interviewed about their experiences of such groups. The model that emerged involves a recursive process of investing in change and continually evaluating its usefulness and safety. Barriers to engagement were often overcome, but sometimes compromised perceived safety, leading to dropout. For others, group participation led to rewards, some of which were integrated beyond group termination. Group engagement can be encouraged by establishing universality around voice hearing early, reducing uncertainty, sharing difficulties with mindfulness practices, and mapping group progress to create a cohering sense of collaboration on therapy tasks.
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Vieira, Bruno, Derya Demirtas, Jeroen B. van de Kamer, Erwin W. Hans, Willem Jongste, and Wim van Harten. "Radiotherapy treatment scheduling: Implementing operations research into clinical practice." PLOS ONE 16, no. 2 (February 19, 2021): e0247428. http://dx.doi.org/10.1371/journal.pone.0247428.
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Background Every week, radiotherapy centers face the complex task of scheduling hundreds of treatment sessions amongst the available linear accelerators. With the increase in cancer patient numbers, manually creating a feasible and efficient schedule has shown to be a difficult, time-consuming task. Although operations research models have been increasingly reported upon to optimize patient care logistics, there is almost no scientific evidence of implementation in practice. Methods A mathematical operations research model was adapted to generate radiotherapy treatment schedules in two Dutch centers. The model was iteratively adjusted to fulfill the technical and medical constraints of each center until a valid model was attained. Patient data was collected for the planning horizon of one week, and the feasibility of the obtained schedules was verified by the staff of each center. The resulting optimized solutions are compared with the ones manually developed in practice. Results The weekly schedule was improved in both centers by decreasing the average standard deviation between sessions’ starting times from 103.0 to 50.4 minutes (51%) in one center, and the number of gaps in the schedule from 18 to 5 (72%) in the other. The number of patients requiring linac switching between sessions has also decreased from 71 to 0 patients in one center, and from 43 to 2 in the other. The automated process required 5 minutes and 1.5 hours of computation time to find an optimal weekly patient schedule, respectively, as opposed to approximately 1.5 days when performed manually for both centers. Conclusions The practical application of a theoretical operations research model for radiotherapy treatment scheduling has provided radiotherapy planners a feasible, high-quality schedule in an automated way. Iterative model adaptations performed in small steps, early engagement of stakeholders, and constant communication proved to facilitate the implementation of operations research models into clinical practice.
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Mai, Loan, and Judy Eng. "Community-Based Elder Care: A Model for Working With the Marginally Housed Elderly." Care Management Journals 8, no. 2 (June 2007): 96–99. http://dx.doi.org/10.1891/152109807780845564.
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The community-based elder care (C-BEC) model is a critical treatment leverage that can be used to serve the older geriatric population who live in marginal housing tenements and who have little to nonexistent formal or informal support systems. Service engagement includes a model of care encompassing health maintenance with ongoing assessment of several specific dimensions. These dimensions include motor functioning, environmental barriers, emotional health, supportive services, and adherence motivation. All of these effect outcome and treatment course, despite a variety of medical diagnosis, level of functioning, and supportive needs. From evaluation of the individuals described in this article, considerations for collaborative treatment relationships, interdisciplinary teams, and service assessments are recognized as focal points of change that can be facilitated with C-BEC. The model is replicable and recommended for service providers working with an ambulatory, homebound, frail, and older aged population.
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Keogh, Kandice, Paul Clark, Patricia C. Valery, Steven M. McPhail, Candise Bradshaw, Melany Day, and Anthony C. Smith. "Use of telehealth to treat and manage chronic viral hepatitis in regional Queensland." Journal of Telemedicine and Telecare 22, no. 8 (October 30, 2016): 459–64. http://dx.doi.org/10.1177/1357633x16673794.
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For regional and rural Queenslanders, chronic viral hepatitis treatment is a major unmet health need, with restricted access to specialists outside of tertiary, largely metropolitan hospitals. To increase treatment of chronic viral hepatitis in regional Queensland, a team-based telehealth model was expanded. This expansion embedded an initial nursing consultation prior to specialist telehealth consultation. We conducted a retrospective audit of the introduction and expansion of hepatology telehealth services. Activity from July 2014–June 2015 (pre-expansion) was compared with July 2015– June 2016 (post-expansion). Interviews were conducted with key staff to determine factors contributing to success of the service and identify ongoing challenges to the service model. A greater than four-fold increase in clinical consultation was observed (131 telehealth consultations pre-expansion vs 572 post-expansion; p < 0.001). The failure to attend rate decreased (13.0% vs 6.5%, pre vs post-expansion respectively; p = 0.030), suggesting engagement with the service increased. Staff cited nurse-conducted primary assessment prior to specialist consultation and personalised patient treatment packs as key contributors to increased patient flow and engagement. This expanded team approach appears effective in delivering specialised treatment to an underserved area in regional Central Queensland. It may serve as a model to further expand telehealth management of chronic disease for regional Queenslanders.
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Lewis, Chrystal L., Jennifer Langhinrichsen-Rohling, Candice N. Selwyn, and Emma C. Lathan. "Once BITTEN, Twice Shy: An Applied Trauma-Informed Healthcare Model." Nursing Science Quarterly 32, no. 4 (September 12, 2019): 291–98. http://dx.doi.org/10.1177/0894318419864344.
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Nurses need a pragmatic theory to understand and respond to the impact of vulnerable patients’ previous healthcare experiences, as these are likely to influence response and adherence to treatment plans. The authors of this paper present the new BITTEN (Betrayal history by health-related institutions, Indicator for healthcare engagement, Traumas related to healthcare, Trust in healthcare providers, patient Expectations and Needs) Model of Trauma-Informed Healthcare. BITTEN identifies patients’ current healthcare expectations and needs as a function of their previous betrayal by healthcare systems, which operates in conjunction with their current health indicators to potentially trigger trauma symptoms and impact trust in healthcare providers.
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Seltzer, Ryan G. N., Stephen Michael, Heather P. York, and Nicole Yuan. "The predictive value of intake questions on informing tailored quitline services." Journal of Smoking Cessation 15, no. 3 (June 17, 2020): 149–56. http://dx.doi.org/10.1017/jsc.2020.18.
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AbstractThe Minimal Data Set are demographic and tobacco use questions asked during enrollment at many quitlines. We tested whether these questions can be used to predict program engagement and success, and to evaluate whether findings can inform the tailoring of protocols to disparate populations. We analyzed 7,920 Arizona Smokers' Helpline treatment records to test a Structural Equation Model of the mediating effects of quitline services and short-term cessation outcomes on the relationship between intake questions and 7-month quit rate. Education (b = 0.05), gender (b = 0.03), Medicaid (b = −0.09), longest length of previous quit attempt (b = 0.05), confidence in quitting for 24 h (b = 0.04), environmental risk (b = −0.05), and life stress (b = 0.04) all significantly (P < 0.05) predicted engagement in quitline services. Program engagement had a direct effect on an in-program cessation outcomes construct (b = 0.47) and 7-month quit rate (b = 0.44). This in-program cessation outcomes construct had a significant direct effect on 7-month quit rate (b = −0.12). This model showing the relationship between program engagement and outcomes suggests that tailoring protocols can focus on engaging clients who have historically not taken full advantage of quitline services.
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Ennis, Robin Parks, Kathleen Lynne Lane, and Wendy Peia Oakes. "Empowering Teachers With Low-Intensity Strategies to Support Instruction: Within-Activity Choices in Third-Grade Math With Null Effects." Remedial and Special Education 39, no. 2 (March 2018): 77–94. http://dx.doi.org/10.1177/0741932517734634.
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Instructional choice is a low-intensity strategy that can improve academic engagement. In this study, we investigated the effects of within-activity choices offered during math by third-grade teachers to participating students with behavioral and academic needs. We utilized a professional development model to train teachers to implement instructional choice in the classroom while collecting direct observation data on student’s academic engagement. Teachers were able to implement practices with high levels of integrity and collect momentary time sampling data on one student with high levels of reliability. Using a withdrawal design, we found no clear functional relation between instructional choice and increases in student’s academic engagement. However, some students demonstrated an increase in level upon the introduction of the intervention. Both teachers and students rated the intervention goals, procedures, and outcomes as acceptable. Possible reasons for a lack of treatment effect on student academic engagement are discussed.
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Pope, Leslie M., and Gregory E. Harris. "Assertive Community Treatment (ACT) in a Rural Canadian Community: Client Characteristics, Client Satisfaction, and Service Effectiveness." Canadian Journal of Community Mental Health 33, no. 3 (December 1, 2014): 17–27. http://dx.doi.org/10.7870/cjcmh-2014-019.
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This study describes an assertive community treatment (ACT) model in a rural Canadian location and examines characteristics of ACT service users, their degree of satisfaction with ACT, and whether their engagement with ACT resulted in reduced reliance on acute psychiatric services and hospital emergency room use. Chart audits were used to collect demographic and clinical participant data, including days of psychiatric admission and emergency room (ER) visits. Twenty-nine ACT clients agreed to participate. The majority of participants (82.8%) were male and had been diagnosed with schizophrenia or a schizoaffective disorder (65.5%). There was a high rate of concurrent substance abuse (75.9%). The average number of readmission days was reduced from 14 to 0 (p < 0.05) following engagement with ACT, and the average number of visits to ER s was reduced from 3 to 1 (p < 0.05). Participants reported overall high satisfaction with ACT services. Study implications for policy and practice are discussed along with future research recommendations.
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Elias, Flavia, Luciana Gallo, Ana Carolina Pereira, Erica Silva, Juliana Girardi, and Daniella Pereira. "PP95 Engagement Of Local Policymakers In HTA With Positive Results." International Journal of Technology Assessment in Health Care 34, S1 (2018): 101–2. http://dx.doi.org/10.1017/s0266462318002398.
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Introduction:São Paulo city in Brazil has implemented social and health care for homeless people with pulmonary tuberculosis since 2007. We conducted a health technology assessment (HTA) of the interventions provided based on a national theoretical model using 2015 data and an overview of systematic reviews. The HTA was requested by national policymakers. The results demonstrated that the interventions for pulmonary tuberculosis were satisfactory. The municipal secretariat implemented actions to improve the national treatment recommendations and adopted incentives to increase adherence to treatments. Our objective was to describe the feedback process for the Health Secretariat.Methods:The feedback was categorized as: (i) an executive abstract with key messages (i.e. ninety-seven percent of notified cases underwent sputum smears, nineteen percent were hospitalized, and fifty-nine percent were cured) reported to policymakers involved in the surveillance program; and (ii) three meetings were organized jointly by the research group and local policymakers.Results:In 2016 we conducted a meeting to present the results. Thirty-nine professionals involved in the primary care team working on the streets (thirty-five percent) and the Tuberculosis Surveillance and Control Program (five percent) were present. The main barriers presented by the professionals were issues of human resources (i.e. suboptimal professional staff and having two different social organizations responsible for health care). The main facilitators presented by professionals were: (i) using homeless-peers as healthcare workers; (ii) having a network linking the primary care and surveillance programs; and (iii) periodic training.Conclusions:In addition to the positive results, the HTA presented an opportunity to discuss the sustainability of incentives for adhering to treatments adopted by the policymakers, such as meal allowances and housing support, to improve social conditions among the homeless.
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Wake, Mark, and William Green. "Relationship between employee engagement scores and service quality ratings: analysis of the National Health Service staff survey across 97 acute NHS Trusts in England and concurrent Care Quality Commission outcomes (2012–2016)." BMJ Open 9, no. 7 (July 2019): e026472. http://dx.doi.org/10.1136/bmjopen-2018-026472.
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ObjectiveThis research explores measures of employee engagement in the National Health Service (NHS) acute Trusts in England and examines the association between organisation-level engagement scores and quality ratings by the Care Quality Commission (CQC).DesignCross-sectional.Setting97 acute NHS Trusts in England.Participants97 NHS acute Trusts in England (2012–2016). Data include provider details, staff survey results and CQC reports. Hybrid Trusts or organisations affected by recent mergers are excluded.Outcome measuresAnalysis uses organisation-level employee engagement and CQC quality ratings.ResultsEmployee engagement is affected by organisational factors, including patient bed numbers (β=−0.46, p<0.05) and financial revenue (β=0.38, p<0.05). CQC ratings are predicted by overall employee engagement score (β=0.57, p<0.001) and financial deficit (β=−0.19, p<0.05). The most influential employee engagement dimension on provider ratings is ‘advocacy’ (λ=0.54, p<0.001). Analysis supports the notion that employee engagement can be predicted from advocacy scores alone (eigenvalue=4.03). Better still, combining advocacy scores from the previous year’s survey or adding in motivation scores is a highly reliable indication of overall employee engagement (95.4% of total variance).ConclusionsNHS acute Trusts with high employee engagement scores tend to have better CQC ratings. Trusts with a high financial deficit tend to have lower ratings. Employee engagement subdimensions have different associations with CQC ratings, the most influential dimension being advocacy score. A two subdimension model of engagement efficiently predicts overall employee engagement in NHS acute Trusts in England. Healthcare leaders should pay close attention to the proportion of employees who would recommend their organisation as a place to work or receive treatment, because this is a proxy for the level of engagement, and it predicts CQC ratings.