Дисертації з теми "Mental Health Assessment"
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1
Coates, Rose. "Assessment of perinatal mental health problems." Thesis, University of Sussex, 2017. http://sro.sussex.ac.uk/id/eprint/67082/.
Анотація:
Mental health problems in pregnancy and the postnatal period can have long-term negative effects on women and their children. A key barrier to helping women in this period is the low level of identification of mental health problems. Depression has commonly been screened for using the Whooley Questions or Edinburgh Postnatal Depression Scale (EPDS) but women may experience a broad range of symptoms of distress not captured by these measures. The research reported in this dissertation was designed to address several aims. The first strand aimed to explore women's experiences of postnatal mental health problems and how they conceptualise their symptoms. The focus of the first qualitative study was the lived experience of 17 women who had experienced psychological distress in the first postnatal year, and used interpretative phenomenological analysis. The second qualitative study used thematic analysis with the same sample to explore different symptoms of distress and women's experiences of being assessed for these. The second strand reviewed and evaluated currently existing measures of commonly reported affective symptoms with a view to informing future assessment. A systematic review found a lack of measures of anxiety designed for or validated sufficiently with perinatal women. Factor analyses of the EPDS then explored the structure of depression and anxiety symptoms in the perinatal period in the Avon Longitudinal Study of Parents and Children (N = 11,195 – 12,166). Results suggested symptom clusters of anhedonia, depression and anxiety. Finally, validity of the CORE-10, a short measure of psychological distress was evaluated in a sample of 366 pregnant women. The CORE-10 showed promising psychometric properties. Anxiety was the most reported symptom. Overall findings suggest that perinatal women need to be assessed for a variety of mental health problems and that further work is needed to identify the most effective assessment tool and process.
2
Skinner, Laura. "Negotiating uncertainty : mental health professionals’ experiences of the Mental Health Act assessment process." Thesis, University of Leicester, 2006. http://hdl.handle.net/2381/8972.
3
Osipov, Maxim. "Towards automated symptoms assessment in mental health." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:42111684-8801-440e-8fbb-00f779d806ee.
Анотація:
Mental and behavioural disorders introduce a significant burden on society, estimated to account for 12% of the global burden of disease, with approximately 450 million suffering from them every day, and only a small number of those getting any treatment. The situation will worsen with time, with unipolar depressive disorders predicted by the World Health Organisation to become the leading cause of disabilities by 2030. Mental disorders affect primarily the mind and the brain, leading to pathological changes in emotions or cognition. Although clinical manifestations of different mental disorders may vary, Liddle et al. suggested five principal symptom dimensions, including reality distortion, disorganisation, psychomotor, mood and anxiety dimensions. For assessment of symptoms in clinical practice, the structured clinical interview, alongside standard questionnaires are used, but in many cases are not providing a reliable and objective diagnostic tool due to the complexity of the assessed phenomena. Activity and motion analysis has the potential to be used as a diagnostic tool for mental disorders. However, to-date, little work has been performed in turning stratification measures of activity into useful symptom markers. The research presented in this thesis has focused on the identification of objective activity and behaviour metrics that could be useful for the analysis of mental health symptoms in the above mentioned dimensions. Particular attention is given to the analysis of objective differences between disorders, as well as identification of clinical episodes of mania and depression in bipolar patients, and deterioration in borderline personality disorder patients. A principled framework is proposed for mHealth monitoring of psychiatric patients, based on measurable changes in behaviour, represented in physical activity time series, collected via mobile and wearable devices. The framework defines methods for direct computational analysis of symptoms in disorganisation and psychomotor dimensions, as well as measures for indirect assessment of mood, using patterns of physical activity, sleep and circadian rhythms. An extensive mHealth software tracking system was constructed, and data collected from over 100 individuals. Using the developed framework, the accuracy of differentiation between healthy controls and bipolar disorder was 67%, healthy controls and borderline personality disorder 70%, and bipolar vs. borderline personality disorder 80%. For identification of clinical states of euthymia, mania and depression the accuracy of differentiation of euthymia and mania was 80%, euthymia and depression 85% and mania and depression 90%, when using leave-one-out cross-validation. For personalised mood models, the mean absolute error of symptom scores estimation was in the range of 1.36 to 3.32 points, this corresponds to the ranges reserved in psychiatric questionnaires for a unique identifiable mood state (4-5 points). Finally, the methods were applied to a new data set (schizophrenia patients and matched controls) and were shown to be 95.3% accurate using leave-one-out cross-validation at classifying the cohort. Both physiological as well as activity features were relevant for classification of this cohort, and so the hypothesis that heart rate added additional predictive power was tested. The combination of HR and locomotor activity features provided almost a 10% increase in classification accuracy above using locomotor features alone, and almost a 17% increase over using heart rate based features alone. The approach of computational behaviour analysis, proposed in this thesis, has the potential for early identification of clinical deterioration in ambulatory patients, and allows for the specification of distinct and measurable behavioural phenotypes, thus enabling better understanding and treatment of mental disorders.
4
Storms, Starr 1948. "An assessment of the mental health of mental health care workers in the public sector." Thesis, The University of Arizona, 1993. http://hdl.handle.net/10150/291732.
Анотація:
The mental and emotional well-being of mental health care professionals can be jeopardized by burnout, a syndrome similar to depression and other affective disorders in its symptomology and effects. A questionnaire designed to assess mental health and burnout was developed using various assessment tools from the mental health care community to obtain information about health habits, stressors, coping skills, personal history, and length of service. Forty-seven workers at a public mental health facility responded to the questionnaire. The results of this study suggest that approximately 20% of mental health care-givers are experiencing high degrees of burnout and mental disease. Neither personal history or long-term service appears to contribute to the burnout. Workers new to the field seem to be at greatest jeopardy. Control coping mechanisms were found to be more effective than escape coping mechanisms in combating stress and mental illness.
5
Morris, Desiree Lin. "MENTAL HEALTH INTERVENTION: DOES AN EXPEDITED PROCESS INCREASE ACCESS TO MENTAL HEALTH SERVICES FOR CHILDREN?" CSUSB ScholarWorks, 2018. https://scholarworks.lib.csusb.edu/etd/640.
Анотація:
Child maltreatment negatively impacts physical, emotional, and the health and well-being of a person, often with lifelong implications. The importance of this study derives from the very necessity of mental health services for children who have suffered trauma. Children’s Assessment Centers (CAC) assess and refer children who have experienced abuse to a therapist in the community. This study examines the use of an enhanced referral process used to connect some CAC clients more quickly to therapeutic services in the community. The study examined whether children who received this expedited referral service were more likely than children who received the standard referral process to see a therapist within three months. The study used data provided by one CAC in California. The CAC provided information on clients who received either the expedited or standard referral process within a 3-month period in 2017. The researcher then contacted the clients’ caregivers to ask whether the child saw a therapist within 3-months of the child’s referral from the CAC. The study used a Chi-square test to analyze whether children who received an expedited referral to mental health services were more likely than children who received the standard referral to receive mental health services within three months. Results indicated no statistically significant difference in access to mental health services for the two groups. However, during data collection, the researcher learned that some children were already engaged in therapy at the time they received the referral, perhaps rendering the referral unnecessary. Implications for social work practice, policy, and research are discussed.
6
Lewis, Sarah Elizabeth. "Assessment of mental health for looked after children." Thesis, University of Hull, 2014. http://hydra.hull.ac.uk/resources/hull:10528.
Анотація:
The portfolio has three parts: Part One: A systematic literature review, in which the literature relating to the assessment and identification of mental health problems in looked after children is reviewed. Part Two: A mixed methods empirical research study which qualitatively explores foster carer’s perceptions of screening measures used with looked after children and the ability of these to capture need. Clinicians’ views regarding the same issue are also explored both quantitatively and qualitatively. Part Three: Appendices including all relevant documents related to the systematic literature review and empirical papers and a reflective statement from the researcher on the process of completing the portfolio.
7
Keynan, Nitzan. "Family Art Assessment Praxis In Community Mental Health." Digital Commons at Loyola Marymount University and Loyola Law School, 2013. https://digitalcommons.lmu.edu/etd/16.
Анотація:
This study endeavors to explore the use of Helen B. Landgarten’s Family Art Assessment as a consultation service, in community mental health clinic settings. This research is a continuation of a pilot project initiated by director of the Helen B. Landgarten Art Therapy Clinic, Dr. Paige Asawa, MFT, ATR-BC, in which Dr. Asawa implemented the Landagarten Family Art Assessment at a local clinic with five families. The initial results of that study were examined and analyzed by Meirav Haber, who used a survey and an art response component to document the participants’ experience. In this study, a focus group was conducted, which consisted of various stakeholders in the agency from administration to the clinicians who participated in the initial pilot project. They shared their thoughts and feelings about the experience in a semi-structured conversational setting. The focus group recording was transcribed and analyzed into three themes: procedural recommendations, assessment conceptualizations, and therapeutic relationship indications. This indication pertained to the formation and stability of the therapeutic relationship between the family and its primary clinician, which must exist prior to conducting the Family Art Assessment. A synthesis of the existing protocol, focus group conversation, and the literature reveals that it is beneficial to have both the assessing art therapist and the primary clinician present in the therapy room during the consultation of the Family Art Assessment, in order for the results of the assessment to be as authentic and valid as possible. These results may contribute to a better understanding of the possibilities of having art therapy consultations as this local clinic, and to promote collaboration between art therapists and mental health professionals.
8
Suihkonen, Angela R. "Dunn County comprehensive health assessment phase II social and mental health /." Online version, 2002. http://www.uwstout.edu/lib/thesis/2002/2002suihkonena.pdf.
9
Fentress, Shelley Greenwell. "A Needs Assessment of Communicare's Children Mental Health Services." TopSCHOLAR®, 2012. http://digitalcommons.wku.edu/theses/1207.
Анотація:
This document is a review of literature on needs assessments and the benefits of conducting one. Communicare is a mental health agency that serves the Lincoln Trail Region. Currently, most of the revenue from their children programs comes from Medicaid, which is a fee-for-services payer source. The Kentucky Medicaid Program is in the process of contracting with managed care organizations to oversee services that have been paid directly from Kentucky Medicaid. With these changes, mental health organizations must identify specific community service needs as well as expanding revenue sources. Applying for grants is one way mental health agencies can expand revenue sources. Communicare has identified the KY SEED grant that focuses on prevention and providing services to early childhood programs as a potential funding source. A needs assessment was conducted to gather information on children services implemented by Communicare. It was conducted in order to assess current programs and seek out potential areas of future program growth. The needs assessment further sought to identify gaps in services for the early childhood programs and assist in the grant application process. A review of existing data on children’s services offered at Communicare, including a satisfaction survey and a System of Care Assessment Report, was conducted as part of the needs assessment. A Community Forum with community partners from the Lincoln Trail region was held to gather additional data for the needs assessment.
10
Farrally, Vicki Lea. "An analysis of need assessment in the mental health context." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24659.
Анотація:
Need assessment methods grew out of the Community Mental Health Centre movement. Developed during a time of rapid expansion of service, there was a focus on providing services matched to the unique needs of a community. In the following years need assessment further developed as a technology and a search began for a "best model'. This paper argues that a "best model' is illusionary, a "best fit' being a more desirable goal. As fiscal constraints have reduced the resources available to consumption Ministries such as Health, need assessment has been increasingly used an allocative tool. Users of the tool, it is argued, must therefore choose their model with care and an understanding of the values and concepts inherent in each model is seen as necessary for intelligent choice. Finally, an examination of the British Columbia mental health context offers an analysis of some of the factors which have and will affect the use of need assessment in this ProvinceMedicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
11
Beckham, Tony A. "Adolescent mental health services the use of psychological consulting /." Theological Research Exchange Network (TREN), 2005. http://www.tren.com.
12
Hope, Judith Dorothy 1969. "Aspects of psychometric assessment of outcomes measurement in mental health." Monash University, Dept. of Psychological Medicine, 2002. http://arrow.monash.edu.au/hdl/1959.1/8119.
13
Ahmed, Abu. "Knowledge engineering for mental-health risk assessment and decision support." Thesis, Aston University, 2011. http://publications.aston.ac.uk/16431/.
Анотація:
Mental-health risk assessment practice in the UK is mainly paper-based, with little standardisation in the tools that are used across the Services. The tools that are available tend to rely on minimal sets of items and unsophisticated scoring methods to identify at-risk individuals. This means the reasoning by which an outcome has been determined remains uncertain. Consequently, there is little provision for: including the patient as an active party in the assessment process, identifying underlying causes of risk, and eecting shared decision-making. This thesis develops a tool-chain for the formulation and deployment of a computerised clinical decision support system for mental-health risk assessment. The resultant tool, GRiST, will be based on consensual domain expert knowledge that will be validated as part of the research, and will incorporate a proven psychological model of classication for risk computation. GRiST will have an ambitious remit of being a platform that can be used over the Internet, by both the clinician and the layperson, in multiple settings, and in the assessment of patients with varying demographics. Flexibility will therefore be a guiding principle in the development of the platform, to the extent that GRiST will present an assessment environment that is tailored to the circumstances in which it nds itself. XML and XSLT will be the key technologies that help deliver this exibility.
14
Aflague, John M. "Suicide assessment by psychiatric-mental health nurses : a phenomenographic study /." View online ; access limited to URI, 2004. http://0-wwwlib.umi.com.helin.uri.edu/dissertations/dlnow/3135890.
15
Kelleher, Shannon R. "Teachers’ Beliefs About Mental Health Issues." CSUSB ScholarWorks, 2014. https://scholarworks.lib.csusb.edu/etd/16.
Анотація:
This study examined teachers’ beliefs about mental health issues in students. A quantitative research method was utilized, and survey instrument was created modeled after the theory of planned behavior. Thirty-seven teachers were surveyed in five areas in relation to their beliefs about assessment and referral; including, previous assessment and referral; mental health training; attitudes toward assessment and referral; the perceived social normality of assessment and referral; and perceived self-efficacy or behavior control. These five areas became independent variable measures, with the dependent variable being their future intention of assessing and referring students with mental health issues. Multiple regression analysis revealed that the overall model was statistically significant in predicting teachers’ intention to assess and refer students; however, independent analysis of independent variable revealed teachers’ attitudes, past behavior, and accesses to mental health training were most the most significant predictors of future intention. Implications of this study highlight the need qualified mental health professionals to be present in schools and/or expanded training of teachers.
16
Au, Chak-kwong. "The making of mental health policy in Hong Kong : problems in need assessment /." [Hong Kong : University of Hong Kong], 1986. http://sunzi.lib.hku.hk/hkuto/record.jsp?B12323172.
17
Bomar, Ginger. "An Assessment of Associations Between Selected Health Practices and Mental Wellness." TopSCHOLAR®, 1994. http://digitalcommons.wku.edu/theses/931.
Анотація:
The purpose of this study was to assess the relationship between mental well-being and selected health behaviors. A cross-sectional study was performed on a sample of 490 students at Western Kentucky University during the 1993 Spring, Summer, and Fall semesters. Study participants completed the Participant Data Sheet, General Weil-Being Schedule, and the Health Behavior Instrument. The data were gathered and analyzed via correlation analysis which revealed a relationship between mental well-being and certain health behaviors. The correlations between general well-being and selected health behaviors were stronger among males than females. There was a relationship found between mental well-being and hours of sleep, eating breakfast, and exercising. It is very noteworthy that there was a significant correlation between GWBS and combined health behaviors.
18
Greene, Jennifer A. "Assessing Readiness to Seek Formal Mental Health Services: Development and Initial Validation of the Mental Health Belief Model Assessment (MHBMA)." Scholar Commons, 2018. http://scholarcommons.usf.edu/etd/7159.
Анотація:
Only a small percentage of people with mental health issues utilize mental health services. This would seem contradictory given the increasing understanding of mental disorders, their high prevalence, and associated disability and distress. Research shows that individual level factors, such as perceptions of need, mental health knowledge, mental health attitudes, and mental health literacy, are related to individuals’ decisions to seek mental health services. The Health Belief Model (HBM) posits four types of health beliefs that affect an individual’s health behavior, in this case, the decision to seek mental health services. To date, researchers and clinicians have no assessment tool to empirically identify the factors affecting a particular individual’s decision making about using mental health services. Therefore, the goal of this study was to develop and validate a self-report instrument, called the Mental Health Belief Model Assessment (MHBMA), designed to assess readiness to seek formal mental health services. Based on the HBM, the MHBMA includes 76 items grouped into five scales: Perceived Susceptibility and Fears, Perceived Severity, Perceived Benefits, Perceived Barriers, and Self-efficacy. A 20-item short form was also developed. The responses of a validation sample of 192 adults provided the initial evidence for reliability and validity of the MHBMA. In terms of reliability, internal consistency reliability was high for each scale, with Cronbach’s alphas ranging from .90 to .97, and test-retest correlation coefficients for each scale were strong, ranging from .82 to .92. Evidence for validity was examined via test content, internal structure, and relations to other variables. Specifically, moderate to high correlations in the expected directions were found between the MHBMA and Attitudes Toward Seeking Professional Psychological Help Scale-Short Form and the Barriers to Help Seeking Scale. The scale scores on the MHBMA were also examined in relation to a number of demographic and service use variables. Guidelines for use and interpretation on the MHBMA, delimitations and limitations of the current study, and implications for research and practice are discussed.
19
Carson, Jerome Francis John. "The stress process in mental health workers : assessment and intervention studies." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.420885.
20
Bodine, Megan N. "Validation of the Mental Health Recovery Measure as a Clinical Assessment." University of Toledo / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1372776438.
21
Elzarka, Mohamed. "Mental Health in Bosnia and Herzegovina: Situational Assessment and Policy Recommendations." University of Cincinnati / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1554214413881192.
22
Purin, Barbara RuthAnn. "Attitudes of community mental health nurses toward doing a spiritual assessment with mentally ill seniors." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape11/PQDD_0020/MQ48832.pdf.
23
Gustafsson, Carina. "Intellectual Disability and Mental Health Problems : Evaluation of Two Clinical Assessment Instruments, Occurrence of Mental Health Problems and Psychiatric Care Utilisation." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3531.
24
Vermeer, Quist Heidi L. "Psychological assessment and consultation in service of the church a collaborative case study using the Multi-method Church Assessment Process /." Online full text .pdf document, available to Fuller patrons only, 2002. http://www.tren.com.
25
Johnson, Eric. "Probation Officer Perspectives on Integrating Mental Health Assessment Results in Case Planning." Thesis, Capella University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10937164.
Анотація:
In the United States, recidivism rates among juvenile offenders continue to grow year after year, despite decades of research to understand the problem, including more recent efforts by the courts to focus on alternatives to incarceration. More contemporary research efforts have suggested that targeting specific risk factors, particularly mental health issues, in juvenile offenders is an effective method for not only reducing recidivism, but the successful completion of probation programs. In virtually all juvenile justice systems across the country, offenders are given a mental health assessment when entering the system, although utilizing the results is neither mandate not nor consistently applied in many cases. This study sought to understand, from the perspective of probation officers in one county in Arizona, why the assessments are not more widely and consistently used. Specifically, this study sought to answer the following research question: How do probation officers for juveniles describe the barriers to implementation of mental health assessments in case planning? This study used a generic qualitative methodology, interviewing current juvenile probation officers. Interviews were recorded, transcribed, analyzed, and ultimately identified three primary themes: lack of training, overwhelming caseloads, and an overall problem with the perceived value of the assessments. Subsequently, these themes are indicators of barriers that probation officers face in their jobs when it comes to implementing mental health assessment results in case planning. Ultimately, this study provided new insight into why juvenile probation officers do not more consistently utilize mental health assessment results and offers implications for future research to expand the population, scope, and understanding of this research topic.
26
Au, Chak-kwong, and 區澤光. "The making of mental health policy in Hong Kong: problems in need assessment." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1986. http://hub.hku.hk/bib/B31974661.
27
Gélinas, Isabelle. "Disability assessment in dementia of the Alzheimer's type." Thesis, McGill University, 1995. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=28756.
Анотація:
Functional disability assessments are recognized as being important for the diagnosis of Dementia of the Alzheimer's type (DAT) as well as for monitoring the impact of intervention and determining the need for home assistance or institutionalization. Existing instruments designed for the assessment of functional disability with this population are generally unsatisfactory with regards to their content or psychometric properties. The objective of this research project was to develop a more appropriate French and English assessment of functional disability for use with proxy-respondents of community-dwelling individuals who have DAT. The Disability Assessment for Dementia (DAD) was developed in several stages using three panels composed of health care professionals and caregivers of individuals with DAT. Forward-backward translation procedures were performed at each stage to ensure that the French and English versions of the scale were comparable. Content validity was verified by a fourth panel of experts. The DAD was then administered to 59 community-dwelling DAT subjects and their caregivers to determine internal consistency and the need to eliminate items. The instrument developed, which consisted of 46 items, was reduced to 40 items, 17 related to basic self-care and 23 to instrumental activities of daily living, as a result of this process. The content validity of the final version was established by a majority of members from the panel of experts. It also demonstrated a high degree of internal consistency (Cronbach's alpha = 0.96) and excellent interrater (N = 31) and test-retest (N = 45) reliability (Intraclass correlation coefficients of 0.95 and 0.96 respectively). In addition, it was found not to have gender bias. Estimates of its validity were determined in another study. The DAD represents a valid and reliable instrument which is short and easy to administer. This instrument should have a positive impact on geriatric rehabilitation, and on clinical and
28
Arnold, Cassidy C. "EVALUATION OF A COMMUNITY MENTAL HEALTH CENTER’S ASSESSMENT CLINIC: DEVELOPMENT OF A NOVEL ASSESSMENT EVALUATION TOOL." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/2597.
Анотація:
High quality assessment services are the linchpin connecting youth with mental health problems to diagnosis-specific, evidence-based treatments. The effort to improve assessment services is in its early days and faces a number of substantial challenges. This study was an initial effort to address these challenges through the development of a standardized, multi-dimensional Assessment Instrument evaluation tool—the Strength of Measure (SoM)—based on operationally defined criteria supported by decades of psychometric research. The SoM and other criteria addressing assessment practices were piloted with data from 32 consecutive assessment reports from a community mental health center’s Assessment Clinic. Results indicate that none of the Assessment Instruments used by the Assessment Clinic met the “Adequate” level of support on each of the SoM dimension. Additional results address Reason for Referral, Primary Axis I Diagnosis, Informants, and Method of Assessment. Implications and directions for future research are discussed.
29
Young, Matthew E. "Comparison of Diagnostic Interviews for Children Accessing Outpatient Mental Health Services." The Ohio State University, 2010. http://rave.ohiolink.edu/etdc/view?acc_num=osu1274748739.
30
Brown, David Raymond Carney Jamie S. "Assessment of spirituality in counseling the relationship between spirituality and mental health /." Auburn, Ala, 2008. http://repo.lib.auburn.edu/EtdRoot/2008/SPRING/Counselor_Education,_Counseling_Psychology,_and_School_Psychology/Dissertation/Brown_David_52.pdf.
31
Kling, Michael Patrick. "Needs Assessment for Mental Health Support Towards Emergency Medical Service (EMS) Personnel." Thesis, Regent University, 2021. http://pqdtopen.proquest.com/#viewpdf?dispub=27961789.
Анотація:
Understanding and assessing the needs of Emergency Medical Service (EMS) personnel and other first responders is crucial for providing these individuals with the resources needed within their community. The literature discusses how EMS personnel are at risk for psychological impairment due to routine exposure to traumatic events and occupational stressors within EMS organizations. Additionally, the research has supported the importance of positive coping abilities, organizational belongingness, and social support within the lives of EMS personnel to enable them to resiliently handle the occupational stress of their job. This study investigated the occupational needs of EMS providers to determine if they are receiving resources within their organization to cope with occupational stressors. Participants for this study comprised (n=153) paramedics and fire-fighters from the Tidewater EMS Council organization. A needs assessment was conducted to explore correlations between quality of life, resiliency, years of service, level of education, burnout, secondary traumatic stress, interpersonal support, positive and negative religious coping, and the occupational needs of EMS personnel. The results revealed that burnout (r=4.27**) and secondary traumatic stress (r.215*) were important factors for determining occupational turnover among EMS personnel. Furthermore, EMS providers reported occupational needs such as easier access to mental health, improved staff relations, adequate staffing, and improved shift hours are needed within their organization. Future research should explore differences in occupational needs with EMS providers among EMS organizations in metropolitan and rural communities. Keywords: Emergency Medical Services (EMS), Burnout, Occupational Stress, Traumatic Critical Incidents
32
McEvers, Sara Elizabeth, and Sara Elizabeth McEvers. "Adolescent Mental Health in Primary Care: A Needs Assessment for Improving Practice." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/624513.
Анотація:
Background: Youth and young adults have the highest incidence and prevalence of mental health issues, and most do not receive the services they need. Mental health is an essential component of wellness, and primary care providers (PCPs) serve a critical role in promoting mental well-being, identifying problems, facilitating and coordinating services, and managing and monitoring mental health outcomes. Many barriers exist to incorporating mental health into routine primary care for adolescents, and little is known about the specific nature of the obstacles that impede the quality improvement process related to integrating mental and physical health and how to overcome them.
Objectives: The purpose of this DNP project was to gain insight into the PCP role, exploring perceptions, current practices, and barriers related to screening, identifying, and managing adolescent mental health needs, understand the challenges and opportunities, and guide future quality improvement projects that reflect and respond to the needs of adolescents in the local community in effective and sustainable ways.
Methods: The project was designed as a needs assessment, and conducted as an anonymous 20 question survey that was distributed to 13 local PCPs that routinely provide primary care services to the community’s adolescent population.
Results: Nine of the surveys were completed and returned. Time constraints and competing demands were dominant concepts, reported as primary barriers to screening, collaboration with mental health professionals, and addressing mental health in general. The participants articulated the need for high-quality professional mental health involvement, improved collaboration, inter-professional development, and inter-agency cooperation to successfully promote mental health and provide excellent care that improves outcomes. They also displayed an interest in innovative solutions and organizational restructuring to better coordinate mental health services.
Conclusion: This project offered preliminary insight into the challenges faced by PCPs addressing adolescent mental health in primary care, and generated ideas for further exploration to guide quality improvement initiatives designed to support the providers' capacity to incorporate mental health into routine care, and contribute to the community’s efforts in promoting mental health for local youth. PCPs occupy esteemed roles in the community, and their perspectives and insight are invaluable.
33
Ashaye, Olakunle Adebisi. "The effectiveness of the Camberwell Assessment of Need for the Elderly (CANE) as a needs assessment tool in the psychiatric day hospital care of older people." Thesis, University College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325591.
34
Jefferies-Sewell, Kiri. "An exploration of barriers and facilitators to risk assessment in mental health professionals." Thesis, University of Hertfordshire, 2015. http://hdl.handle.net/2299/17109.
Анотація:
The decisions made by Mental Health Professionals (MHPs) are of utmost significance for providing the highest quality care to service users. The assessment of risk is one of the pivotal processes that MHPs undertake frequently, as per government policy guidelines, and in order to safeguard patients and the public. Although Risk Assessment Proformas (RAPs) consume a proportion of MHP time and resources, very little research has been undertaken to address factors that might affect their most optimal utilisation in practice. Previous literature suggests that medical decisions, like decision making of other kinds, is fraught with difficulty including being susceptible to the influence of cognitive biases, pre-decisional affect, overconfidence, and subjectively held attitudes towards organisational policies and regulations. Specifically, the presentation of risk information can influence decisions. It has also been suggested that anxiety has the capacity to elicit risk aversive responses, and that overconfidence and negative attitude may lead to complacency in undertaking policy-led responsibilities and produce non-compliance for the same. However, much of what is known about medical decision making has been gleaned from outside of context of mental health. As such, the current programme of research aimed to explore decision making in mental health settings and with a view to raise awareness of the complexity of decision making amongst MHPs. The implementation of quantitative and qualitative techniques (studies 1 and 2) revealed negative attitudes from psychiatrists towards Risk Assessment Proformas (RAPs), which are essentially structured decision making aids. Psychiatrist, compared to other MHPs, spent less time completing RAPs, which may reflect their differing attitudes towards their usefulness, something that was consistently emphasised during in-depth qualitative exploration. It was also found that experience was an additional differentiating factor between MHPs. Relationships between experience and other factors such as anxiety, confidence and complacency were found via conversations with MPHs, experience members of staff being less inclined to provide comprehensive and detailed accounts of service user risk in RAPs. This is problematic since although there is, in the UK, a policy led requirement that RAPs are completed for each service user, it is clear that there are inter-professional variations in how RAPs are being used and this acts to inhibit the best information sharing between all those involved in patient care. Following previous work in the area of cognitive bias and its influence upon general and medical decisions, a clinical vignette was also developed (study 3) to establish whether the presentation of risk information influences psychiatric admission decisions. The current findings supported previous work in that decisions were susceptible to the framing effect. The findings here, and previously in the literature, reveal a necessity for MHPs to be informed of bias in decision making in an attempt to improve objectivity in risk assessment practices. The unearthing of the framing effect also further signals the need for proper use of RAPs, where many MHPs may not be using them to their full potential - i.e. an aid to the systematic consideration of a range of information about a service user. The final part of the thesis (study 4) turned to the piloting of an educational module incorporating content around the factors affecting decision making in an attempt to raise awareness amongst MHPs. The rationale being better awareness of the complexity of decision making may act to enhance decision making processes. Pre and post intervention analyses revealed an improvement of baseline to follow-up knowledge of decision making bias and statistical concepts and this knowledge was maintained to a moderate level at four weeks follow-up. Although individuals maintained their susceptibility to the framing effect, the bias was less prevalent in those who knew of its presence before taking part in the study. Overall the findings give some support to the use of education as an approach to raising awareness about decision making processes in MHPs, although what remains to be seen is whether such education acts to bring about changes in behaviour - for example, different use of RAPs. The PhD programme suggests that MHPs are just as susceptible to cognitive biases, such as the framing effect, as has been demonstrated in both general population and other groups of health practitioners. At the same time, attitudes to RAPs differ depending on exact job role, which psychiatrist being least likely to spend time on their completion and reporting them as a tool for noting decisions reached as opposed to an aid to the process. This acts reduce the quality and quantity of reported information shared with colleagues about a service user. It is possible that MHP behaviour aligns with general attitude-behaviour models, such as the Theory of Planned Behaviour. As such, whilst the current work has demonstrated that educational interventions may act to improve awareness of decision making processes and their influences, further research would benefit from considering if these types of approach affect actual behaviour. For example, improved used of RAPs as decision-aids, reduced susceptibility to framing effects, consciousness around how information is represented in RAPs given knowledge of how the information may be used by others.
35
Lee, Victoria. "The organisation of access in child mental health assessments : a conversation analysis of initial assessment appointments at a child and adolescent mental service." Thesis, University of Leicester, 2018. http://hdl.handle.net/2381/42786.
Анотація:
Initial child mental health assessment appointments are an under researched area of interaction. Within the appointment, parents and children work to present a case to the clinicians of the child’s difficulties which situates their cause as legitimate, doctorable, and as requiring specialist services. The clinicians establish the reason for the child’s attendance, build an understanding of the difficulties the child is facing, and formulate and communicate a decision about whether there is a mental health related concern. The objective of this research was to explore the sequences of interaction between clinicians, parents, and the children in order to understand the social actions that are being accomplished through the participants talk. A conversation analytic framework was utilised to explore the interactions at a child and adolescent mental health service within 15 video recorded initial assessment appointments. Access to mental health services is organised through the construction of each participant’s turns in the interaction. Clinician’s question design elicits certain responses from the child, which then further orient to their perceived right to knowledge. Parents work to build a case for their child’s difficulties using a variety of rhetorical devices such as extreme case formulations and contrast devices that legitimise their need for specialist intervention. Clinicians deliver their decision about the child’s difficulties in such a way that asserts their authority and accountability in the relationship, whilst parents’ responses maintains this asymmetry. In conclusion, through their turns at talk, all parties in the interaction perform and accomplish different tasks which impact on the shape of the remainder of the appointment as well as the clinician-patient relationship and the child centeredness of the interaction. Conversation analysis proves a valuable and appropriate resource for researching child mental health appointments; a communication centred methodology for a communication based service.
36
Williams, Evelyn S. "Kenyan women with disabilities: An assessment of social support and mental health status." Kent State University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=kent1374846797.
37
Newbury, Emily Christine. "Internalized Homophobia of LGB Emerging Adults: Identity Complexities and Mental Health." Antioch University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1561720872149952.
38
Winters, Krysta. "A voice in the wilderness a needs assessment of a developing rural community /." Online full text .pdf document, available to Fuller patrons only, 2002. http://www.tren.com.
39
Walsh, Sean. "Performance-Based Assessment of Oral Dependency within a Forensic Inpatient Mental Health Population." University of Toledo / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1480456507489641.
40
McAllister, Margaret. "Enriching values : an educational criticism approach role of assessment in teaching mental health." Thesis, Queensland University of Technology, 1997.
Анотація:
This study focused on exploring student assessment approaches utilised by various teachers of mental health. Classrooms of three (3) teachers were selected to become
the subject of case studies that were described and analysed using an educational criticism method. The following evolved as major research questions:
What are the teacher's assessment values?
What effect does assessment have on enriching the learning process?
A qualitative approach was considered appropriate to address these questions because the nature of the enquiry was understanding rather than proof. Methods of
inquiry used for the study were
a) observation,
b) interviews with teachers and their
students, and
c) educational criticism as a medium for describing, analysing and presenting findings.
The case studies, each focussing in some way on mental health, produced rich descriptions of particular situations and prompted detailed analytical criticism from the researcher. Different themes about assessment of students in
psychiatric/mental health courses were uncovered and included:
• When assessment is reframed to mean pedagogy, instead of the more familiar notion as technique, it becomes part of teaching rather than an addition to it. In this way, the role of the teacher in promoting learning is enhanced and revalued. In relation to assessment, a teacher needs to have
technical expertise but more important are the creative ways a teacher invites students to think about and share approaches to assessment and practise the particular learning being assessed.
• Students who are learning the knowledge and practice of a discipline need guidance and support from their teachers. Furthermore, teachers have a commitment to the profession and to the community to graduate safe, effective practitioners. Therefore, assessment performs a dual role: in guiding and in judging.
Teachers are pressed with a fundamental tension between a desire to do justice to the content of a curriculum and to provide activities and pace that make it possible for students to engage with the subject matter, feel compassion for the people with whom they aim to work and develop
commitment to the profession. Some teachers recognise the inequalities that exist between teachers and students, and take effective action to reduce these inequalities without
surrendering the teacher's responsibility to assess students.
Some students prefer a passive role within the classroom but teachers can help overcome this resistance to active participation by easing students into the new role, by modelling approaches to learning and assessment, and by
providing regular, consistent, constructive formative assessment throughout the everyday classroom experience.
These themes were subsequently distilled into metaphors of teaching that reclaim the craft of teaching and assessment, remind teachers of the holistic role assessment can play within the classroom and may be used to guide future teacher action. These metaphors were teaching as a dance, a choir, and a journey. Woven into all of these images, is an understanding of assessment that appreciates assessment as a way of judging student progress: as a well performed dance and choir, or a successful journey. In order to diagnose specific areas in need of improvement, each these
events may be reduced to their component parts. Students may be assisted to achieve proficiency in component parts by listening to teacher's feedback.
However, a dance, choir, or journey can never be understood completely by examining one of their parts. So too, one cannot assess mastery of the subject matter simply by adding the sum of each assessment part. Mastery is decided when the dancer completes the dance, the singer performs in the choir, and the journey is complete. Metaphors such as these offer teachers insight into concepts like assessment by illuminating complexities and suggesting improved approaches to education.
41
Edwards, Brian. "Trends in Reporting Mental Health Concerns among College Student Athletes based on the National College Health Assessment." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1535374506247441.
42
Aller, Ty B. "Mental Health Awareness and Advocacy: Assessment Tool Development and an Evaluation of a College-Based Curriculum." DigitalCommons@USU, 2019. https://digitalcommons.usu.edu/etd/7701.
Анотація:
Students’ mental health issues are a common concern on college campuses and are often addressed via prevention programming called mental health literacy. This dissertation consists of two studies regarding mental health literacy programming for college students at a western university in the United States. In study one, the Mental Health Awareness and Advocacy Assessment Tool (MHAA-AT) was created and evaluated for its utility in assessing college students’ mental health literacy. This assessment tool is unique in that it is built upon a process-based approach to mental health literacy. The assessment tool demonstrated adequate psychometric properties and it was deemed an appropriate tool to assess college students’ mental health literacy, specifically their declarative knowledge, self-efficacy, and behaviors. In study two the Mental Health Awareness and Advocacy (MHAA) curriculum was created and evaluated in a college student population. The MHAA curriculum is unique in that is taught in-person or online in a degree seeking program at a college or university. Results from study two suggest that the MHAA curriculum was effective in increasing college students’ mental health literacy scores, specifically their declarative knowledge and self-efficacy. The benefit of this two-study dissertation is that it provides a unique way to deliver and evaluate effective mental health literacy prevention programming on a larger scale via a degree-seeking program to college students.
43
Tejada, Paola A. "The Global Mental Health Assessment Tool Primary Care and General Health Setting Version (GMHAT/PC) : a validity and feasibility study : Spanish version." Thesis, University of Chester, 2017. http://hdl.handle.net/10034/620649.
Анотація:
BACKGROUND: There is an urgent need to provide training and tools to frontline health workers in order for them to properly diagnose and treat mental illnesses in Latin-American communities, since the vast majority of people with a mental illness suffer in silence. A computer-assisted interview, the Global Mental Health Assessment Tool (GMHAT/PC) has been developed to assist general practitioners and other health professionals to make a quick, convenient, yet reasonably comprehensive and standardised mental health assessment. GMHAT/PC has been translated into various languages including German, Dutch, Chinese, Hindi and Arabic. This is the first study, of a GMHAT/PC Spanish version carried out in Latin America, to establish its validity in that culture and feasibility to be used in the health care setting. If proven a valid tool through this study, the GMHAT/PC Spanish version will be an important aid towards improving the mental health of Spanish-speaking communities within the Latin-American region. AIM: The study aims at assessing both the validity of a GMHAT/PC Spanish version, and the feasibility of utilising a computer assisted diagnostic interview by GPs. DESIGN: 1) Validation study was planned to establish whether the GMHAT/PC based diagnosis compares well with the consultants ICD-10 based diagnosis (Gold Standard) 2) Feasibility study was carried out to examine whether GMHAT/PC can be used in routine clinical care in a general health setting. MATERIALS AND METHODS: In the first study (validation), participants varied from those who were in remission i.e. without much psychopathology to those had symptoms of a severe mental illness. They were recruited from in-patient (82%) and out-patient (18%) mental health settings in Colombia. The participants were expected to have a wide range of psychiatric diagnoses (anxiety disorders, depression, psychosis, bipolar affective disorder, organic mental disorders, and other diagnoses). All consecutive patients were interviewed by GPs using GMHAT/PC and psychiatrists made an independent diagnosis applying ICD-10 criteria. The second study (feasibility) was carried out on patients hospitalised at medical, surgical and women’s wards during a period of one month in each service. The diagnosis of a medical illness was made by specialists in each service. A trained GP carried out psychiatric assessment of all participants using GMHAT/PC. RESULTS: First study (validity): two hundred ninety-nine patients (n=299) participated, 54.18% males and 45.81% females in the age range of 14-78. All patients were interviewed independently by seven psychiatrists with over five years of clinical experience. The mean duration of GMHAT/PC interview was 12.5 minutes. Most patients were pleased that they were asked about every aspect of their mental health. Psychiatrists made a single diagnosis in 183 (61%) cases, multiple (two) diagnosis in 112 (37%) cases and multiple (three) diagnosis in another four cases. GMHAT/PC in almost all cases gave additional multiple diagnoses. The results show an acceptable-to-good level of agreement between the GPs’ (GMHAT/PC) diagnoses and the psychiatrists’ (clinical) diagnoses of any mental illness, Kappa 0.58- 95% C.I (0.46, 0.72). There is a good level of sensitivity (81%) and specificity (92%), with GPs correctly identifying 242 out of the 250 participants diagnosed with a mental illness, and 27 out of 35 of those who do not present any whatsoever. The agreement (kappa value) between GMHAT/PC diagnosis and psychiatrists ICD-10 based diagnosis of specific disorders were as follows: Organic disorders-0.87; Psychosis- 0.56; Depression-0.53; Mania-0.6, Alcohol and drug misuse- 0.62, Learning disorder- 0.4; Personality Disorder- 0.39 and Anxiety disorders- 0.14. The sensitivity of different disorders ranged from 63% (Mania) to 100% (Anxiety) and specificity from 71% (Anxiety) to 100% (organic). The second study (feasibility): out of 455 medically-ill patients, 4.8% had a mental illness identified by GMHAT/PC interview. Anxiety, depression and organic disorders were the most frequently identified mental disorders in internal medicine and surgery. Cancer had a significantly higher prevalence of comorbid mental illness. CONCLUSION: GMHAT/PC -Spanish version used by GPs in this study detected mental disorders accurately and it was feasible to use GMHAT/PC in Colombia and Latin-American health settings. The findings of this study will have a big impact upon mental health service provision in Spanish-speaking nations within the Latin-American region as the Spanish version for GMHAT/PC will assist primary care physicians and other health workers in detecting and managing mental health disorders in the communities. There is no other comparable easy-to-use comprehensive mental health diagnostic tool available in Spanish.
44
Baird, Pud D. S. "Quality assurance and community mental health : an assessment of legislative mandate and perceived effectiveness /." The Ohio State University, 1996. http://rave.ohiolink.edu/etdc/view?acc_num=osu148794066543706.
45
Turner, Elizabeth Kate Turner. "A Study of Dementia Assessment Practices in Ohio Prisons." Wright State University Professional Psychology Program / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=wsupsych1530901309258281.
46
Rock, Daniel. "A revision of the World Health Organisation psychiatric disability assessment schedule." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1999. https://ro.ecu.edu.au/theses/1225.
Анотація:
The burden schizophrenia places on the individual, on the family and on society in general is determined more by the associated disability rather than the manifest symptoms. Therefore, measurement of disability provides a baseline for evaluating change and directing treatment. This research has two main aims. The primary purpose of this study was to develop and validate a contemporary revision of the World Health Organisation-Psychiatric Disability Assessment Schedule (1988). Data used was based on data from the WHO Collaborative Study on Determinants of Outcome of Severe Mental Disorders (Sartorius et al., 1986). The second aim of this study was to develop a methodology for the construction of a psychometrically rigorous instrument. This involved the use of standard, modified and original data checking and analysis techniques and input from content-experts. Results from this process indicated that the criteria and selection of experts is based upon the considered judgement of the researcher that the sum of the advantages of the expert validation process outweigh the disadvantages. This study has two discrete outcomes: The revised DAS can be used to assess disability in schizophrenia, and a "gold standard" methodology which can be applied during instrument development.
47
Corbalán, Fernando. "The assessment of the cognitive regulation of emotions in bipolar I disorder using galvanic skin conductance and heart rate." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=103686.
Анотація:
The cognitive regulation of negative emotions using a situational focused strategy require the activation of prefrontal and subcortical structures, in particular the dorsolateral prefrontal cortex (DLPFC) and the amygdala (Amy). These structures present structural and functional abnormalities in bipolar disorder, a psychiatric illness characterised by an abnormal mood regulation. This thesis presents the assessment of physiological responses to a paradigm designed to assess the functioning of the DLPC and the Amy. This paradigm tests the response to stimuli of different valence and assesses the down-regulation of negative emotions. We employed GSR and HR with the goals to determine whether changes occurring at the central nervous system can be recorded at a peripheral level. We also wanted to see if these variations differed between individuals either affected or non-affected by bipolar disorder. Finally, this study assesses the usefulness of the designed paradigm to be used in a future study using functional Magnetic Resonance Imaging. Results show that the recording of Heart Rate (HR) in non-affected individuals allows the detection of the exposure to negative stimuli and that the recording of the Galvanic Skin Response (GSR) is sensitive to detecting the exposure to negative stimuli and as well as the effects of the cognitive regulation of negative emotions. These effects are not observed in the group affected by bipolar disorder who seem to have an attenuated response to the exposure to stimuli of difference valence and to the effects of the cognitive regulation of negative emotions.La régulation cognitive des émotions négatives avec une concentration sur la stratégie situationnelle demande l'utilisation de structures préfrontales et subcorticales, en particulier celles du cortex préfrontal dorsolateral et de l'amygdale. Ces structures présentent des anomalies structurelles et fonctionnelles dans les troubles bipolaires, maladie qui se caractérise par une anormale régulation de l'humeur. Cette thèse présente l'évaluation des réponses physiologiques à un paradigme désigné à évaluer le fonctionnalisme du cortex préfrontal dorsolateral et de l'amygdale. Ce paradigme évalue les réponses aux stimuli émotionnels visuels ainsi que la réponse à la régulation des émotions négatives. La conductance galvanique de la peau et le rythme cardiaque ont étés employés pour déterminer si les changements qui se présentent au niveau du system nerveux central peuvent être enregistrés au niveau périphérique. De plus, nous sommes intéressés à déterminer si ces changements varient entre les personnes atteintes et non atteintes de trouble bipolaire. Enfin, cette étude vise à étudier si le paradigme employé serait utile pour une étude à venir en imagerie cérébrale avec l'utilisation de résonance magnétique fonctionnelle. Les résultats de cette étude ont démontré que chez les individus non atteint de trouble bipolaire l'enregistrement du rythme cardiaque permet la détection à l'exposition aux stimuli négatifs. Les résultats ont aussi démontré que la conductance de la peau est sensible à détecter l'exposition aux stimuli négatifs ainsi que les effets de la régulation cognitive aux émotions négatives. Ces effets ne sont pas aperçue chez les sujets atteintes de trouble affective bipolaire, lesquels semblent avoir des réponses atténués à l'exposition aux stimuli de différents types émotionnels et à l'effet de la régulation cognitive des émotions négatives.
48
Cimino, Emily Luis. "Factors associated with school-based mental health services delivered by school psychologists." [Tampa, Fla] : University of South Florida, 2007. http://purl.fcla.edu/usf/dc/et/SFE0001878.
49
Speller, Heather Korkosz. "Mental Health Literacy: A Comparative Assessment of Knowledge and Opinions of Mental Illness between Asian American and Caucasian College Students." Thesis, Boston College, 2005. http://hdl.handle.net/2345/364.
Анотація:
Thesis advisor: Ramsay LiemUnderutilization of mental health services among Asian Americans is a pressing concern. It is possible that knowledge and beliefs about mental illness (a.k.a. “mental health literacy”) serve as barriers to seeking appropriate help, and that Asian cultural values plays a role in determining such attitudes. This study investigated the relationships among mental health literacy, attitudes towards mental health services, and adherence to Asian cultural values. A sample of 17 Caucasian and 22 Asian American college students completed a questionnaire including the Asian Values Scale, the Attitudes Toward Seeking Professional Psychological Help Scale – Shortened Version, and four vignettes portraying depression, schizophrenia, alcohol dependency, and anorexia. Results indicated that Caucasians were slightly more likely to correctly recognize and identify mental illnesses than were Asian Americans. Causal attributions varied greatly across different mental disorders, and Asian Americans showed less positive attitudes towards seeking professional psychological help, and preferred to solve problems on their own or seek help from family or friends. The greatest barriers to treatment for Asian Americans were a fear of showing personal weakness and concern about stigma. Adherence to Asian cultural values was inversely associated with willingness to seek professional help, and with willingness to take medication for psychological problems
Thesis (BA) — Boston College, 2005
Submitted to: Boston College. College of Arts and Sciences
Discipline: Psychology
Discipline: College Honors Program
50
Newnham, Elizabeth A. "Informing best practice in mental health : using feedback to improve clinical outcomes." University of Western Australia. School of Psychology, 2009. http://theses.library.uwa.edu.au/adt-WU2010.0096.
Анотація:
[Truncated abstract] Physical healthcare uses a suite of tools for measuring response to treatment. However, reliable systems of regular patient monitoring are rare in mental healthcare. Mental health services often measure a treatment response from pre- to post- therapy, yet measurement between those occasions is less common. This omission is problematic since arguably there is a need for an alarm system in psychotherapy (Andrews & Page, 2005). A substantial minority of patients do not experience reliable change following treatment, and a small proportion deteriorates (Hansen, Lambert, & Forman, 2002; Newnham, Harwood, & Page, 2007). Without monitoring, it is not always possible to know which patients are progressing poorly. Since the publication of Howard and colleagues' (1996) proposal that patient progress be monitored routinely during therapy and the results fed back to clinicians to direct treatment, this monitoring regime has garnered attention in the United States and Europe (Lambert, 2007; Lutz, et al., 2006). Findings in outpatient psychotherapy have demonstrated that providing real-time feedback on patient progress to clinicians and patients significantly improves clinical outcomes for those patients demonstrating a negative response to treatment (Harmon et al., 2007; Lambert et al., 2001; Lambert et al., 2002). What is not yet apparent is how these processes would generalize to inpatient and day patient (i.e. patients attending hospital for a whole day of treatment) psychiatric care. Inpatients often present with greater severity and are treated in an intensive setting. ... Deviations from this expected pattern would highlight possible differences between inpatient and outpatient care. To develop an appropriate system for monitoring patient progress, it was important to first define clinically significant recovery in inpatient psychiatric care, and provide criteria for clinicians to judge outcome in routine practice (Newnham, Harwood, & Page, 2007). Second, a quick and easy-to-administer system of progress monitoring and real-time feedback was developed to enhance treatment decision making (Newnham, Hooke, & Page, 2009). Third, the system was evaluated to determine clinical effectiveness. Using the World Health Organizations Wellbeing Index, a program for monitoring patient progress and providing feedback to clinicians and patients was established at Western Australia's largest private psychiatric service. The sample consisted of 1308 consecutive inpatients and day patients whose primary diagnoses were predominantly depressive (67.7%) and anxiety (25.9%) disorders. Feedback to patients and clinicians was effective in reducing depressive symptoms (F (1,649) = 6.29, p<.05) for those patients at risk of poor outcome, but not effective in improving wellbeing (F (1,569) = 1.14, p>.05). The findings support the use of progress monitoring and feedback in psychiatric care to improve symptom outcomes, but raise questions about changes in wellbeing during psychotherapy. The effectiveness study was conducted as a historical cohort trial, consistent with quality improvement efforts, and replication with a randomized controlled design is warranted. Feedback of progress information appears to be an important process within psychotherapy, and further investigation of the means by which clinicians and patients use that information is necessary.