Mental health practitioner experiences of engaging with service users in community mental health settings: a systematic review and thematic synthesis of qualitative evidence

Introduction: Effective mental health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with mental health services. Quantitative studies reveal some salient factors that seem to predict engagement but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of health professionals’ experiences and understanding of effective engagement have been published. Aim: This review aimed to systematically identify, evaluate and synthesise results from these studies with a view to informing effective practice in this area. Methods: Electronic databases Medline, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining mental health practitioners’ experiences of engagement in community mental health settings was conducted. Results: Mental health practitioners see engaging service users as depending upon complex, multi-dimensional phenomena which should include individualised person-centred approaches as well as practical, social and clinical support. Mental health practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users.Implications for practice: As a core aspect of nurse education, registered mental health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community mental health teams, more clarification is needed of practitioner's engagement experiences in early intervention settings.Key words Systematic Literature Reviews, Staff Perceptions, Qualitative Methodology, Therapeutic Relationships, Social Support.<br/

Applying the COM-B model to creation of an IT-enabled health coaching and resource linkage program for low-income Latina moms with recent gestational diabetes: the STAR MAMA program.

BACKGROUND:One of the fastest growing risk groups for early onset of diabetes is women with a recent pregnancy complicated by gestational diabetes, and for this group, Latinas are the largest at-risk group in the USA. Although evidence-based interventions, such as the Diabetes Prevention Program (DPP), which focuses on low-cost changes in eating, physical activity and weight management can lower diabetes risk and delay onset, these programs have yet to be tailored to postpartum Latina women. This study aims to tailor a IT-enabled health communication program to promote DPP-concordant behavior change among postpartum Latina women with recent gestational diabetes. The COM-B model (incorporating Capability, Opportunity, and Motivational behavioral barriers and enablers) and the Behavior Change Wheel (BCW) framework, convey a theoretically based approach for intervention development. We combined a health literacy-tailored health IT tool for reaching ethnic minority patients with diabetes with a BCW-based approach to develop a health coaching intervention targeted to postpartum Latina women with recent gestational diabetes. Current evidence, four focus groups (n = 22 participants), and input from a Regional Consortium of health care providers, diabetes experts, and health literacy practitioners informed the intervention development. Thematic analysis of focus group data used the COM-B model to determine content. Relevant cultural, theoretical, and technological components that underpin the design and development of the intervention were selected using the BCW framework. RESULTS:STAR MAMA delivers DPP content in Spanish and English using health communication strategies to: (1) validate the emotions and experiences postpartum women struggle with; (2) encourage integration of prevention strategies into family life through mothers becoming intergenerational custodians of health; and (3) increase social and material supports through referral to social networks, health coaches, and community resources. Feasibility, acceptability, and health-related outcomes (weight loss, physical activity, consumption of healthy foods, breastfeeding, and glucose screening) will be evaluated at 9 months postpartum using a randomized controlled trial design. CONCLUSIONS:STAR MAMA provides a DPP-based intervention that integrates theory-based design steps. Through systematic use of behavioral theory to inform intervention development, STAR MAMA may represent a strategy to develop health IT intervention tools to meet the needs of diverse populations. TRIAL REGISTRATION:ClinicalTrials.gov NCT02240420

Field Validation of Toxicity Tests to Evaluate the Potential for Beneficial Use of Produced Water

This study investigated potential biological effects of produced water contamination derived from occasional surface overflow and possible subsurface intrusion at an oil production site along the shore of Skiatook Lake, Oklahoma. We monitored basic chemistry and acute toxicity to a suite of standard aquatic test species (fathead minnow-Pimephales promelas, Daphnia pulex, Daphnia magna, and Ceriodaphnia dubia) in produced water and in samples taken from shallow groundwater wells on the site. Toxicity identification evaluations and ion toxicity modeling were used to identify toxic constituents in the samples. Lake sediment at the oil production site and at a reference site were also analyzed for brine intrusion chemically and by testing sediment toxicity using the benthic invertebrates, Chironomus dilutus, and Hyallela azteca. Sediment quality was also assessed with in situ survival and growth studies with H. azteca and the Asian clam, Corbicula fluminea, and by benthic macroinvertebrate community sampling. The produced water was acutely toxic to the aquatic test organisms at concentrations ranging from 1% to 10% of the whole produced water sample. Toxicity identification evaluation and ion toxicity modeling indicated major ion salts and hydrocarbons were the primary mixture toxicants. The standardized test species used in the laboratory bioassays exhibited differences in sensitivity to these two general classes of contaminants, which underscores the importance of using multiple species when evaluating produced water toxicity. Toxicity of groundwater was greater in samples from wells near a produced water injection well and an evaporation pond. Principle component analyses (PCA) of chemical data derived from the groundwater wells indicated dilution by lake water and possible biogeochemical reactions as factors that ameliorated groundwater toxicity. Elevated concentrations of major ions were found in pore water from lake sediments, but toxicity from these ions was limited to sediment depths of 10 cm or greater, which is outside of the primary zone of biological activity. Further, exposure to site sediments did not have any effects on test organisms, and macroinvertebrate communities did not indicate impairment at the oil production site as compared to a reference site. In situ experiments with H. azteca and C. fluminea, indicated a sublethal site effect (on growth of both species), but these could not be definitively linked with produced water infiltration. Severe weather conditions (drought followed by flooding) negatively influenced the intensity of lake sampling aimed at delineating produced water infiltration. Due to the lack of clear evidence of produced water infiltration into the sub-littoral zone of the lake, it was not possible to assess whether the laboratory bioassays of produced water effectively indicate risk in the receiving system. However, the acutely toxic nature of the produced water and general lack of biological effects in the lake at the oil production site suggest minimal to no produced water infiltration into surficial lake sediments and the near-shore water column. This study was able to demonstrate the utility of ion toxicity modeling to support data from toxicity identification evaluations aimed at identifying key toxic constituents in produced water. This information could be used to prioritize options for treating produced water in order to reduce toxic constituents and enhance options for reuse. The study also demonstrated how geographic information systems, toxicity modeling, and toxicity assessment could be used to facilitate future site assessments

Exploring the influence of ownership history on object valuation in typical development and autism

Items with special histories (e.g. celebrity owners) or qualities (e.g. limited editions) are more valuable than similar “inauthentic” items. Typically developing (TD) children privilege authenticity and are particularly influenced by who objects belong to. Here, we explore why children and adults over-value items with special ownership histories and examine how autism spectrum disorder (ASD) affects object valuation. In Studies 1 and 2, TD children perceived items belonging to famous owners (with “good” or “bad” reputations) to be more valuable than similar items belonging to non-famous owners. However, they ascribed significantly higher values to items belonging to famous heroes than infamous villains when compared. Children with ASD did not over-value objects with special ownership histories, but their valuations were moderated by qualities unrelated to ownership (e.g. rarity). In Study 3, adults with ASD assigned high values to authentic items with special ownership histories but were more likely to keep inauthentic objects than neurotypical adults. Our findings show that association with a famous owner is sufficient to increase an item’s value for TD children and adults (with and without ASD). The degree of added value may be determined by the famous owner’s character for TD children, but not adults. By contrast, children with ASD value objects via a different strategy that prioritizes material qualities over ownership history. However, the awareness of authenticity displayed by adults with ASD suggests that the emergence of ownership history as an important influence on object evaluation may be developmentally delayed in ASD, rather than completely absent