Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review.

Due to recent increases in the use of feedback from outcome measures in mental health settings, we systematically reviewed evidence regarding the impact of feedback from outcome measures on treatment effectiveness, treatment efficiency, and collaborative practice. In over half of 32 studies reviewed, the feedback condition had significantly higher levels of treatment effectiveness on at least one treatment outcome variable. Feedback was particularly effective for not-on-track patients or when it was provided to both clinicians and patients. The findings for treatment efficiency and collaborative practice were less consistent. Given the heterogeneity of studies, more research is needed to determine when and for whom feedback is most effective

Development and validation of the illness perceptions questionnaire for youth anxiety and depression (IPQ-Anxiety and IPQ-Depression)

Background: The Revised Illness Perceptions Questionnaire (IPQ-R) is a well-established measure for measuring illness representations with sound psychometric properties. However, one limitation is that it provides a generic measure of illness representations and lacks specificity to individual health conditions, making it difficult to capture the nuances of illness beliefs for different populations. Objective: The aim of this study was to develop reliable and valid versions of the IPQ-R for young people with anxiety and depression to better understand how they perceive and cognitively represent the course, severity, impact, and treatability of their anxiety and depression. Methods: This mixed-methods study consisted of a qualitative study, involving semi-structured interviews (n = 26) followed by think-aloud interviews (n = 13), and a quantitative study (n = 349), resulting in the development of the IPQ-Anxiety (IPQ-A) and IPQDepression (IPQ-D). Item development is reported, along with the psychometric properties of the measures. Concurrent validity was assessed by correlating the IPQ-A and IPQ-D with the Brief Illness Perceptions Questionnaire (B-IPQ) across equivalent dimensions. Results: Results suggest that the IPQ-A, IPQ-D, B-IPQ-A and B-IPQ-D are valid and reliable tools for measuring mental illness representations. The measures show acceptable model fit, high factor loadings, and good to excellent internal consistency, test – retest reliability across subscales and concurrent validity with mental health measures. Conclusions: The development of these measures represents an important step in the field of youth mental health by providing the opportunity for reliable assessment of young people’s conceptualisations of their anxiety and depression. Better understanding of young people’s illness beliefs has the potential to open a range of intervention possibilities by prioritising illness perceptions over the supposed objective condition severity and trajectory

Evaluating the Peer Education Project in secondary schools

Purpose The purpose of this paper is to determine the efficacy of the Peer Education Project (PEP), a school-based, peer-led intervention designed to support secondary school students to develop the skills and knowledge they need to safeguard their mental health and that of their peers. Design/methodology/approach Six schools from across England and the Channel Islands took part in an evaluation of the PEP across the 2016/2017 academic year. In total, 45 trained peer educators from the sixth form and 455 Year 7 students completed pre- and post-questionnaires assessing their emotional and behavioural difficulties, perceived school climate, and knowledge, skills and confidence related to mental health. Findings Results indicate that participation in the PEP is associated with significant improvement in key skills among both peer educators and student trainees, and in understanding of key terms and readiness to support others among trainees. Most students would recommend participation in the programme to other students. Originality/value While peer education has been found to be effective in some areas of health promotion, research on the effectiveness of peer-led mental health education programmes in schools is limited. This study contributes evidence around the efficacy of a new peer education programme that can be implemented in secondary schools. </jats:sec

Power up: patient and public involvement in developing a shared decision-making app for mental health

Background The importance of patient and public involvement (PPI) in designing interventions to support young people’s mental health is becoming a central tenet of the research process. Existing research has indicated that co-design with service users may help to engender multiple improvements in research projects, from design through to applications of study findings. Aims The aim of this study is to examine our experience of making the involvement of young people an ongoing part of the research process. We report on PPI in relation to a feasibility trial of the development of an app called Power Up, which is designed to support shared decision-making in mental health. Method Young people, carers, and clinicians were involved in each aspect of the project from governance, needs and environment analysis, to development and revisions of the Power Up smartphone app intended for use within child and adolescent mental health services. Involvement was achieved through ongoing contributions to steering groups, co-design workshops, and interviews. The project model was approached as a cyclical multidirectional process of ideas, PPI input, reflection, and alterations. Conclusion PPI was embedded into the project model from the outset, to be iterative and cyclical informing the development and direction of the digital tool at each stage. Involving service users resulted in the identification and implementation of multiple changes to the app, both conceptual and tangible. Several challenges associated with PPI were also encountered, warranting future research and discussion

A Feasibility Trial of Power Up: Smartphone App to Support Patient Activation and Shared Decision Making for Mental Health in Young People

Background: Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and therefore, develop evidence-based recommendations for practice.Objective: To determine the feasibility of undertaking a cluster randomized control trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health.Methods: Overall, 270 young people were screened for participation and 53% (N = 142) were recruited and completed baseline measures across eight specialist child mental health services (n = 62, mean (SD) age = 14.66 (1.99) years, 52% female) and two mainstream secondary schools (n = 80; mean (SD) age = 16.88 (0.68) years, 46% female). Young people received Power Up in addition to management as usual or received management as usual only. Post-trial interviews were conducted with 11 young people from the intervention arms (specialist services n = 6; schools n = 5).Results: Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported: 1) their motivation for use of Power Up, 2) the impact of use, and 3) barriers to use. Out of the 142 recruited participants, 45% (64/142) completed follow up measures, and the approaches to increase retention agreed by the steering group are discussed.Conclusions: The findings of the present research indicate that the app is acceptable and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized control trial

Systematic review of approaches to using patient experience data for quality improvement in healthcare settings

Objectives: Explore how patient-reported experience measures (PREMs) are collected, communicated and used to inform quality improvement (QI) across healthcare settings. Design: Systematic review. Setting: Various primary and secondary care settings, including general practice, and acute and chronic care hospitals. Participants: A full range of patient populations from (children through to the elderly) and staff (from healthcare practitioners to senior managers). Methods: Scientific databases were searched (CINAHL, PsycINFO, MEDLINE and Cochrane Libraries) as was grey literature. Qualitative and quantitative studies describing collection of PREM data and subsequent QI actions in any healthcare setting were included. Risk of bias was assessed using established criteria. Of 5312 initial hits, 32 full texts were screened, and 11 were included. Results: Patient experience data were most commonly collected through surveys and used to identify small areas of incremental change to services that do not require a change to clinician behaviour (eg, changes to admission processes and producing educational materials). While staff in most studies reported having made effective improvements, authors struggled to identify what those changes were or the impact they had. Conclusions: Findings suggest there is no single best way to collect or use PREM data for QI, but they do suggest some key points to consider when planning such an approach. For instance, formal training is recommended, as a lack of expertise in QI and confidence in interpreting patient experience data effectively may continue to be a barrier to a successful shift towards a more patient-centred healthcare service. In the context of QI, more attention is required on how patient experience data will be used to inform changes to practice and, in turn, measure any impact these changes may have on patient experience

A Qualitative Exploration of Patient and Clinician Views on Patient Reported Outcome Measures in Child Mental Health and Diabetes Services

Patient Reported Outcome Measures (PROMs) are increasingly being recommended for use in both mental and physical health services. The present study is a qualitative exploration of the views of young people, mothers, and clinicians on PROMs. Semi-structured interviews were conducted with a sample of n = 10 participants (6 young people, 4 clinicians) from mental health services and n = 14 participants (4 young people, 7 mothers, 3 clinicians) from a diabetes service. For different reasons, young people, mothers, and clinicians saw feedback from PROMs as having the potential to alter the scope of clinical discussions