Parents Served by Assertive Community Treatment: A Needs Based Assessment

poster abstractAssertive Community Treatment (ACT) represents an effective treatment for individuals with severe mental illness. Though studies estimate roughly half of all people with severe mental illness are parents, little is known about consumers receiving ACT services who are parents. Thus, the purpose of the present study was to 1) estimate the prevalence of parent ACT consumers, 2) identify current ACT team policies and services for parent consumers, and 3) examine the perspective of parent consumers served by ACT teams. Quantitative and qualitative data were collected and analyzed via two studies. In study 1, 82 ACT providers from 76 teams in the US and Canada were surveyed. Providers estimated roughly 21.6% of ACT consumers were parents. Only 46.3% of providers reported formally asking consumers about parental status and 20.7% of providers belonged to ACT teams that offer services designed for parent consumers. The majority of providers (75.6%) reported negative or mixed attitudes about parents with severe mental illness. In study 2, seventeen parents receiving ACT services were interviewed. All parents endorsed positive attitudes about parenting, though most (76.5%) also identified negative aspects of parenting. Almost all parents (88.2%) reported loss of custody at least once. Parents expressed interest in parent-focused treatment services like family therapy, parenting skills, communication skills training, and peer support groups. Regarding satisfaction with ACT services, most parents with adult children (87.5%) reported no unmet parent-related needs and high satisfaction (4.63 of 5) with ACT services, whereas parents with young children (77.8%) reported unmet parenting needs and low satisfaction (3.78 of 5) with ACT services. Thus, results indicate the ACT treatment model may not be adequately serving parents with young, dependent children. Overall, findings suggest the need for more focus on parents with severe mental illness, including formal identification of parental status and parent-related treatment services and support

Re-­Thinking Shared Decision‐Making: Context Matters

Objective Traditional perspectives on shared decision-making (SDM) focus attention on the point in a clinical encounter where discussion of a treatment decision begins. We argue that SDM is shaped not only by initiation of a treatment decision, but also by the entire clinical encounter, and, even more broadly, by the nature of the patient–provider relationship. Method The Four Habits Approach to Effective Clinical Communication, a validated and widely used framework for patient–provider communication, was used to understand how SDM is integrally tied to the entire clinical encounter, as well as to the broader patient–provider relationship. Results The Four Habits consists of four categories of behaviors: (1) invest in the beginning; (2) elicit the patient's perspective; (3) demonstrate empathy; and (4) invest in the end. We argue that the behaviors included in all four of these categories work together to create and maintain an environment conducive to SDM. Conclusion SDM cannot be understood in isolation, and future SDM research should reflect the influence that the broader communicative and relational contexts have on decisions. Practice implications SDM training might be more effective if training focused on the broader context of communication and relationships, such as those specified by the Four Habits framework

Staff Turnover in Statewide Implementation of ACT: Relationship with ACT Fidelity and Other Team Characteristics

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature

What we are like when we are at our best: Appreciative stories of staff in a community mental health center

Appreciative Inquiry is an organizational change methodology that discovers what works well in an organization and then pursues strategies to enhance those factors. The initial discovery process itself provides data ripe for qualitative analysis. Narratives were collected from 27 community mental health staff about times when they were at their best. An emergent, consensus-based analysis was used to understand the stories and exemplary work -- with competent, caring staff and elements needed to support them. Findings are discussed in light of self-determination theory that people are at their best with a sense of mastery, connection, and autonomy

Agenda Setting in Psychiatric Consultations: An Exploratory Study

Patient- or consumer-centeredness has been recognized as a critical component of quality in primary health care, but is only beginning to be recognized and studied in mental health. Among the first opportunities to be consumer-centered is collaboratively producing an agenda of topics to be covered during a clinic visit. Early agenda setting sets the stage for what is to come and can affect the course, direction, and quality of care. OBJECTIVE: To study agenda setting practices among 8 prescribers (5 psychiatrists and 3 nurse practitioners) at the beginning of their encounters with 124 consumers diagnosed with schizophrenia spectrum disorders (56%), bipolar disorder (23%), major depression (15%), and other disorders (6%). METHOD: We modified an extant agenda setting rubric by adding behaviors identified by a multi-disciplinary team who iteratively reviewed transcripts of the visit openings. Once overall consensus was achieved, two research assistants coded all of the transcripts. Twenty-five transcripts were scored by both raters to establish inter-rater reliability. RESULTS: We identified 10 essential elements of agenda setting. Almost 10% of visits had no agenda set and only 1 of 3 encounters had partial or complete elicitation of a single concern. Few additional concerns (4%) were solicited and no encounter contained more than 6 essential elements. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Collaborative agenda setting represents a unique opportunity to translate the concept of consumer-centeredness into mental health care. Initial results suggest the rating system is reliable, but the essential elements are not being utilized in practice

Why are you here again? Concordance between consumers and providers about the primary concern in recurring psychiatric visits

Patient-centered care has become increasingly important over the last decade, both in physical and mental health care. In support of patient-centered care, providers need to understand consumers׳ primary concerns during treatment visits. The current study explored what primary concerns were brought to recurring psychiatric visits for a sample of adults with severe mental illness (N=164), whether these concerns were concordant with those recognized by providers, and which factors predicted concordance. We identified 17 types of primary concerns, most commonly medications and symptoms, with only 50% of visits showing evidence of at least partial agreement between consumers and providers. Contrary to expectations, consumer demographics, activation, trust, and perceptions of patient-centeredness were not predictive, while greater preferences for autonomy predicted poorer agreement. Our findings highlight the need for interventions to promote a shared understanding of primary concerns in recurring psychiatric visits. Further attention is needed to ensure the provision of patient-centered care such that consumer concerns are acknowledged and addressed within recurring psychiatric visits

Appreciative Inquiry as Organizational Change in a Community Mental Health Setting

poster abstractAppreciative Inquiry (AI) is an approach to organizational change that focuses on the strengths of an organization – discovering what is working well, and generating ideas within the organization for building on those strengths. AI has been applied in a variety of contexts including education, social work, health care, and academia. Little to no research, however, has applied AI to mental health contexts. The current study reports themes from staff member interviews conducted in the early phases of AI applied in a community mental health center (CMHC); these themes paint a picture of this CMHC “at its best” and will be fed-back to employees to lay the foundation for change and enhancing morale among staff. Interviews were conducted by 11 staff who volunteered from various departments and were trained by research staff at an all-day training. Appreciative Interviews first involved asking staff to describe a time they were at their best at this organization. Next, participants were asked to share what it was about themselves, others, and the setting that contributed to this experience. Additionally, interviewees were asked to “dream into the future” and to describe what they wish to see for this organization. Interviews were audio recorded, transcribed, and de-identified. Iterative, consensus-based coding was conducted by a multidisciplinary team that included CMHC staff. Several consistent themes emerged among participants’ stories. Staff at their best frequently reported feeling effective and seeing success in working with consumers. Other themes included working as a team, communicating well, and trusting one another. Stories also involved feeling valued and supported by their supervisors and coworkers. A foundational aspect involved believing in and caring about consumers with whom they work. Themes from participants’ interviews reflect perceptions of this community mental health center at its best and are consistent with tenets self-determination theory and future study

Mind-Body Skills Groups for Adolescents with Depression in Primary Care: A Pilot Study

Objective: To determine acceptability and preliminary effectiveness of Mind-Body Skills Groups (MBSGs) as a treatment for depressed adolescents in primary care. Methods: A single arm clinical trial was conducted. A 10-week MBSG program was implemented in primary care. Participants completed self-report measures at baseline, post-intervention, and 3-months following the MBSGs. Measures included the Children’s Depression Inventory-2, Suicidal Ideation Questionnaire, Mindful Attention Awareness Scale, Self-Efficacy for Depressed Adolescents, rumination subscale of the Children’s Response Style Questionnaire, and a short acceptability questionnaire. Results: Participants included 43 adolescents. The total depression scores significantly improved following the MBSG intervention and continued to improve significantly from post-treatment to follow-up. Mindfulness, self-efficacy, rumination, and suicidal ideation all had significant improvement following the intervention. Acceptability of the program was strong, and attendance was excellent. Discussion: Preliminary evidence suggests that MBSGs are an acceptable treatment for primary care settings and lead to improved depression symptoms in adolescents.Sandra Eskenazi Mental Health Center and the Herbert Simon Family Foundation (070241-00002B