The MATRIx Models – Conceptual frameworks of barriers and facilitators to perinatal mental health care

Background: Perinatal Mental Health (PMH) problems are a leading cause of maternal death and increase the risk of poor outcomes for women and their families. It is therefore important to identify the barriers and facilitators to implementing and accessing PMH care. Aim: To develop a conceptual framework of barriers and facilitators to PMH care to inform PMH services. Methods: Relevant literature was systematically identified then categorised and mapped onto the framework. The framework was then validated through evaluating confidence with the evidence base, and feedback from stakeholders (women and families; health professionals; commissioners and policy makers). Results: Barriers and facilitators to PMH care were identified at seven levels: Individual (e.g., beliefs about mental illness); Health professional (e.g., confidence addressing perinatal mental illness); Interpersonal (e.g., relationship between women and health professionals); Organisational (e.g., continuity of carer); Commissioner (e.g., referral pathways); Political (e.g., women’s economic status); and Societal (e.g., stigma). The MATRIx conceptual frameworks provide pictorial representations of 66 barriers and 39 facilitators to PMH care. Conclusions: The MATRIx frameworks highlight the complex interplay of individual and system level factors across different stages of the care pathway that influence women accessing PMH care and effective implementation of PMH services. Recommendations are made for health policy and practice. These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to PMH care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services; and quality training for health professionals with protected time to complete it

Conceptual frameworks of barriers and facilitators to perinatal mental healthcare: the MATRIx models

BACKGROUND: Perinatal mental health (PMH) problems are a leading cause of maternal death and increase the risk of poor outcomes for women and their families. It is therefore important to identify the barriers and facilitators to implementing and accessing PMH care. AIMS: To develop a conceptual framework of barriers and facilitators to PMH care to inform PMH services. METHOD: Relevant literature was systematically identified, categorised and mapped onto the framework. The framework was then validated through evaluating confidence with the evidence base and feedback from stakeholders (women and families, health professionals, commissioners and policy makers). RESULTS: Barriers and facilitators to PMH care were identified at seven levels: individual (e.g. beliefs about mental illness), health professional (e.g. confidence addressing perinatal mental illness), interpersonal (e.g. relationship between women and health professionals), organisational (e.g. continuity of carer), commissioner (e.g. referral pathways), political (e.g. women's economic status) and societal (e.g. stigma). The MATRIx conceptual frameworks provide pictorial representations of 66 barriers and 39 facilitators to PMH care. CONCLUSIONS: The MATRIx frameworks highlight the complex interplay of individual and system-level factors across different stages of the care pathway that influence women accessing PMH care and effective implementation of PMH services. Recommendations are made for health policy and practice. These include using the conceptual frameworks to inform comprehensive, strategic and evidence-based approaches to PMH care; ensuring care is easy to access and flexible; providing culturally sensitive care; adequate funding of services and quality training for health professionals, with protected time to complete it

Exact boundary S-matrices of the supersymmetric sine-Gordon theory on a half line

Using the boundary Yang-Baxter equations and exact results on the bulk $S$-matrices, we compute exact boundary scattering amplitudes of the supersymmetric sine-Gordon model with integrable boundary potentials.Comment: 15 pages, requires phyzzx.tex. Serious typo-errors are correcte

Barriers and facilitators to implementing perinatal mental health care in health and social care settings: A systematic review

The improvement of perinatal mental health forms part of the World Health Organization’s Millennium Development goals. However, research suggests implementation of perinatal mental healthcare is variable. To ensure successful implementation, barriers and facilitators to implementing perinatal mental health services need to be identified. The objectives of this review were to determine the barriers and facilitators to implementing perinatal mental health assessment, care, referral and treatment into health and social care services. A systematic review was carried out by conducting literature searches in CINAHL (1982- present); Embase (1974 – present); Medline (1946- present); and PsycINFO (1806 – present). The date of the last search was 11th December 2019 and forward and backward were completed by the 31st March 2020. Studies were included if they made statements about factors that either facilitated or impeded implementation of perinatal mental health assessment, care, or treatment. Partial (10%) dual screening and data extraction was carried out. Data were analysed using thematic synthesis. A total of 46 studies were included in the review. Implementation occurred in a wide range of settings. Implementation was affected by individual (e.g. inability to attend), healthcare professional (e.g. training), interpersonal (e.g. trusting relationships), organisational (e.g. clear referral pathways), political (e.g. funding) and societal factors (stigma and culture). There are a complex range of barriers and facilitators that can support the implementation of perinatal mental health policy and practice. Perinatal mental health services should be flexible, woman-centred and delivered by well-trained healthcare professionals working within a structure that facilitates continuity of carer. Strategies that can be used to improve implementation include, but are not limited to, co-production of services, implementation team meetings, funding and coalition building. Future research should focus on implementation barriers and facilitators dependent on illness severity, healthcare setting and inpatient care

Influence of Stress Ratio on the Elevated-Temperature Fatigue of a Silicon Carbide Fiber-Reinforced Silicon Nitride Composite

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65470/1/j.1151-2916.1991.tb07152.x.pd

Meta-review of the barriers and facilitators to women accessing perinatal mental healthcare

Perinatal mental health (PMH) problems are common and can have an adverse impact on women and their families. However, research suggests that a substantial proportion of women with PMH problems do not access care. OBJECTIVES: To synthesise the results from previous systematic reviews of barriers and facilitators to women to seeking help, accessing help, and engaging in PMH care, and to suggest recommendations for clinical practice and policy. DESIGN: A meta-review of systematic reviews. REVIEW METHODS: Seven databases were searched and reviewed using a Preferred Reporting Items for Systematic Reviews and Meta Analyses search strategy. Studies that focused on the views of women seeking help and accessing PMH care were included. Data were analysed using thematic synthesis. Assessing the Methodological Quality of Systematic Reviews-2 was used to assess review methodology. To improve validity of results, a qualitative sensitivity analysis was conducted to assess whether themes remained consistent across all reviews, regardless of their quality rating. RESULTS: A total of 32 reviews were included. A wide range of barriers and facilitators to women accessing PMH care were identified. These mapped across a multilevel model of influential factors (individual, healthcare professional, interpersonal, organisational, political and societal) and across the care pathway (from decision to consult to receiving care). Evidence-based recommendations to support the design and delivery of PMH care were produced based on identified barriers and facilitators. CONCLUSION: The identified barriers and facilitators point to a complex interplay of many factors, highlighting the need for an international effort to increase awareness of PMH problems, reduce mental health stigma, and provide woman-centred, flexible care, delivered by well trained and culturally sensitive primary care, maternity, and psychiatric health professionals. PROSPERO REGISTRATION NUMBER: CRD42019142854

Negotiating the modern cross-class ‘model home’:domestic experiences in Basil Spence’s Claremont Court

This article investigates the spatial articulation of architecture and home through the exploration of current domestic experiences in Basil Spence’s Claremont Court housing scheme (1959-1962), Edinburgh. How architecture and home are both idealized and lived is the backdrop for a discussion that draws on the concept of “model home,” or physical representation of a domestic ideal. The article reads Claremont Court as an architectural prototype of the modern domestic ideal, before exploring its reception by five of its households through the use of visual methods and semistructured interviews. Receiving the model home involves negotiating between ideal and lived homes. Building on this idea, the article contributes with a focus on the spatiality of such reception, showing how it is modulated according to the architectural affordances that the “model home” represents. The article expands on scholarship on architecture and home with empirical evidence that argues the reciprocal spatiality of home

Tenure, gender and household structure

Starting with a review of recent literature on gender and housing, this paper goes on to develop a new theory of household structure, in which concepts of gender and generation play a key role. The utility of this theory is then demonstrated in the analysis of data from a survey of households in the City of Salford

Sentencing drug offenders under the 2003 Criminal Justice Act: Challenges for the probation service

For the most part the 2003 Criminal Justice Act, which came into effect in England and Wales in April 2005, was accepted by the probation service with relatively little opposition. Given the enormity of its impact acquiescence to this degree of change ought to come as something of a surprise. The 2003 Act changed fundamentally the nature of community supervision, it brought to an end the traditional range of non-custodial penalties and replaced them with a single community order to which sentencers could add any of 12 possible requirements. This paper considers the impact of the 2003 legislation on one particular offender group - drug misusers. Drug misusing offenders have the potential to pose serious difficulties for probation officers; the habitual nature of drug addiction and a tendency toward an irregular lifestyle make drug misusers particularly susceptible to breach. Under the new legislation courts have significantly fewer options available to them when responding to incidents of offender non-compliance. This paper argues that many of the provisions of the 2003 Act together with developments elsewhere in the UK are likely to have impacted disproportionately on those groups whose lifestyles are chaotic and whose routines are incompatible with the terms and conditions of modern day probation practice. It concludes that greater flexibility towards non-compliance, supported by regular and consistent judicial review, would encourage improved rates of compliance and retention in treatment and improved outcomes for offenders