Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives

Open Access journalBackground Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders“ understanding of the meaning of quality in the context of CAMHS. Method The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant’s views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. Results An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. Conclusions No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area

Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives

BACKGROUND: Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. METHOD: The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. RESULTS: An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. CONCLUSIONS: No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area

Additional file 1: of Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives

Interview guide – Stakeholder interviews (all groups) – Qualitative interview data. (DOCX 22 kb

Political theory

Political theory, sometimes also called “normative political theory”, is a subfield of the disciplines of philosophy and political science that addresses conceptual, normative, and evaluative questions concerning politics and society, broadly construed. Examples are: When is a society just? What does it mean for its members to be free? When is one distribution of goods socially preferable to another? What makes a political authority legitimate? How should we trade off different values, such as liberty, prosperity, and security, against one another? What do we owe, not just to our fellow citizens, but to people in the world at large? In this article, we review the methodology of a core branch of contemporary political theory: the one commonly described as “analytic” political theory. In Section 1, we briefly demarcate the scope of political theory. In Section 2, we comment on the analysis of political concepts. In Section 3, we introduce the notions of principles and theories, as distinct from concepts. In Section 4, we discuss the methods of assessing such principles and theories, for the purpose of justifying or criticizing them. In Section 5, we review a recent debate on how abstract and idealized political theory should be. In Section 6, finally, we discuss the significance of disagreement in political theory. Although we cover established ground, we do so from an angle that will be somewhat unfamiliar to at least some political theorists – namely an angle inspired by the philosophy of science. We have chosen this angle with a view to systematizing the activity of analytic political theorizing so as to make its connections with other fields of philosophy and positive science more transparent