Outcomes for children who care for a parent with a severe illness or substance abuse

Quantitative studies of children’s caring activities during parental illness have increased in the past 10 years. However, the various outcomes for these children have been investigated less frequently. In the present study, we investigate whether the children have different outcomes when the parent has a severe physical illness, mental illness, or substance abuse and whether any factors are associated with the positive and negative outcomes of the children’s caregiving. This was a cross-sectional, multicenter study. We recruited parents who were out- or inpatients in five public hospitals in Norway as well as their children. The sample included 246 children ages 8–18 and 238 of their parents with a severe physical illness, mental illness, or substance abuse. Ten percent reported negative outcomes at a clinical level of concern, and nearly half of the children reported stress. However, the outcomes were not significantly different across parental illness groups. Positive and negative outcomes were associated with the nature of caring activities (e.g., personal care, financial and practical management, household management), social skills, and perceived external locus of control. Health professionals must provide a more comprehensive and overall assessment of both the parents’ and the children’s needs. To recognize the role taken by the child, an assessment of children’s caring activities and their need for adequate information should be performed. In particular, should the children’s need for follow-up regarding caring activities, respite, and emotional support be assessed to secure their necessary skills and feeling of mastery

Utprøving av ACT-team i Norge. Hva viser resultatene?

KoRus Øst/ Nasjonal kompetansetjeneste fikk i oppdrag av Helsedirektoratet å evaluere utprøvingen av 12 norske ACT- team. ACT- teaemene er geografisk plassert fra Tromsø i nord til Jæren og Kristiansand i sør. Det er etablert 7 ACT- team i Helse Sør- Øst, 4 team i Midt- Norge, 2 i Helse Vest og 1 i Nord- Norge. Samtlige ACT- team er organisert som et samarbeid mellom spesialisthelsetjenesten (DPS) og en eller flere kommuner/bydeler.De norske ACT- teamene har lykkes i å rekruttere målruppen slik den er definert av Helsedirektoratet. Teamene er trofaste mot ACT- modellen, og utfører helhetlige tjenester enten alene eller i samarbeid med andre tjenester. Brukerne rapporterer høy tilfredshet med ACT

The Practical and Social Functioning (PSF) scale: development and measurement properties of an instrument for assessing activity and social participation among people with serious mental illness

Background: Participation in society and the ability to perform various activities are crucial aspects of everyday functioning. The intertwined relationship between functioning, disability, and health is emphasized in the "International Classification of Functioning, Disability and Health (ICF)" framework. In recent decades, mental health care units have increasingly focused on this aspect. The Practical and Social Functioning scale (PSF) was developed and validated in Norwegian as an easy-to-administer instrument to assess practical and social functioning among patients with serious mental illness in different clinical settings. Methods: The PSF was developed and revised using data from different Norwegian studies. Data from a total of 562 patients with serious mental illness in different clinical settings were included. The validation process included the evaluation of items into categories by 25 professionals. Development and revision took place in three different stages, and factor analyses were conducted. The quality of the PSF was assessed according to the COSMIN standards for systematic reviews on patient-reported outcome measures. Results: The final version of the PSF comprises seven subscales, each consisting of four items, resulting in a total of 28 items. These subscales, along with their corresponding items, are loaded onto two factors representing the main dimensions of functioning: activity and participation. Content validity comprises three domains: relevance, comprehensiveness, and comprehensibility. Relevance and comprehensibility were found to be adequate, whereas comprehensiveness was doubtful. Structural validity was adequate, internal consistency was very good, and construct validity was adequate compared to the Global Assessment of Functioning scale. Responsiveness was found to be doubtful in our study with data from an 18-month observation period. Nearly 60% of the items showed a ceiling effect. No items showed a floor effect. Conclusion: The development and validation of the Norwegian version of the PSF resulted in an instrument consisting of seven subscales and a total of 28 items. The items and subscales assess functioning related to two key factors according to the ICF framework: activity and participation. Our results show that the PSF is an easy-to-administer instrument that may be particularly sensitive for detecting variation among persons with severely impaired functioning.Open access funding provided by Akershus University Hospital (AHUS) The study at Nordfjord CMHC was funded partly by the Norwegian Council for Mental Health and partly by the CMHC. The Assertive Community Treatment study was funded by the Norwegian Directorate of Health. The study Committed Collaborative Treatment was funded by Akershus University Hospital. The study Implementation of National Guidelines was funded by the South-Eastern Norway Regional Health Authority

“It’s like being stuck on an unsafe and unpredictable rollercoaster” : experiencing substance use problems in a partner

publishedVersio

Carer involvement in the assessment of personal recovery: A naturalistic study of assertive community treatment in Norway

BackgroundThe user and carer movements have come a long way in becoming embedded in mainstream mental health services for individuals with serious mental illness. However, implementing recovery-oriented practice continues to be plagued by an individualistic clinical focus. The carers do not feel integrated despite policies and best intentions. The implementation of Assertive Community Treatment (ACT) provided an opportunity to involve the carers and compare their assessment of personal recovery with the users.AimsThe aims of this study were to examine (i) how family carers and users differed in their assessment of personal recovery, (ii) whether familial and personal relationships influenced how carers assess personal recovery of users, and (iii) if the experience of family carers with the ACT team was associated with personal recovery.MethodsThe naturalistic, explorative study recruited 69 users and 36 family carers from 12 Norwegian ACT teams. The users and carers assessed the user's personal recovery. Family carers also reported their experience and satisfaction with the ACT teams. Analyses included independent and paired sample T-tests and correlation analysis.ResultsFamily carers were significantly more conservative than the users' assessment of the intrapsychic and interpersonal subscales of personal recovery. The pattern held true whether the family carers were matched to the users or part of the total sample. Lastly, there was a significant negative correlation between the family carer's experience of cooperation with the ACT team and their assessment of the user's intrapersonal process of recovery.ConclusionsThe results of our study were consistent with previous research on carer involvement in MHS. However, it is the first study that engaged carers and assessed personal recovery of the users of ACT services. Discrepancy between carers and users is the rule. Clinicians are encouraged to embrace the discrepancy and diversity carers bring and learn the methodology of multi-informant assessments. There also is a need to address, update, and integrate the personal, familial, and relational aspects of recovery. Modification of recovery measures such as QPR and their creative use with carers has the potential to generate valuable third-party information and to involve them meaningfully in mental health services

Discrepancies between patients and professionals in the assessment of patient needs: a quantitative study of Norwegian mental health care

Artikkelen undersøker avvik mellom pasienter og fagfolks vurderinger av pasientens behov. Analyser kan indikere vekt på brukerorientering i norsk psykisk helsevern.Fagfolk og pasienter viste tydelig uenighet med hensyn til mengde og type behov som var til stede. Spesielt fagfolk identifiserte flere behov enn pasienter (9,3 vs. 4,3, henholdsvis) og denne forskjellen var preget av et sterkt faglig fokus på behov angående profesjonell overvåking og oppfølging. En lav faglig vekt på brukermedvirkning kan være indisert i noen tilfeller. Resultatene er diskutert med hensyn til spenningen mellom autonomi og omsorgsbehov

Carer involvement in the assessment of personal recovery: A naturalistic study of assertive community treatment in Norway

Background: The user and carer movements have come a long way in becoming embedded in mainstream mental health services for individuals with serious mental illness. However, implementing recovery-oriented practice continues to be plagued by an individualistic clinical focus. The carers do not feel integrated despite policies and best intentions. The implementation of Assertive Community Treatment (ACT) provided an opportunity to involve the carers and compare their assessment of personal recovery with the users. Aims: The aims of this study were to examine (i) how family carers and users differed in their assessment of personal recovery, (ii) whether familial and personal relationships influenced how carers assess personal recovery of users, and (iii) if the experience of family carers with the ACT team was associated with personal recovery. Methods: The naturalistic, explorative study recruited 69 users and 36 family carers from 12 Norwegian ACT teams. The users and carers assessed the user’s personal recovery. Family carers also reported their experience and satisfaction with the ACT teams. Analyses included independent and paired sample T-tests and correlation analysis. Results: Family carers were significantly more conservative than the users’ assessment of the intrapsychic and interpersonal subscales of personal recovery. The pattern held true whether the family carers were matched to the users or part of the total sample. Lastly, there was a significant negative correlation between the family carer’s experience of cooperation with the ACT team and their assessment of the user’s intrapersonal process of recovery. Conclusions: The results of our study were consistent with previous research on carer involvement in MHS. However, it is the first study that engaged carers and assessed personal recovery of the users of ACT services. Discrepancy between carers and users is the rule. Clinicians are encouraged to embrace the discrepancy and diversity carers bring and learn the methodology of multi- informant assessments. There also is a need to address, update, and integrate the personal, familial, and relational aspects of recovery. Modification of recovery measures such as QPR and their creative use with carers has the potential to generate valuable third-party information and to involve them meaningfully in mental health services

The association between GP and patient ratings of quality of care at outpatient clinics.

BACKGROUND: GPs and patients are frequently asked to evaluate mental health care, but studies including evaluations from both groups are rare. OBJECTIVE: To assess the association between GPs' and patients' assessment of mental health outpatient clinic in Norway and identify important health care predictors for patient and GP satisfaction with the clinics. METHODS: Two cross-sectional national surveys were carried out: survey of GPs in 2006 and patients in 2007 evaluating outpatient clinics at 69 community mental health centres in Norway. A total of 2009 GPs and 9001 outpatients assessed the clinics by means of a postal questionnaire. Main outcome measures were correlations between GP and patient ratings of the outpatient clinics at the clinic level and health care predictors for patient satisfaction and GP satisfaction with the clinics. RESULTS: Clinic scores for GPs' and patients' assessment of waiting time were moderate to highly correlated (0.65), while clinic scores for GP and patient satisfaction had a lower but significant positive association (0.37). Significant positive correlations between clinic scores for GP and patients ratings were found for 38 of the 48 associations tested. The most important predictors for patient satisfaction with the clinics were interaction with the clinician (beta: 0.23) and being met with politeness and respect at the clinic (beta: 0.19), while the most important predictors for GP satisfaction with the clinics were perceived competence (beta: 0.25), rejection of referrals (beta: -0.17) and waiting time for patients (beta: -0.16). CONCLUSIONS: A consistent positive association between GP and patient ratings at the clinic level was identified. Mental health services aiming at improving GP and patient satisfaction should be sensitive to the fact that the two groups prioritize different health care factors

Development of a Measure of Model Fidelity for Mental Health Crisis Resolution Teams

Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a fidelity scale to assess adherence to a model of best practice for CRTs, based on best available evidence