No description available.

Postpartum Depression (PPD) occurs in 10-20% of new mothers. PPD can lead to serious health risks to both the mother and infant, increase the risk of complications during birth, and cause lasting effects on the development and wellbeing of the child. Many mothers suffering from PPD do not receive treatment due to fear of being stigmatized, lack of education, or not being able to access mental health services. High prevalence of PPD, along with the negative and lasting effects it can cause point to the importance of developing an effective and feasible method of assessing and treating this disorder. A pediatric primary care office may be an opportune setting to screen for PPD since mothers often accompany their children to regularly scheduled well child visits. While some studies have examined PPD screening within the pediatric primary care setting, few have explored the addition of an on-site Behavioral Health Consultant to provide brief interventions for depressed mothers as part of a stepped care model. The primary aim of the current study is assess the feasibility of implementing a stepped care protocol that assesses PPD and provides brief interventions and referrals for depressed mothers within a pediatric primary care clinic. The protocol consists of several phases including: 1) distribution of the Edinburgh Postpartum Depression Screener to every mother arriving for a well child visit during the first six months of their child’s life; 2) appropriate documentation in the clinic’s electronic health record (EHR) of the Edinburgh score and resulting plan of action; 3) a brief same day intervention by the on-site Behavioral Health Consultant and referral to outside provider, if applicable; and 4) phone call follow up with the mother and referred provider, if applicable. Research assistants will monitor the EHR to determine the clinic’s fidelity to the protocol (e.g., if the Edinburgh is being administered properly). Data will also be collected from the EHR to determine if a correlation exists between Edinburgh scores and number of Emergency Room visits made by the child, immunizations administered to the child, and number of well child checks the child attended. Data collected throughout the month of March showing the Edinburgh uptake, consistency with protocol, and any correlation between Edinburgh scores and other variables will be presented.

No description available.

Background. Stepped care is widely implemented as a means to organise depression treatment. However, it is unclear how this system and the system it was designed to replace – long-term intensive psychotherapy for all – compare. Aim. To further the development and evaluation of stepped care. Specifically, assess the clinical effectiveness of stepped care and prepare for a fully-powered evaluation of stepped care vs. high-intensity psychotherapy alone for depressed adults. Design. A systematic review and mixed methods feasibility study encompassing a pilot randomised controlled trial and semi-structured interviews. Results of the systematic review. Fourteen randomised controlled trials involving 4580 participants were included. Relative to controls, there was significantly greater improvement in depression for adults treated with stepped care (d=0.34 at six months; 95% CI 0.20 to 0.48). The quality of included studies was good and there was little evidence of publication bias. All comparisons were with usual care. Results of the feasibility study. 66 patients were recruited to the pilot trial. The recruitment rate was 2.9% and follow-up data was obtained from 90.9% of participants. A third of stepped care patients stepped up to high-intensity therapy. Patients improved in both groups: the mean reduction in depressive symptoms was 13.4 in the stepped care group and 13.6 in the high-intensity therapy alone group. Recruitment methods were appropriate to patients and therapists but only somewhat appropriate to IAPT staff. Although the stepped care intervention was broadly acceptable to therapists, patient experience varied and some patients who demonstrated a low level of self-efficacy declined any therapy or dropped out of treatment. Conclusions. The effectiveness of stepped care compared with long-term intensive psychological therapy for all has not yet been established. A fully-powered trial of stepped care vs. high-intensity therapy alone is feasible although pilot trial methods and procedures should be modified to improve recruitment and acceptability.

Background: Depression is a major health concern and self-management of depressive symptoms using patient-initiated strategies has the potential to reduce the burden of this condition. A better understanding of behaviour change related to these patient-initiated strategies is needed. Method: This randomized controlled trial study used an online survey and Knowledge Translation and Transfer theory-based educational intervention to examine the Theory of Planned Behavior model in the context of nine patient-initiated strategies for the self-management of depression and low mood. Results: Perceived Behavioural Control was identified as the single greatest predictor of Intentions to engage in strategies. Attitudes predicted Intentions to a lesser degree. Subjective Norms were not identified as unique predictors. Theory of Planned Behavior antecedent variables together explained over one third of the variance in Intentions. Intentions to engage in patient-initiated strategies were shown, in some cases, to significantly predict actual engagement in strategies. Level of depressive symptoms did not meaningfully impact any of the antecedent variables or Intentions. Results also suggest that an educational intervention based on Knowledge Translation and Knowledge Transfer principles significantly improved both Attitudes and Subjective Norms – Physician towards patient-initiated strategies. Perceived Behavioural Control and Intentions were not improved as a result of the educational intervention. Theoretical Conclusions: Findings suggest that the Theory of Planned Behavior functions well in the context of patient-initiated strategies for depression and low mood. Perceived Behavioural Control was identified as the greatest predictor of Intentions to engage in patient-initiated strategies. Results also suggest mood difficulties are not captured by the model’s antecedent variables but instead should be included as an additional variable in this model. The findings of the current study support an integrated model of Knowledge Translation and Transfer and Theory of Planned Behavior. Practical Conclusions: The current study’s findings provide a better understanding of behaviour change in the context of patient-initiated strategies and will help guide interventions aimed at improving engagement in these behaviours. Findings also provide support and recommendations for the use of Knowledge Translation and Transfer theory-based educational interventions to improve self-management of depression and low mood.

Cette étude de cas vise à comparer le modèle de soins implanté sur le territoire d’un centre de santé et des services sociaux (CSSS) de la région de Montréal aux modèles de soins en étapes et à examiner l’influence de facteurs contextuels sur l’implantation de ce modèle. Au total, 13 cliniciens et gestionnaires travaillant à l’interface entre la première et la deuxième ligne ont participé à une entrevue semi-structurée. Les résultats montrent que le modèle de soins hiérarchisés implanté se compare en plusieurs points aux modèles de soins en étapes. Cependant, certains éléments de ces derniers sont à intégrer afin d’améliorer l’efficience et la qualité des soins, notamment l’introduction de critères d’évaluation objectifs et la spécification des interventions démontrées efficaces à privilégier. Aussi, plusieurs facteurs influençant l’implantation d’un modèle de soins hiérarchisés sont dégagés. Parmi ceux-ci, la présence de concertation et de lieux d’apprentissage représente un élément clé. Néanmoins, certains éléments sont à considérer pour favoriser sa réussite dont l’uniformisation des critères et des mécanismes de référence, la clarification des rôles du guichet d’accès en santé mentale et l’adhésion des omnipraticiens au modèle de soins hiérarchisés. En somme, l’utilisation des cadres de référence et d’analyse peut guider les gestionnaires sur les enjeux à considérer pour favoriser l’implantation d’un modèle de soins basé sur les données probantes, ce qui, à long terme, devrait améliorer l’efficience des services offerts et leur adéquation avec les besoins populationnels. / The purpose of the present study was to compare the care model of one Montreal local territory to the stepped-care model and to investigate factors influencing the implementation of this model. A qualitative case-study approach was employed involving 13 semi-structured interviews with services providers and managers from primary and specialist mental healthcare. Results showed that the hierarchical care model in place in this territory is compared in several points with the stepped-care model. However, some elements of these models have to be integrated to improve efficiency and quality of care, including the introduction of objective evaluation criteria and the specification of evidence-based interventions. Furthermore, some factors influenced the implementation of this hierarchical care model. Thus, the presence of collaborative working and learning strategies were identified to be a key condition. However, some elements must be considered to facilitate its success like the standardization of the referral criteria and process, the clarification of the mental health guichet d’accès (centralized access point) roles and the general practitioners' adherence to the care model. In conclusion, the use of the reference and analysis frames of this study may guide managers on issues to be considered to support the implementation of an evidence-based care model which may facilitate mental healthcare efficiency and its adequacy with the population needs.

Cette étude de cas vise à comparer le modèle de soins implanté sur le territoire d’un centre de santé et des services sociaux (CSSS) de la région de Montréal aux modèles de soins en étapes et à examiner l’influence de facteurs contextuels sur l’implantation de ce modèle. Au total, 13 cliniciens et gestionnaires travaillant à l’interface entre la première et la deuxième ligne ont participé à une entrevue semi-structurée. Les résultats montrent que le modèle de soins hiérarchisés implanté se compare en plusieurs points aux modèles de soins en étapes. Cependant, certains éléments de ces derniers sont à intégrer afin d’améliorer l’efficience et la qualité des soins, notamment l’introduction de critères d’évaluation objectifs et la spécification des interventions démontrées efficaces à privilégier. Aussi, plusieurs facteurs influençant l’implantation d’un modèle de soins hiérarchisés sont dégagés. Parmi ceux-ci, la présence de concertation et de lieux d’apprentissage représente un élément clé. Néanmoins, certains éléments sont à considérer pour favoriser sa réussite dont l’uniformisation des critères et des mécanismes de référence, la clarification des rôles du guichet d’accès en santé mentale et l’adhésion des omnipraticiens au modèle de soins hiérarchisés. En somme, l’utilisation des cadres de référence et d’analyse peut guider les gestionnaires sur les enjeux à considérer pour favoriser l’implantation d’un modèle de soins basé sur les données probantes, ce qui, à long terme, devrait améliorer l’efficience des services offerts et leur adéquation avec les besoins populationnels. / The purpose of the present study was to compare the care model of one Montreal local territory to the stepped-care model and to investigate factors influencing the implementation of this model. A qualitative case-study approach was employed involving 13 semi-structured interviews with services providers and managers from primary and specialist mental healthcare. Results showed that the hierarchical care model in place in this territory is compared in several points with the stepped-care model. However, some elements of these models have to be integrated to improve efficiency and quality of care, including the introduction of objective evaluation criteria and the specification of evidence-based interventions. Furthermore, some factors influenced the implementation of this hierarchical care model. Thus, the presence of collaborative working and learning strategies were identified to be a key condition. However, some elements must be considered to facilitate its success like the standardization of the referral criteria and process, the clarification of the mental health guichet d’accès (centralized access point) roles and the general practitioners' adherence to the care model. In conclusion, the use of the reference and analysis frames of this study may guide managers on issues to be considered to support the implementation of an evidence-based care model which may facilitate mental healthcare efficiency and its adequacy with the population needs.

Research has indicated that offering support and services for people who experience mental health problems and their families is a complex and contested area. Despite the controversies surrounding therapeutic interventions with families, it has now been recognised that relatives and other supporters of people with mental health problems should be included in their care. Whole- family interventions and partnership working with carers and families is now central to secondary care UK mental health policies and clinical practice guidelines. However, for many families/ carers this remains an aspiration rather than a reality. The way in which we successfully developed family focused mental health practice, as well as specialist family interventions (FI) for people who have been given a diagnosis of psychosis, has therefore aroused considerable interest. The Somerset Partnership NHS Foundation Trust has adopted a Strategy to Enhance Working Partnerships with Carers and Families, developed best practice guidance and has established two complementary workforce development projects - the development of specialist family intervention services and the widespread training of mental health staff to create a ‘triangle of care’ with service users and their families. This has resulted in widespread adoption of systemically informed, ‘whole-family’ practice. In response to the widespread difficulties experienced following other staff- training initiatives we developed specialist family interventions (FI) services by means of an innovative one-year course delivered in partnership with Plymouth University. This training initiative has been widely acknowledged for its novel integration of psycho-educational and systemic approaches and the effective in-situ, multi-disciplinary service development model. An advantage of this approach is that by the end of the course a local FI Service has been established and staff experience fewer difficulties in applying their new skills than people trained in other programmes. We then ensure the continued development of clinical skills by means of a service structure that emphasises on-going supervision. Regular audits of the service and in-depth research studies clearly indicate that the service is effective and highly valued by users. Our ‘cognitive-interactional’ approach, which integrates systemic therapy with psychosocial interventions (individual- and family-CBT) within a collaborative therapeutic relationship, enables us to meet the needs of families in a flexible, tailored manner. The FI teams are able to deliver early interventions for people with first episode psychosis, as well as meeting the NICE guidelines for people with longstanding symptoms. Recognising that many families do not require formal family interventions/ therapy, we also have been designing ‘stepped-care’ family intervention services. We have developed, and extensively evaluated, short training packages to enhance working partnerships with families throughout our mental health services. We have used this three-day package to train a range of community and inpatient teams. We have also encouraged family- inclusive practice with the establishment of a trustwide steering group, practice guidelines and the establishment of ‘family liaison’ posts to facilitate family meetings on inpatient units, as part of the assessment process. Both training initiatives explicitly focus on developing systemic thinking, by integrating CBT and systemic therapy. The involvement of families/ carers in the design and delivery of both training initiatives is also crucial.