Thesis (Ph.D.)--Ohio University, November, 2003. / Title from PDF t.p. Includes bibliographical references (leaves 149-163)

Thesis (Ph.D.)--Duquesne University, 2006. / Title from document title page. Abstract included in electronic submission form. Includes bibliographical references (p. 346-364) and index.

Thesis (Ph. D.)--Ohio State University, 1984. / Includes vita. Includes bibliographical references (leaves 70-75). Available online via OhioLINK's ETD Center.

The study developed a model for projecting potential economies from manpower substitution among the four core mental health professions and applied the model to a proposed substitution situation which would substitute psychologists for psychiatrists in the delivery of a proportion of present private practice (fee-for-service) psychiatry services in British Columbia. The model identifies three controlling variables: treatment substitutability (TS), practice privilege constraints (PPC), and relative payment rates (RR). In the model, TS and PPC are conceptualized as determining the estimated substitutable share of costs (SSC%); RR, in combination with the values derived for SSC%, is then used to estimate potential cost savings (CS%). Two conditions were defined for each of the three controlling variables in order to provide a range of possible values for SSC% and CS%. For reasons of data availability, data were obtained from the Manitoba Health Services Commission for private practice psychiatry services for FY 1984 and estimates of SSC% calculated. These estimates were then applied to B.C. Medical Services Commission data for FY 1984, and projected values of CS% calculated. Calculations were made both for all services and for the subset of psychotherapy services, which accounted for 80 percent of the larger set of services. The results of the study indicated considerable possibilities for manpower substitution, ranging from 35 to 70 percent for all services and 40 to 75 percent for psychotherapy services. However, the study also found that while salaried psychologists offered the possibility of substantial cost savings, a fee-for-service arrangement suggested virtually no potential savings. Projected values of CS% for the salaried alternative were 20 to 40 percent for all services and 15 to 30 percent for psychotherapy services but in the fee-for-service alternative, only 4 to 8 percent for all services and 4 to 7 percent for psychotherapy services. Licensure and market rigidities which might pose barriers to implementation were evaluated and a review of professional training standards (TS), licensure standards (PPC), and funding alternatives (RR) indicated that the projected economies could be achieved with no necessity for modifications in existing arrangements. PPC appear to present almost no barriers to economies from the proposed manpower substitution and those barriers which are presented by TS and RR limitations still allow considerable potential for economies. Thus, the greatest opportunities for intervention in achieving and enhancing the projected, economies appear to be in the exploration of relative payment rates and relative effectiveness of treatment methods (e.g., psychotherapy vs. pharmacotherapy). The study concludes with a discussion of factors lying outside the boundaries of the model but which impinge, nonetheless, upon the feasibility of the proposed substitution and fall, necessarily, to policy makers to address. The existing network of B.C. community mental health centres was suggested as a possible mechanism for the delivery of the substitutable share of private practice psychiatry services. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

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The Surgeon General of the United States in 2003 documented the existence of striking disparities for minorities and immigrants in mental health services and the underlying knowledge base. This thesis expands the knowledge base by examining the personal experiences and perspectives of community health workers (CHWs) employed in a mental health project. CHW interventions have been shown to increase access and reduce barriers to health care services. CHWs come from similar cultural and ethnic backgrounds as recipients of services and share similar life experiences. As cultural mediators between ethnic communities and a primary health care system, CHWs are able to provide valuable insight into immigrant mental health disparities. Through case study analysis, this thesis explores the personal experiences of CHWs employed by a grant-funded mental health project. Utilizing ethnographic research methods to better understand the CHW intervention, this thesis focuses on CHW motivations, their challenges and the impact of work on their personal lives. Results suggest that CHWs experienced many positive changes in their own lives as a result of their work. CHWs are better able to address their own physical and mental health needs. By increasing access to community and clinic services, CHWs help to improve the mental and physical health status of clients. Results suggest that the cultural competency of clinic staff, service providers and clients improved. CHWs help to strengthen community bonding or social capital by expanding social networks and empowering individuals to create change in their own lives. / Graduation date: 2006

Thesis (MA (Psychology))--University of Stellenbosch, 2006. / In order to make mental health care more accessible and even out the skewed distribution of services, policies were put in place to integrate mental health services into primary health care. For this to be effective, more trained mental health personnel needed to be employed in the public sphere as well as non-governmental and community organizations; and in state services. The BPsych degree which was instituted to meet this need has however, been plagued with controversy since its inception. This study aims to determine the employment patterns of BPsych graduates in the Western Cape so as to ascertain whether the expressed goals for establishing the degree, that is, addressing the need for primary mental health care workers, is in fact being met. Combinations of quantitative and qualitative methods were employed in this study. A self-constructed questionnaire was used for obtaining data. Quantitative data was analysed using SPSS and qualitative data was analysed by means of thematic content analysis. The quantitative data suggest that most of the respondents are employed and have completed the board exam. The majority of respondents are female and are employed within either community or NGO settings, or the private sector. Just over one third of respondents are employed as counsellors. A qualitative analysis of the data has suggested that the majority of employers are unaware of the category of registered counsellor. Respondents placed a large emphasis on the value of the practical component of the course. Based on the results obtained, one could argue that access to mental health care has not been significantly improved by the implementation of this category of registration.

Introduction: It was previously established that mental health workers in Rwanda experience secondary traumatic stress when working with trauma survivors. The effects of secondary traumatic stress can be serious and permanent in mental health workers when working with traumatized clients. It interferes with mental health worker’s ability to do their work effectively. Aim: This study aimed to explore STS and to develop an intervention model to manage secondary traumatic stress in mental health workers in Kigali, Rwanda. Methodology: This study was carried out into five cycles using action research approach. In the first cycles of the study a quantitative design was used to explore secondary traumatic stress in mental health workers in Rwanda. For this cycle, the particular aim was to determine the extent of the secondary traumatic stress in mental health workers in Rwanda. A total of 180 participants were selected using convenience sampling to be part of the quantitative study. In the second cycle of the study a qualitative design was used to explore mental health workers’ experiences of secondary traumatic stress. For this cycle 30 unstructured interviews were conducted. The third cycle aimed at developing the model to manage secondary traumatic stress. Action research approach was used in this phase. Experts from mental health services involved in the study were asked to participate in the study based on their availability as research team members. The fourth cycle of the study consisted of implementing the model in one mental health service and the fifth cycle consisted evaluation of the implementation of the model after six weeks period. The main aim of this cycle was an observation of the model implantation. Results: A diagrammatical model to manage secondary traumatic stress was developed by mental health professionals. In the model development cycle of the study, it emerged that there are very strong concurrence between the findings from experts in mental health care system and literature in terms of what needs to be included in the intervention model to manage secondary traumatic stress in mental health workers in Rwanda. The key elements to include in the model were based on preventive, evaluative and curative strategies to manage secondary traumatic stress in mental health workers in Rwanda. During the evaluation of the implementation, it emerged that participant noticed a change in coping strategies when facing the stressful incident in the practice. Recommendations: include an emphasis on more psychological support for mental health professional in their workplace and for more concrete aids such as supervision, guidelines on stress management on workplace, education on secondary traumatic stress management and implementation of counseling service for mental health workers. Conclusion: The model developed in the present study outlined different ways to manage STS at the individual, social and organizational levels. There is a need to translate the interventions to manage STS into active ongoing coping activities to be conducted at the individual, group and organizational levels. Organizational responses, such as creating a supportive organizational culture that acknowledges the potential for secondary traumatic stress, may help mental health workers to deal with workplace related secondary traumatic stress. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2010.