Active Caseload Research Articles

Lovaas Institute for Early Intervention (LIFE).

For many years, O. Ivar Lovaas ran a small clinic for children with autism through the department of psychology at UCLA, with undergraduate students providing most of the direct instruction. Throughout the 1970s, the clinic enrolled just a few children in treatment at a time. By the early 1980s, the active caseload had increased to about 5-10 children, and this number rose slowly over the next few years. However, after the publication of Lovaas's landmark study of early intensive behavioral intervention (EIBI) in 1987, followed by an extraordinary firsthand account of one family's experience with the intervention (Maurice, 1993), Lovaas began receiving more requests for treatment in a single day than he had previously received over an entire year.

Collaborative Care: An Integral Part of Psychiatry’s Future

Collaborative Care: An Integral Part of Psychiatry’s Future

Dysphagia Management Practices Among Speech-Language Pathologists in Malaysia

In Malaysia, speech-language pathology services for dysphagia managementare yet to be fully established. Detailed knowledge of current practices is necessary to inform future training and infrastructure needs. Therefore, the current study aimed to: (a) explore current practice for dysphagia management among speech-language pathologists (SLPs) in Malaysia and (b) compare Malaysian practice to those of SLPs working in settings with an established dysphagia service (Queensland Health, Australia). A questionnaire was mailed to 30 SLPs working in Malaysian governmenthospitals. The same set of questionnaires was then mailed to SLPs in Queensland government hospitals who matched the Malaysian cohort. Survey findings from the Malaysian clinicians revealed at least moderate consistency of practice for 24 out of 25 clinical items examined, with 71% of these items classified as having high practice consistency. Comparisons with the matched cohort of SLPs, revealed patterns of practice were comparable across 19 of the 25 (76%) aspects of dysphagia assessment and treatment examined. The most noticeable areas of inconsistencyof practice between the two groups related to the proportion of active caseload dedicated to dysphagia management, the use of a team approach to dysphagia management, involvement in making diagnoses, and differences regarding the nature and frequency of use of instrumental diagnostic tools. Despite identifying a number of areas which require further education and training, overall the current study demonstrated that the dysphagia service in Malaysia is moving toward standards of practice largely comparable to more established services. The findings provide insight into patterns of service development for other countries developingdysphagia services.

Missed Diagnosis of Autism in an Australian Indigenous Psychiatric Population

The aim of this paper is to review the diagnosis among adult Indigenous patients from the Kimberley region of Western Australia who had an existing diagnosis of schizophrenia. A visit from a psychiatrist specializing in intellectual disability provided the opportunity for conducting psychiatric assessments from a developmental perspective. Selected patients with schizophrenia were assessed from an intellectual disability perspective from an active case load of 215 patients. Thirteen out of 14 selected patients were considered to have a diagnosis of autism when a developmental history was undertaken. Case studies are presented to illustrate the overlap in symptoms and potential for the diagnosis of autism to be missed. Autism spectrum disorders may be missed in Indigenous population groups. This has implications for treatment and service provision. Clinicians need to be mindful of the diagnostic possibility that an autism spectrum disorder might be masquerading as schizophrenia in the context of intellectual disability and atypical presentation.

With out a quality management tool, all HIV Managers shall not realise any steps forward for improvement: a Taso Uganda experience

Methods Start with your baseline assessment from where a quality statement is chosen. The materials include Quality statement, quality program, performance measurement system, determining quality improvement goals, stakeholders & patient participation, an implementation plan and evaluation. Determine an active case load where a sample is got through a computer automated system or manual lists. Using performance indicators, patient’s files sampled are reviewed by the quality team. Results are shared and discussed with the quality team, staff and then another quality statement can be made. Though many performance gaps can be identified the rule of one is employed in selecting the quality statement.

Case Management Innovation in a Large, Urban Trial Court: The Critical Importance of Legal Stakeholder Attitudes

This article, based on research conducted in the Circuit Court of Cook County (Chicago) from June 2006 through March 2007, addresses the challenge of a large, urban felony court in reducing delay through the introduction of a Differentiated Case Management (DCM) system. The research design incorporates an empirical data analysis of caseflow and an opinion survey of over 500 legal stakeholders. While the court demonstrated a positive clearance rate, there was evidence of considerable case delay and backlog in the active pending caseload. In stark contrast, the survey findings indicate a lack of stakeholder awareness of case delay, a low level of acceptance of felony time standards, and a general concern that an expedited pace of case management, through the introduction of a DCM system, might cause injustice. The implications of these findings for the future success of Differentiated Case Management in this court are discussed, as is the relevance of the findings for other jurisdictions interested in improving case management.

The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth

Objective For child protective services (CPS) youth who may have experienced more than one form of maltreatment, the unique contribution of emotional abuse may be over-looked when other forms are more salient and more clearly outside of accepted social norms for parenting. This study considers the unique predictive value of childhood emotional abuse for understanding adolescent post-traumatic stress disorder (PTSD) symptomatology and dating violence. Further, PTSD symptomatology is assessed as an explanatory bridge in the emotional abuse—teen dating violence link. Methods A random sample of 402 youth from the active caseload of a large urban CPS catchment area participated as part of a larger longitudinal study on adolescent health behaviors. Mid-adolescent youth across types of CPS status were targeted. CPS youth reported on lifetime maltreatment experiences, PTSD symptomatology, and past year dating experiences, using published scales. Results Over 85% of CPS youth had begun dating. For dating youth, some level of dating violence was common: over half of females (63–67%) and nearly half of males (44–49%). Taking into account other forms of maltreatment, emotional abuse emerged as a significant predictor of both PTSD symptomatology and dating violence among males and females. PTSD symptomatology was a significant mediator of the male emotional abuse-perpetration and the female emotional/physical abuse-victimization links, indicating a gendered patterning to findings. Conclusions These results indicate that: (1) CPS youth are a high priority group for dating violence and PTSD-linked intervention; and (2) CPS youth continue to experience the unique negative impact of childhood emotional abuse in their adolescent adjustment. All CPS children should be evaluated for emotional abuse incurred, and appropriate intervention attention be given as to how it specifically impacts on the child's approach to relating to themselves and to others. Practice implications The present study directs practice implications in regards to: (1) the problem of teen dating violence, (2) the salience of childhood emotional abuse; and (3) the importance of targeting PTSD symptomatolgy among CPS youth. A substantial number of CPS youth report early engagement in violent romantic relationships and require support towards attaining the non-coercive relationship experiences of their non-CPS-involved age mates. The topic of dating, healthy dating relationships, and dating violence may need to be part of the regular casework, with a view towards supporting youths’ conceptualization of and skill set for healthy, close relationships. Further, this knowledge needs to be translated to foster parents and group home staff. With regard to the impact of childhood emotional abuse, CPS workers need to be sensitive to its potential for long-term, unique impact impairing relationship development. Emotional abuse is (a) unique among genders (i.e., for females, it clusters with physical abuse) and (b) uniquely predictive of PTSD symptoms and dating violence. Finally, as is consistent with theory and biopsychosocial evidence, PTSD symptomatology is a key causal candidate for understanding maltreatment-related impairment. Attention to targeting PTSD symptoms may be preventative for dating violence; attention to targeting emotional abuse experiences may be preventative for PTSD symptoms. CPS youth are an important population to involve in research, as their inclusion adds to the evidence-base to achieve evidence-informed practice and policy within child welfare.

An Early Intervention in Psychosis Service for adolescents

AbstractAims: To describe a service operating in Teesside, England, that provides early intervention for young people aged 14–18 years at high risk of, or affected by psychotic illness.Methods: The Service Delivery Model for evaluating and managing young people referred to the service is described. In addition, data routinely collected as part of performance management are presented.Results: During 2006 42 young people were referred to the service of which 29 were accepted. At the end of 2006 the team active caseload was 22 patients.Conclusion: An ‘adolescent‐specific’ team as part of a 14–35 Early Intervention Service appears to be a feasible and sustainable development and may confer advantages over less age‐orientated care.

Consumers with a disability of substance abuse: Exploring beliefs impacting placement

Given the increased prevalence of substance abuse among U.S. citizens, this study utilized the Theory of Planned Behavior to explore the beliefs influencing the placement of consumers with a disability of substance abuse. Based on the Theory of Planned Behavior, the Disability of Substance Abuse survey was developed and administered to 163 public rehabilitation placement professionals with active caseloads. Participants identified nine outcomes of placement which included increased consumer self-esteem and opportunity for consumer success; reported three groups of persons influencing placement decisions; and delineated nine impediments to placement which included consumer lack of support systems and consumer misdemeanor and arrest history. The findings suggest public rehabilitation placement professionals perceived the placement of persons with a disability of substance abuse as beneficial; however, their behavior was influenced by (a) rehabilitation placement peers in their agency, (b) employers with whom they work, and (c) impediments to, rather than resources for, placement.

Factors That Influence Staffing of Outpatient Substance Abuse Treatment Programs

This study examined whether and how various organizational and environmental forces influence staffing in outpatient substance abuse treatment programs. The authors used data from the 1995 and 2000 waves of the National Drug Abuse Treatment System Survey (NDATSS), a telephone survey of unit directors and clinical supervisors. Multivariate analyses with generalized estimating equations were conducted. Two measures of staffing were modeled: the number of weekly treatment hours per client, and active caseload. Managed care activity influenced active caseloads but not the number of treatment hours per client. Significant differences were noted in staffing levels among private for-profit, private nonprofit, and public treatment programs, with public units offering fewer hours per client and having larger caseloads. Units accredited by the Joint Commission on Accreditation of Healthcare Organizations offered more treatment hours per client. The results of this study contribute to the understanding of various influences on treatment staff time and caseloads. Understanding these relationships is critical for policy makers, managed care companies, and managers, because staffing levels have the potential to affect both the cost and the quality of treatment.

Community mental healthcare in England: associations between service organisation and quality of life

The present authors set out to explore the relationship between different forms of service organisation and quality of life (QoL) for service users. Four mental health trusts and their corresponding social services departments were recruited to exemplify: (1). high and low levels of integration between health and social services; and (2). high and low levels of targeting at users with severe mental health problems. The authors used the Lancashire Quality of Life Profile, and chose their sample size to be able to detect a difference of 0.5 in subjective satisfaction scales. Analysis of covariance was used to investigate the simultaneous impact of variables representing user characteristics, objective and subjective QoL, and service organisation. Two hundred and sixty users selected at random from the active caseloads of mental health services in the four districts were interviewed at time 1 and 232 people were interviewed 6 months later (time 2). No bias was detected in the non-respondents at time 2. The authors found few differences between districts. As in other similar studies, QoL seemed to be stable for the whole sample over time. In 6 months, general satisfaction with leisure increased and the number of people who had been in hospital fell. Negative affect score was the only variable found to be associated with subjective QoL, and no predictors of objective QoL were identified. There was some evidence of better objective outcomes for people in receipt of integrated mental health services. They socialised more, and seemed to have less difficulty accessing police and legal services. The results also suggest that interventions targeted at negative affect could have benefits for subjective QoL.

Flexible Needs led Community COPDOutreach Service

Introduction:Four hundred admissions annually to North Tyneside General Hospital with COPD, high rate of Social Service input, high rate of consultations and house calls to GPs, high rate of elderly patients.Rationale:Patients with COPD require care, encompassing physical, medical, social, psychological and social needs. The limitations of the current service provision highlighted a vulnerable client group that was receiving fragmented care. Social Services and the Respiratory Team at NTGH identified the unmet needs in patients with COPD. The COPD Service was therefore initiated to provide a flexible, needs led, proactive and health-promoting service. The Service comprises of a Respiratory Nurse Specialist who leads a team of six generic outreach workers. Since commencement of referrals in July 2000 to the end of March 2001 the service had received 115 referrals. Fity-five of these patients were provided with Outreach support. Fourty-five patients were assessed and appropriate needs addressed solely by the Respiratory Nurse Specialist. Fifteen were inappropriate referrals to the service.Evaluation:The service was reviewed at the end of March in conjunction with the University of Northumbria. Postal questionnaires were sent to all patients with an 82% response rate. Telephone interviews with 6 patients, interviews with all staff. At that time the active caseload was 33 patients.Mean age was 75 years58% Male, 42% FemaleMRC Scale 5–76%66% on Oxygen therapy, 45% LTOT, 21% p.r.n.The caseload can be divided into four main bands, palliative care, exercise and breathing training, social isolation and carer relief.

Characteristics of severely mentally ill patients in and out of contact with community mental health services.

Community mental health nurses have been criticized for failing to prioritize work with people with a severe or enduring mental illness, many of whom have no contact with specialist mental health services and rely entirely on their general practitioner and primary care team. It is important to ensure that those in contact with specialist services actually need this level of input but, conversely, that those in contact with only primary care receive a service that is equipped to meet their needs. This study examines the differences between these two groups of patients. A sample of 253 community-based patients with a severe or enduring mental illness was divided into those with mental health service contact and those without. Differences in the demographic characteristics of the two groups were assessed and further, more detailed, comparisons were made with a sub-sample of 49 individuals randomly drawn from this larger sample. Instruments adopted for these purposes comprised the Camberwell Assessment of Need and the Life Fulfilment Scale. It was found that patients with a psychotic disorder were more likely than those with neurosis to be in contact with mental health services and patients with schizophrenia were significantly more likely to be on the active caseload of a community mental health nurse than those from all other diagnostic groups. However, patients' levels of need, unmet need and quality of life did not differ in relation to their service contact. Whilst the study provides limited evidence that community mental health nurses are targeting people with the most serious disorders, questions remain about the large proportion not receiving specialist care. Because primary care plays a significant role in the care of severely mentally ill people living in the community, the further mental health training of general practitioners and practice nurses is becoming increasingly important.

Managing suicidal emergencies: Recommendations for the practitioner.

All practicing psychologists with an active caseload occasionally encounter a patient or client whom they consider to be a suicidal emergency. Few psychologists, however, have had education or training focused on managing such cases, The current article conceptualizes what a behavioral is, gives recommendations for containing the emergency client's emotional turmoil, and sets forth an evidencebased approach, using diagnosis-specific risk factors, for improving the clinician's ability to estimate suicide risk. Recommendations are also given for appropriate responses to the patient or client on the basis of the level of estimated risk. Having such an algorithm or plan for dealing with the suicidal client is essential to good practice.

Applying Clinical Reasoning: A Caseload Management System for Community Occupational Therapists

This article presents a system of caseload management for community occupational therapists. Using the clinical reasoning work of Mattingly and Fleming as a framework, the perceived complexity of each case for a community occupational therapist was analysed and then paralleled with the type and amount of clinical reasoning required. Following an initial occupational therapy assessment, each case is given a numerical weighting, graded at 3 for complex cases and from 1 for non-complex or simple cases. The degree of complexity or weighting is recognised to be a subjective phenomenon dependent on the experience, knowledge and skills of the therapist. The cases held by an occupational therapist are able to be mixed so that the experienced therapist holds a varied caseload of complex and simple work. Beginning therapists can follow the same measured approach thus augmenting their background experience. This method promotes continuing education, assists experiential learning and provides variety. Using this system, it is proposed that occupational therapy services are enhanced by reducing unnecessary casework from therapists' active caseloads, allowing increased time to work on complex cases and using expertise more efficiently.

Reduction in caseload after multidrug therapy in an urban leprosy control programme - a retrospective study in Bombay

A fall in the active registered case prevalence rate together with a fall in the active caseload per worker after the introduction of multidrug therapy (MDT) is becoming a managerial issue in leprosy control. A retrospective analysis was undertaken to assess the caseload per paramedical worker with reference to active cases for treatment (3341), cases for surveillance (2227) and cases for care after cure (165) at the end of December 1989. All these cases were under the care of 24 paramedical workers. The analysis showed that the caseload per worker was 239 (active cases 139, plus surveillance cases 93, plus care after cure cases 7), though active registered case prevalence rate declined from 1.82/1000 (before starting MDT) to 0.79/1000 by the end of December 1989. The case detection rate was 0.49/1000 by the end of 1989. So, although the active registered case prevalence rate declines, the worker will have enough to do because of the need for surveillance and the detection of relapses, early neuritis, early disabilities and care after cure. Simultaneously, new case detection and treatment must be continued. All these aspects need to be considered when programme managers are reviewing leprosy control strategy.

Evaluation of New Jersey's Intensive Supervision Program

New Jersey's Intensive Supervision Program (ISP) has an active caseload of approximately 400 nonviolent offenders. ISP requires employment and provides a high frequency of field contacts with participants, including random tests to detect drug use. Because ISP requires that participants first serve a few months in prison, perform community service, and obey curfews, it provides a level of punishment intermediate between probation and ordinary terms of imprisonment. Evaluation research showed that, in comparison to ordinary imprisonment and parole, ISP achieved slight reductions in recidivism, modest saving of prison space, and was substantially more cost-effective.

A PRELIMINARY STUDY OF NORTRIPTYLINE IN DEPRESSION.

The sudden and unexpected withdrawal of tranylcypromine (Parnate) from the market provided an unusual opportunity to study the effects on patients of withdrawal of psychotherapeutic drugs. A survey was done in our Outpatient Psychiatric Clinic in which psychiatric residents, medical stu dents, staff social workers, and psychology trainees are involved in the care of psychi atric outpatients. The average active case load of the clinic is 200 patients. All individuals seeing patients in the clinic were asked to report on all patients who had been on tranylcy promine and who had been taken off the drug at the time it was removed from the market. The elapsed time between drug withdrawal and the clinician's report on the patient was from one to three weeks. Information was obtained as to the pa tient's age, sex, and diagnosis. Also data were collected as to the time the patient