Context Of Health Services Research Articles

Doctors managing in primary care: An international focus

As well as looking after their patients and running their own small businesses, family doctors have to build and sustain an increasingly complex web of long-term relationships. These doctors require an independent entrepreneurial spirit as well as an ability to influence others without having direct authority over them. They also need to be politically astute, to understand 'the big picture' of how health services function as a whole, but also be able to work through the detail to ensure seamless patient care. Finally, given the nature of primary care, and its place in healthcare systems, this paper concludes that those doctors who are by nature problem-solvers, tolerant of ambiguity and inherent optimists are those who thrive best in this particular management environment. The paper draws its arguments from the organisational context of health services and the position of primary care doctors within that system. It examines the future in terms of emerging health service trends and wider societal pressures. This leads to an analysis of the key management competences. What does it take to manage as a doctor in primary care and how can doctors prepare themselves for this role?

Political violence, psychosocial trauma, and the context of mental health services use among immigrant Latinos in the United States

Objectives. We present the prevalence of exposure to political violence (PV) among Latino immigrants in the US, and perceived need for and correlates of mental health services use among this population. Methods. We use the National Latino and Asian American Study (NLAAS), a nationally representative epidemiological survey of US Latinos, including a probability sample of 1630 immigrant Latinos. Our conceptual framework assumes a strong role of social and cultural factors in understanding the risk for psychopathology and mental health service use. Results. Eleven percent of all immigrant Latinos reported PV exposure and 76% described additional lifetime traumas. Among those with a history of PV, an increased likelihood of using mental health services was associated with female gender, English language proficiency, experiencing personal assaults, higher perceived discrimination, and having an anxiety or substance disorder. Latino men and specific subgroups of Latinos were less likely to access mental health services after experiencing PV. Perceived need for mental health services use is the strongest correlate of any lifetime and last-12-months service use. Conclusions. Individuals who come from countries with a history of political violence often have multiple traumatic experiences. This suggests a need for systematic screening for trauma and related psychiatric disorders. Specific outreach interventions focused on perceptions of need could be helpful for subgroups of Latinos including men who are particularly underrepresented in mental health services but who exhibit significant trauma histories.

Asking the right questions: Scoping studies in the commissioning of research on the organisation and delivery of health services

Scoping studies have been used across a range of disciplines for a wide variety of purposes. However, their value is increasingly limited by a lack of definition and clarity of purpose. The UK's Service Delivery and Organisation Research Programme (SDO) has extensive experience of commissioning and using such studies; twenty four have now been completed.This review article has four objectives; to describe the nature of the scoping studies that have been commissioned by the SDO Programme; to consider the impact of and uses made of such studies; to provide definitions for the different elements that may constitute a scoping study; and to describe the lessons learnt by the SDO Programme in commissioning scoping studies.Scoping studies are imprecisely defined but usually consist of one or more discrete components; most commonly they are non-systematic reviews of the literature, but other important elements are literature mapping, conceptual mapping and policy mapping. Some scoping studies also involve consultations with stakeholders including the end users of research.Scoping studies have been used for a wide variety of purposes, although a common feature is to identify questions and topics for future research. The reports of scoping studies often have an impact that extends beyond informing research commissioners about future research areas; some have been published in peer reviewed journals, and others have been published in research summaries aimed at a broader audience of health service managers and policymakers.Key lessons from the SDO experience are the need to relate scoping studies to a particular health service context; the need for scoping teams to be multi-disciplinary and to be given enough time to integrate diverse findings; and the need for the research commissioners to be explicit not only about the aims of scoping studies but also about their intended uses. This necessitates regular contact between researchers and commissioners.Scoping studies are an essential element in the portfolio of approaches to research, particularly as a mechanism for helping research commissioners and policy makers to ask the right questions. Their utility will be further enhanced by greater recognition of the individual components, definitions for which are provided.

Leadership competencies in the context of health services

In a rapidly changing health-care environment, clinicians are increasingly called upon to assume complex leadership responsibilities. The research was undertaken to develop an understanding of the limits to the conceptual and methodological basis of leadership competency modelling in health services context. Data were collected from all of the clinicians in a Psychiatric Hospital, Bahrain using a researcher-developed questionnaire. Data were gathered to critically assess the validity of the competency-based approach to leadership on the basis of subjects' capacity to discriminate in terms of importance and accomplishment between the items featured in a research tool containing a comprehensive list of 124 leadership competencies. The results of the analyses indicate a weak identification with the competencies in the sense of revealing low levels of discriminatory sophistication on the part of subjects. The study design was limited to participants working in single hospital; therefore, the conclusions made cannot yet be regarded categorically as generalizable. Leadership selection, development and education activities may not achieve their ultimate outcomes due to the subject identification problem associated with the competence approach. It might be necessary to reconsider the efficiency of human resource activities that rely solely on the competency approach. The conceptual basis of leadership competence in health services has been previously neglected. This research casts doubt on competency approaches to leadership if based on subject identification with pre-defined items.

Induction and transition in the National Health Service for four professional groups

AbstractNational Health Service policies of induction and supporting transition into posts face three key issues: meeting a diversity of needs in terms of change, the integration of induction into a service with profession‐specific policies and practices, and their configuration with workforce policies designed to alter role boundaries and develop more interprofessional working. In examining these three areas, the study reported here reviews current practice in four professional groups (dentists working in the community dental service, children's nurses, pharmacists and radiographers) with the purpose of reviewing their experience of induction and transition in relation to National Health Service policies and contexts. The small‐scale qualitative study was conducted between September 2005 and March 2006. Twenty‐one interviews were undertaken with pharmacists and children's nurses working in hospitals and primary care, radiographers in hospitals and community dentists in primary care; relevant national and local policy documents were also analysed. The study concludes by recognizing that ‘statutory’ induction is secure, that more attention is needed to support interprofessional learning at points of transition; that disparities in access to training may become increasingly problematic; that significant aspects of current practice do not match contemporary policy requirements; and that more research into the models of learning that will facilitate more effective interprofessional working are needed.

Implementation of clinical supervision in action: Part 3: The development of a model

Implementation has been observed to be crucial to the successful introduction of clinical supervision. Despite its importance, there is limited literature which articulates principles or process to guide it. The first and second parts of this three-part paper present findings of a qualitative exploration of the implementation of clinical supervision in a rural mental health service. The findings were discussed in light of the Driscoll model of implementation. While this model provided a valuable tool to interpret some aspects of the findings, its focus was primarily on the preimplementation stage, particularly in terms of assessing the workplace culture and the recognition of the pushing and resisting forces in relation to clinical supervision. This paper presents a new model of implementation with interrelated and dynamic stages. The model was developed in a rural mental health service context. An overview of this research-based model is presented in this paper.

Assessing the Organizational Social Context (OSC) of Mental Health Services: Implications for Research and Practice

The organizational social context in which mental health services are provided is believed to affect the adoption and implementation of evidence-based practices (EBPs) as well as the quality and outcomes of the services. A fully developed science of implementation effectiveness requires conceptual models that include organizational social context and tools for assessing social context that have been tested in a broad cross-section of mental health systems. This paper describes the role of organizational social context in services and implementation research and evaluates a comprehensive contextual measure, labeled Organizational Social Context (OSC), designed to assess the key latent constructs of culture, climate and work attitudes. The psychometric properties of the OSC measure were assessed in a nationwide study of 1,154 clinicians in 100 mental health clinics with a second-order confirmatory factor analysis of clinician responses, estimates of scale reliabilities, and indices of within-clinic agreement and between-clinic differences among clinicians. Finally, the paper illustrates the use of nationwide norms in describing the OSC profiles of individual mental health clinics and examines the cross-level association of organizational-level culture and climate with clinician-level work attitudes.

Experiences of an action learning set

AbstractThis paper outlines the background to the establishment of a multidisciplinary action learning set in the Irish Health Service context; describes the action learning set process; explores set members' experiences of set membership and action learning; and concludes by making some recommendations. Copyright © 2007 John Wiley & Sons, Ltd.

Weighing up triangulating and contradictory evidence in mixed methods organisational research

AbstractThis paper explores the role of the context-familiar researcher in the interpretation of research data, specifically in terms of applying a transparent process to weighing up triangulating evidence in mixed methods research. It is erroneous to assume that all research data will converge on an undisputable ‘truth’ or ‘fact’, but few writers on the concept of data triangulation offer advice on how researchers might handle conflicting evidence in their research projects. Furthermore, little appears to be written about whether or not some evidence in a study employing multiple sources can assume greater importance as evidence than other data. In other words, are all data equal? In this paper, I critically reflect on how I applied trustworthiness principles that are implicitly reflexive to resolve these issues in a research project undertaken in the professional health services context in which I have extensive prior experience.

Clinical Priorities: Strengthening Social Work Practice in Health*

In the context of health services, decisions regarding priorities for social work intervention and, hence, the allocation of social work expertise and resources have traditionally been based on an interaction between social work knowledge, principles and skills, historical precedence, health policy, multidisciplinary team requirements, and manager opinion. In the current context of health services, traditional practices are questioned and it has become essential for social work as a profession to clarify its role, its choice of interventions, and to state clearly and strongly, on the basis of social work knowledge, its core priorities for practice and, hence, the allocation of resources. This paper presents the findings of an exploratory study, undertaken by joint university and practice collaboration, designed to develop a set of priorities for social work practice in health. The study was undertaken in the Hunter Health region of New South Wales, Australia, where social workers are employed across a range of hospital, mental health, specialist, and community services. The resulting set of clinical priorities for social work practice in health has implications for the allocation of social work resources and expertise to the social issues central in individual family and community health status, and for the profession's capacity to strengthen the role of social work in health.

Setting up a clinical psychology service for commercial sex workers

The objective of this study was to provide what we believe to be the first report of the establishment of a clinical psychology service to provide accessible psychological assessment, intervention and crisis support, integrated within an existing East London sexual health clinical and outreach service for commercial sex workers (CSWs). Data are presented on referral patterns, demographics, presenting issues to clinical psychology, interventions and outcomes for the first year of the service. Women presented with a range of psychosocial needs. Psychological interventions included direct therapy, signposting to other services and consultation with staff. We concluded that this flexible model of service provision improves access to mental health services within the context of a specialist sexual health and outreach service for CSWs. The provision of a named, female clinical psychologist who provides both the clinical sessions and attends outreach has been an important factor in developing trust and familiarity, leading to better uptake of the clinical psychology service.

Barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia

To examine the barriers and incentives to HIV treatment uptake among Aboriginal people in Western Australia. In-depth, semi-structured interviews were conducted between February and September 2003 with 20 Aboriginal people who were HIV-positive; almost half the total number of Aboriginal people known to be living with HIV in Western Australia at that time. Despite having access to treatments in both urban and rural areas, only 11 of the 20 participants were on antiretroviral treatment at the time of interview. Four of the women had been prescribed treatment during pregnancy only. The main barriers to treatment uptake were fear of disclosure and discrimination, heavy alcohol consumption and poverty. The incentives were pregnancy and access to services whose approach can be described as broad-based and holistic, i.e. supporting people in the context of their everyday lives by providing psychosocial and welfare support as well as healthcare. For many Aboriginal people, maintaining social relationships, everyday routines and the respect of friends, families and community is a greater priority than individual health per se. Treatment regimens must be tailored to fit the logistical, social and cultural context of everyday life, and be delivered within the context of broad-based health services, in order to be feasible and sustainable.

Introducing Evidence‐Based Family Assessment and Therapy in Child and Youth Mental Health Services: Applying Systemic Principles to Maintain, Sustain and Build Capacity

The purpose of this article is to overview the context of the mental health service in which we work, and family therapy's status prior to and after the impact of changes wrought by the introduction of the National Mental Health Policy. We then explore some key issues that we think contribute to the persistence of the occlusion of family therapy in child psychiatric services; and the strategies that we developed and are continuing to develop to support change. Finally, we describe the use of a family assessment instrument that we believe is central to our change strategy.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterGregory A. Aarons Ph.D.Gregory A. Aarons Ph.D.Search for more papers by this authorPublished Online:1 Nov 2006https://doi.org/10.1176/ps.2006.57.11.1656AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: Mr. Seitzer's letter regarding my article supports the contention that high-quality leadership is an important consideration in the provision of high-quality mental health services. Establishing a link between leadership and the attitudes of mental health service providers toward adopting innovation and change—evidence-based practices in particular—was the main point of the article. The article does not, however, contend that evidence-based practices are the only means of improving outcomes for those involved in mental health services. There is considerable debate regarding applicability, standards for fidelity, and the need for local adaptation of evidence-based practices. The article takes no stand on the value of evidence-based practices per se. The Evidence-Based Practice Attitudes Scale ( 1 ), which was used in the study, was developed because providers' attitudes toward adopting innovation have been largely ignored in the research literature, even while the impetus to disseminate and implement evidence-based practices has gained momentum. Mr. Seitzer's assertion that outcomes matter more than particular practices raises a complex and important issue. Services might be greatly improved if outcomes were routinely empirically assessed in usual care. Rigorous outcome measurement and use of such outcome data to inform clinical practice are relatively rare. Indeed, research suggests that clinicians' attitudes about using such measures vary greatly, with some believing that clinical knowledge and judgment are at least as accurate as empirically reliable and valid assessment, thus obviating the need for such measures ( 2 ). There is evidence that draws such an assumption into question ( 3 ). Assessments will likely be beneficial to the degree that they can be incorporated into the clinical process both to better understand initial diagnoses and problems and to track clinical progress. Although my study did not directly address outcome assessment, it did establish a link between leadership and providers' attitudes toward adopting evidence-based practices as part of a research program on improving the context for delivery of high-quality mental health services and implementation of innovation ( 4 ). An innovation in mental health care may or may not be evidence based. What is emerging from this line of research is that leadership and organizational context are likely to play an important role in implementing innovation and promoting more positive outcomes for mental health and social service agencies and clinics ( 5 ). Reference1. Aarons GA: Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research 6:61-74, 2004Google Scholar2. Garland AF, Kruse M, Aarons GA: Clinicians and outcome measurement: what's the use? Journal of Behavioral Health Services and Research 30:393-405, 2003Google Scholar3. Dawes RM, Faust D, Meehl PE: Clinical versus actuarial judgment. Science 243:1668-1674, 1989Google Scholar4. Aarons GA: Measuring provider attitudes toward evidence-based practice: consideration of organizational context and individual differences. Child and Adolescent Psychiatric Clinics of North America 14:255-271, 2005Google Scholar5. Glisson C: The organizational context of children's mental health services. Clinical Child and Family Psychology Review 5:233-253, 2002Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 57Issue 11 November, 2006Pages 1656-1656PSYCHIATRIC SERVICES November 2006 Volume 57 Number 11 Metrics PDF download History Published online 1 November 2006 Published in print 1 November 2006

Evidence-Based Practice: Current Issues and Future Directions

Evidence-based practice approaches continue to increase in popularity in health and human service contexts in Australia and internationally. As social workers face pressures to evidence practice and justify outcomes, the limitations in applying an evidence-based practice approach to social work are confronted. The present paper identifies the features of evidence-based practice and notes the potential benefits and limitations of this approach in social work. Debates surrounding the nature of social work interventions, effectiveness and evidence are reviewed. The current context and climate influencing the use of research and other evidence in social work are discussed. The paper also considers the position of qualitative, interpretive and critical reflective approaches in relation to evidence-based practice. Issues for the future of evidence-based practice in social work are identified, including the need for the profession to examine more closely the relationship between critical reflective and evidence-based approaches to practice.

New service development: a stakeholder perspective

PurposeTo increase understanding of both the process of new service development (NSD) and the nature of services as delivered to customers.Design/methodology/approachFour qualitative, exploratory case studies encompassing public (health) and private (financial) sector service organisations.FindingsManagers select stakeholder groups for involvement in NSD attributing stakeholder salience, centrality to the process and power to influence the final service design. Customers are “dormant” stakeholders, thought to lack the knowledge/experience to contribute meaningfully to NSD. Their interests and needs are channelled through other stakeholders.Research limitations/implicationsThe research is confined to two service industries based on a key informant approach; thus generalisability to other industries may be limited.Practical implicationsMultiple stakeholder involvement places a growing emphasis on the need for NSD managers to be skilled in managing complex, multi‐layered and multi‐faceted processes, often without legitimate power. This is likely to be a particular challenge for the public sector.Originality/valueThis paper examines the relatively underdeveloped area of NSD and from an unusual perspective, i.e. that of services as outcomes of an amalgam of stakeholder interactions and relationships. Furthermore, it represents one of only a few in‐depth studies of NSD within a health service context.

Health service use of whole system interventions

PurposeThis paper aims to evaluate a whole system intervention (WSI) that was applied to North Tyneside (UK) adult mental health services and offer a discussion on the broader implications of these results. WSIs are brief, participant‐intensive, democratic change methods that are widely utilised but have received relatively little empirical consideration.Design/methodology/approachTwo methods were used for the WSI evaluation: comparative (of local documentary evidence with scientific and professional sources); and qualitative (analysis of semi‐structured interviews with project planners, stakeholders and participants).FindingsIssues emerged from the research associated principally with the following topics: system definition, power, stakeholder representation, facilitator role, intervention planning, as well as WSI follow‐up and time‐scale.Originality/valueGuidance is offered associated with WSI methodology choice and its implementation within a health service context.

Training CAMHS Professionals in Developing Countries: An Indian Case Study.

This paper presents a rationale for the education of CAMHS staff and service development as a partnership between the UK and developing countries. The local context and background of child and adolescent mental health services in India are described, and the rationale for the teaching principles is outlined. The planning and delivery of the teaching, following these principles, is illustrated through a case study of work in India. The discussion focuses on what worked well, problems and difficulties faced, how these were managed, and how visitors can influence change whilst respecting the local perspective. Suggestions are made for improving future programmes so as to maximise the outcomes of such links.

Women, Mental Health, and the Psychiatric Enterprise: A Review

This article raises questions about how social workers can be more responsive to the needs and wants of women who struggle with mental, emotional, and behavioral disorders. Specifically, the article examines the history and theoretical context of mental health services for women, reviews lessons learned from women's own descriptions of their lived experiences with mental illness, and summarizes needed responses to the treatment needs of women. Recommendations are offered in areas of the general structure of the service delivery system, psychosocial and psychotherapeutic interventions, and psychopharmacology.

All aboard in the NHS: collaborating with colleagues who use different approaches

Drawing on the author's Mental Health Trust experience, this paper explores and celebrates the diversity of multi‐disciplinary, multi‐model approaches within a National Health Service context and the challenges systemic practitioners encounter in fitting what they have to offer into these complex professional systems. It suggests that we can best meet these challenges both by looking for underlying similarities between approaches and finding ways to accommodate and celebrate the differences.