Training In Psychosocial Interventions Research Articles

Care coordinator delivered method of levels therapy to improve engagement and other outcomes in early psychosis (CAMEO): protocol for a feasibility cluster-randomised controlled trial

BackgroundRates of disengagement from early intervention in psychosis (EIP) services are high. Care coordinators make up the largest staff group in EIP services and have the most frequent and sustained contact with service users. The quality of relationships between service users and care coordinators plays a central role in determining the effectiveness of EIP services. Care coordinators, however, are not routinely offered training in psychosocial interventions that could enhance the therapeutic impact of their role. Method of levels (MOL) is a flexible, transdiagnostic cognitive therapy with potential advantages over previously evaluated approaches. Training care coordinators in MOL could make their routine contacts with service users more helpful and improve outcomes such as recovery rates and levels of engagement.AimsThis study aims to assess the feasibility of training care coordinators in EIP services to deliver MOL, to understand whether this approach might improve service user engagement and recovery from psychosis compared to treatment as usual, and to assess the feasibility of conducting a cluster-randomised controlled trial (C-RCT) with clustering at the level of teams. Specific feasibility outcomes relate to the recruitment and retention of participants, care coordinators’ level of engagement with the MOL training and supervision programme, implementation of MOL in practice, and the acceptability of the intervention amongst participants.MethodsA feasibility parallel group cluster-randomised controlled trial (C-RCT) designs with two arms: (1) treatment as usual (TAU) or (2) TAU plus support from a care coordinator who has received training in MOL. Randomisation will take place at the level of EIP teams with an allocation ratio of 1:2 in favour of the intervention arm. Our recruitment target is 12 EIP teams, 24 care coordinators working in participating EIP teams, and up to 96 service users working with participating care coordinators. Outcomes will be collected at baseline, 3 months, and 6 months. Qualitative methods will be used to understand participants’ experiences of the study, MOL training programme, and MOL intervention.DiscussionThis is the first study that aims to evaluate the feasibility of training EIP care coordinators to deliver MOL in their routine practice. Training care coordinators in MOL could enhance the quality of relationships between care coordinators and service users and improve outcomes for people experiencing early psychosis. Results will be used to determine the appropriateness of progressing to a larger evaluation trial.Trial registrationThis study was prospectively registered with the ISRCTN Registry (14082421).

Perspectives on competency-based feedback for training non-specialists to deliver psychological interventions: multi-site qualitative study of the EQUIP competency-based approach.

The use of feedback to address gaps and reinforce skills is a key component of successful competency-based mental health and psychosocial support intervention training approaches. Competency-based feedback during training and supervision for personnel delivering psychological interventions is vital for safe and effective care. For non-specialists trained in low-resource settings, there is a lack of standardised feedback systems. This study explores perspectives on competency-based feedback, using structured role-plays that are featured on the Ensuring Quality in Psychosocial and Mental Health Care (EQUIP) platform developed by the World Health Organization and United Nations Children's Fund. Qualitative data were collected from supervisors, trainers and trainees from multiple EQUIP training sites (Ethiopia, Kenya, Lebanon, Peru and Uganda), from 18 key informant interviews and five focus group discussions (N = 41 participants). Qualitative analysis was conducted in Dedoose, using a codebook with deductively and inductively developed themes. Four main themes demonstrated how a competency-based structure enhanced the feedback process: (a) competency-based feedback was personalised and goal-specific, (b) competency-based feedback supported a feedback loop, (c) competency-based feedback supported a comfortable and objective feedback environment, and (d) competency-based feedback created greater opportunities for flexibility in training and supervision. A better understanding of the role of feedback supports the implementation of competency-based training that is systematic and effective for trainers and supervisors, which ultimately benefits the learning process for trainees.

Substance use disorders in hospice palliative care: A narrative review of challenges and a case for physician intervention.

Substance use disorders (SUDs) are frequently encountered in hospice palliative care (HPC) and pose substantial quality-of-life issues for patients. However, most HPC physicians do not directly treat their patients' SUDs due to several institutional and personal barriers. This review will expand upon arguments for the integration of SUD treatment into HPC, will elucidate challenges for HPC providers, and will provide recommendations that address these challenges. A thorough review of the literature was conducted. Arguments for the treatment of SUDs and recommendations for physicians have been synthesized and expanded upon. Treating SUD in HPC has the potential to improve adherence to care, access to social support, and outcomes for pain, mental health, and physical health. Barriers to SUD treatment in HPC include difficulties with accurate assessment, insufficient training, attitudes and stigma, and compromised pain management regimens. Recommendations for physicians and training environments to address these challenges include developing familiarity with standardized SUD assessment tools and pain management practice guidelines, creating and disseminating visual campaigns to combat stigma, including SUD assessment and intervention as fellowship competencies, and obtaining additional training in psychosocial interventions. By following these recommendations, HPC physicians can improve their competence and confidence in working with individuals with SUDs, which will help meet the pressing needs of this population.

Parental experiences of caring for children who have learning disabilities and procedural anxiety in hospital: An interpretive phenomenological study.

BackgroundChildren with learning disabilities (LD) are more likely to have health conditions that require hospital attendance than children without LD. Like all children, they can experience fear and distress related to procedural anxiety. Parents play a key role in managing procedural anxiety in children with LD. No previous published qualitative studies have explored parental experiences of caring for a child with LD and procedural anxiety in hospital.ObjectivesTo explore how parents experienced caring for their child with LD and procedural anxiety in hospital.MethodsA purposive sample of six participants were recruited through a Facebook group for parents of children with LD. Remote semi‐structured interviews were conducted via telephone, Microsoft Teams or Whatsapp. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis.ResultsFive key themes were generated: (1) Emotional toll: parents characterized their experiences as highly emotional; reporting feeling stressed, anxious and worried. (2) Restraint and holding: parents spoke of their experiences of restraint which was largely viewed as negative and sometimes inappropriate. (3) Advocacy: parents articulated their responsibility as advocates for their children. (4) Going it alone: parents were extremely proactive in managing their child's anxieties but some also felt highly‐pressurized and isolated. (5) Inconsistency and uncertainty: parents experienced inconsistency and uncertainty in their children's care from healthcare professionals which led to anxiety and frustration.ConclusionParents of children with both LD and procedural anxiety experienced many challenges. Parents' expertise must be utilized by clinicians when caring for children with LD and procedural anxiety whilst ensuring appropriate support for parents. Nurses require specific training in psychosocial interventions to enhance care for children with LD and procedural anxiety. Further research identifying effective nursing strategies to enhance parental experiences would be beneficial to improve care to this patient group.

"Stuck between a Rock and a Hard Place": How Mental Health Nurses' Experience Psychosocial interventions in Irish Mental Health Care Settings.

WHAT IS KNOWN ON THE SUBJECT?: Psychosocial interventions (PSI) are recognized and recommended internationally as they primarily focus on improving a client's mental health and preventing relapse. Limited qualitative studies focus on the similarities and differences on offering PSI in practice across many countries. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This manuscript provides readers with qualitative findings of mental health nurses' (MHNs) experiences of using PSI in practice and the need for regular clinical supervision to increase MHNs confidence and enhance the offering of PSI. MHNs want PSI guidelines for the offering of these skills to their client groups across practice settings. MHNs require work release from practice to attend supplementary training on PSI so that they can do their job adequately. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This study sheds light on the similarities and differences on PSI in Irish mental health services. It also highlights what MHNs recognize as important for PSI to be implemented. Clinical supervision and the development of PSI guidelines are necessary so that MHNs feel confident delivering these skills. They also need ongoing work release from practice to attend supplementary PSI training to provide best evidence to enhancing client experiences and positive PSI recovery outcomes. ABSTRACT: Description The paper will report on the interview data of trained MHNs' experiences of using PSI within the Irish context. This observational data will be reported elsewhere (Smyth et al. 2020-under review). Introduction This research is conducted when the current reform of Irish mental health governance demands clarification of key psychosocial skills (PSI) required for mental health nurses (MHNs) to embrace recovery-orientated ways of working. There is limited evidence about this important topic in Ireland and across countries. Aim To explore PSI-trained MHNs' experiences of using PSI within Ireland. Method A multiple case study methodology was used and situated within an interpretive paradigm. Data were gathered using semi-structured interviews with 40 PSI-trained MHNs. Findings Three overarching themes developed from the analysis. These included (a) PSI-trained MHNs' understanding and use of PSI; (b) facilitating factors supporting the use of PSI by PSI-trained MHNs; and (c) obstacles limiting the use of PSI by PSI-trained MHNs. Discussion MHNs recognize that regular clinical supervision is required to increase their confidence, along with PSI guidelines for the offering of these skills across practice settings. MHNs also need work release to attend supplementary training on PSI so that they can do their job adequately. Implications for practice This study suggests that MHNs are often stuck between a rock and a hard place when delivering PSI in practice. MHNs need to be aware that this can affect client outcomes. Relevance statement This research identified a gap in knowledge within the Irish context but also across the world on this important topic. MHNs need access to regular clinical supervision, PSI guidelines and ongoing PSI training to feel confident in order to keep abreast of the changes happening in mental health practice and research.

Exploring the barriers to the implementation of cognitive behavioural therapy for psychosis (CBTp)

Purpose The purpose of this paper is to identify barriers for people with psychotic spectrum disorders accessing CBTp in NHS Lothian. Despite national guidelines recommending CBT for the treatment of schizophrenia (National Institute for Health and Care Excellence Guidelines 2014) and (Scottish Intercollegiate Guidelines Network Guidelines 2013), levels of access to CBTp remain low. The overall goal of the study is to uncover emergent themes regarding barriers to access to CBT for patients with psychosis. In addition, the influence of psychosocial skills intervention (PSI) training for psychosis (Brooker and Brabban, 2006) will be explored and if completion of this training effects referral behaviours and attitudes to CBTp. Design/methodology/approach This study is a quantitative service evaluation project which uses a questionnaire design to explore the factors that influence a clinician’s decision to refer a patient for CBTp. Three qualitative questions are included for thematic analysis to allow the respondents to elaborate on their views on potential barriers. All appropriate Community Mental Health Team (CMHT) staff in adult mental health in NHS Lothian were invited to participate in the study. Findings CMHT staff in NHS Lothian hold favourable views of CBTp and would support an increase in access for patients with psychosis. Key barriers to access for CBTp identified in this study comprise of, little or no access to CBTp, lack of integration of services and unclear referral pathways. Further themes emerging from the study also included, improving multi-disciplinary communication and increasing CMHT staff knowledge and confidence in CBTp. PSI training was shown to have a significant effect on referral rates. Further research would be warranted to explore the influence of PSI training on CMHT staff confidence and knowledge in CBTp. Originality/value This is the first paper of its kind to investigate the potential barriers to access to CBTp in Scotland. The paper has highlighted some key barriers and potential strategies to overcome the barriers identified will be discussed.

Counseling in Botswana: History, Current Status and Future Trends

The article presents an overview of counseling in Botswana, an update of the history, current status, anticipated future trends and challenges in light of the social and educational development in the country. Counseling in Botswana has evolved over years. The initial effort started in 1963 with an introduction of career guidance in secondary schools. The development of guidance and counseling programs for schools has influenced a number of psychosocial intervention services and training programs. A number of training programs emerged at Colleges of Education and at the University of Botswana. All these developments had several challenges in the area of developing robust professional counseling service statues. The article discusses the current status, future trends in counseling and make recommendations for future development of the profession in Botswana.

Counseling in Botswana: History, Current Status and Future Trends

The article presents an overview of counseling in Botswana, an update of the history, current status, anticipated future trends and challenges in light of the social and educational development in the country. Counseling in Botswana has evolved over years. The initial effort started in 1963 with an introduction of career guidance in secondary schools. The development of guidance and counseling programs for schools has influenced a number of psychosocial intervention services and training programs. A number of training programs emerged at Colleges of Education and at the University of Botswana. All these developments had several challenges in the area of developing robust professional counseling service statues. The article discusses the current status, future trends in counseling and make recommendations for future development of the profession in Botswana.

Can Schwartz Center Rounds support healthcare staff with emotional challenges at work, and how do they compare with other interventions aimed at providing similar support? A systematic review and scoping reviews

Objectives(i) To synthesise the evidence-base for Schwartz Center Rounds (Rounds) to assess any impact on healthcare staff and identify key features; (ii) to scope evidence for interventions with similar aims,...

Work-related stress in forensic mental health professionals: a systematic review

PurposeThe purpose of this paper is to investigate the prevalence of stress and burnout among forensic mental health (FMH) professionals.Design/methodology/approachA systematic review of the available literature accessed by relevant databases was conducted.FindingsThis study concluded that FMH suffer from moderate levels of both stress and burnout. There is insufficient evidence to establish that they suffer from higher levels of stress than their non-forensic colleagues. Interventions such as psychosocial intervention training have been reported to demonstrate an improvement in staff knowledge and attitudes towards patients, whilst reducing burnout.Practical implicationsStress in FMH is a cause of concern. Conclusions drawn are applicable only to nursing staff as other professions were not adequately represented. As most studies used the burnout scores, results were directly comparable. Further research is needed to fully evaluate stress and burnout in professionals who work within FMH settings.Originality/valueHigh levels of stress and burnout have negative effects on an individual’s ability to work and subsequently there is a financial and also moral incentive for the management of health service workforces to intervene. This study highlights that FMH, as a population, are at risk.

Working globally, thinking locally: Providing psychosocial intervention training in Sierra Leone

This article reflects on the work of a project that brings clinical psychologists from Europe and the United States to Sierra Leone to train local workers in psychosocial interventions. Strengths, weaknesses and opportunities associated with this work are highlighted.

Getting psychosocial interventions into mental health nursing practice: a survey of skill use and perceived benefits to service users

To investigate the use of psychosocial interventions by mental health nurses following training and perceived benefits to service users. Psychosocial interventions are recommended to support the recovery of persons with enduring mental illness. Despite two decades of postgraduate training in psychosocial interventions internationally, implementation challenges still remain. A cross-sectional exploratory, descriptive survey was employed. A survey was mailed to the total population of nurses (n=58) working in some health regions in Ireland who completed training in psychosocial interventions between 2005-2010. Data were collected between November 2011-January 2012, yielding a response rate of 64%. Descriptive and correlational statistics were used to analyse the data. There were statistically significant increases in the use of psychosocial interventions post training. Cognitive behavioural therapy and family interventions were the least used interventions. Assessment and outcome measures, concordance therapy and relapse prevention were preferential interventions. Perceived outcomes for service users were awareness of relapse indicators, enhanced coping skills and fewer admissions. Case load demands, lack of access to supervision and time constraints prevented implementation. Free text comments indicated a dissonance between generic nursing roles and implementation of structured psychosocial interventions in practice. The findings indicate a requirement for nursing leadership to legitimize psychosocial interventions as core nursing work. For service users to experience this type of nursing, we propose the nomination of dedicated psychosocial intervention nurses to multidisciplinary teams. Support through guidelines, clinical supervision and audit by senior nurse managers is critical to implementation.

Psycho social intervention training in Dublin South East – Greenhalgh's innovation model

Psycho social intervention training in Dublin South East – Greenhalgh's innovation model

Psychosocial paediatric training in Iraq: perspectives of trainers and students

There is an absence of education regarding psychosocial issues in Iraqi paediatric training programmes. The aim of this study is to examine current knowledge and perspectives around these topics and to explore potential development in these programmes. 56 paediatric trainers and students at the Child Central Teaching Hospital, a hospital affiliated to the Al-Mustansyria medical college in Baghdad, responded to a questionnaire to evaluate knowledge and perspectives regarding psychosocial approaches to child and adolescent health as delivered presently via academic training and used in professional practice. The majority of the respondents reported having no training in psychosocial interventions. Using a scale from 0 (‘not relevant’) to 10 (‘very important’), psychosocial issues were rated 7.1 in their relevance to everyday paediatric practice. On a scale of 0 (‘very poor’) to 10 (‘totally adequate’), respondents rated formal current psychosocial training at 2.5. It is concluded that incorporating psychosocial approaches in paediatric training will lead to a broader base of knowledge in children’s health and contribute to the promotion of multidisciplinary practice in Iraq.

“Acute concerns”: is the mental health workforce equipped and supported to meet complex needs?

PurposeThe focus of this paper is to consider the findings of a survey, which aims to identify the types of training that acute mental health staff could access, in relation to workforce development and substance misuse issues in acute mental health care.Design/methodology/approachAn electronic survey was developed and distributed using work email lists to all clinicians who worked in acute mental health services across a region in England. Not all NHS organisations agreed to participate.FindingsA total of 89 clinicians responded to the survey, some failed to indicate their consent, therefore the results of the 77 that did are presented. The main finding was that most acute care staff had only accessed mandatory training such as risk assessment. Many staff had not been trained in the use of psychosocial approaches. Drug and alcohol specific activities were performed on the whole only “sometimes”.Research limitations/implicationsIt was not possible to determine the total number of potentially eligible staff who were sent the survey, therefore, response rates cannot be calculated. It is possible that the findings may not be generalisable to other services. There may be bias in those who choose to respond to an electronic email, in terms of those who had access to a computer or who were more IT literate. In addition, the survey did not specifically set out to examine substance misuse issues as its main focus.Practical implicationsAcute care staff work with service users with increasingly complex needs. Creative and cost effective ways of facilitating access to training and support must be found as a priority to ensure that staff have the competencies to identify and manage substance users effectively in acute mental health settings.Originality/valueThe findings reinforce previous studies highlighting the deficit in access to psychosocial interventions training for acute care staff.

An evaluation of the outcomes of psychosocial intervention training for qualified and unqualified nursing staff working in a low-secure mental health unit

Psychosocial intervention (PSI) training results in enhanced knowledge, more positive attitudes, increased confidence and lower levels of clinical burnout for qualified mental health professionals and better outcomes for service users who they work with. This paper describes an evaluation of a PSI training course for qualified and unqualified nurses working in a low-secure unit. Forty-two staff (21 qualified) were randomly allocated to an experimental training group or a waiting list control group. Knowledge, attitudes and burnout were assessed before and after the training. In addition, a random sample of 44 care plans written by the qualified nurses were audited before and after to examine evidence of implementation of PSI in practice. Qualified and unqualified nurses in the experimental group showed significant improvements in knowledge and attitudes compared with the control group. Care plans showed a significant increase in the implementation of PSI. The only significant change in burnout was a reduction in depersonalization for qualified nurses in the experimental group. The PSI training may result in improvements in knowledge, attitude and practice in qualified and unqualified nurses working with severely mentally ill patients in low-secure settings, but in this study the training did not incur protection against burnout.

Rate of Agreement Between Clinicians on the Content of a Cognitive Formulation of Delusional Beliefs: The Effect of Qualifications and Experience

A key process in Cognitive Therapy (CT) is the development and sharing of a formulation. How clinicians develop formulations is under-researched, particularly in working with people with psychosis. This study investigated agreement between clinicians, when conceptualizing an individual's psychotic beliefs. It also explored whether agreement was dependent on qualifications and experience. Eighty-two clinicians watched a video of an individual with delusional beliefs, and were asked to provide formulations using a CT template. These were compared with a "benchmark" formulation provided by three experts. There was good agreement for overt behaviours, emotions, and some aspects of early experience. However, identification of theory driven components such as core beliefs or assumptions was poorer. Greater clinical experience improved the agreement with the benchmark formulation overall, and greater CT specific experience improved formulation of the theory driven items. The more experience a clinician had of working with people with psychosis the lower the rate of agreement with the expert formulation. Formulation of delusional beliefs from a cognitive perspective is dependant on overall experience in cognitive therapy and not knowledge of psychosis, which may hinder performance. The implications for training in CT and psycho-social interventions are considered.

The utility of the Illness Perception Questionnaire in the evaluation of mental health practitioners' perspectives on patients with schizophrenia

RATIONALE, AIMS, OBJECTIVES: The Illness Perception Questionnaire (IPQ) was designed as a measure of illness perception and has been used extensively for measuring the perceptions of people with physical illness. Latterly modified versions of the IPQ have been used to measure the illness perceptions of people with mental health problems and their carers. This study examined the utility of a modified version of the IPQ to measure changes in mental health practitioners' illness perceptions about schizophrenia after undertaking psychosocial intervention training. A total of 245 mental health practitioners who undertook psychosocial intervention training completed a modified version of the IPQ before and after training. The structure of the questionnaire was tested using confirmatory factor analysis. The internal consistency of sub-scales embedded in the instrument was also examined. The hypothesized structure failed to account for the data. Model fit indices revealed a poor fit to the data across all models evaluated. Cronbach's alpha revealed a number of sub-scales in the instrument to have mediocre internal consistency characteristics. The modified version of the IPQ is not suitable for evaluating the impact of psychosocial intervention training on changes in illness perceptions of schizophrenia in mental health practitioners. However, the study has highlighted the need to develop a valid and reliable measure to assess the illness perceptions health professionals have of patients in their care.

The side effects of evidence‐based training

The mental health inpatient workforce has been targeted for continuing training to promote improved practice and enhance morale. The effects of intensive training and innovations in clinical practice on staff well-being are poorly understood. The aim of this paper is to measure the impact of a programme of team training and clinical practice development on levels of stress, job satisfaction and burnout in inpatient mental health workers. A repeated measures design was used in which participants acted as their controls. Participants were assessed before and after training using standardized measures of stress and burnout. During the training period, mean scores on all measures remained stable. Over the practice implementation period, there were significant increases in perceived stress and burnout and a significant reduction in job satisfaction. Training in novel psychosocial interventions had no impact on staff psychological well-being and satisfaction. Attempting to implement, these interventions did appear to have harmful effects. Intensive clinical support to sustain novel practices did not prevent these outcomes.

Exploring the role and perspectives of mental health nurse practitioners following psychosocial interventions training

Psychosocial interventions (PSI) offer a range of problem-centred activities designed to improve the health and quality of life of clients and their carers. The paper reports the findings of a study on the roles and perspectives of mental health nurse practitioners towards clients with enduring mental illness and their carers following completion of PSI training. Focus groups interviews were conducted with PSI mental health nurse practitioners (n = 8) and data were analysed for thematic content. The results of the study indicated that PSI practitioners developed positive attitudes towards their client following PSI training and this attitudinal change enabled clients to develop more confidence and autonomy in managing the symptoms of their illness in a more empowered way. Focus group participants observed reduced levels of anxiety among clients and their carers. This was attributed to the 'sense of hope' within the caring milieu which was established as a result of collaborative working with the client and family. The findings suggest that there is a need for further exploration of the PSI practitioner role with a particular focus on the centrality of positive attitudes on the development of the therapeutic milieu for clients with severe and enduring mental ill health.