Client Recovery Research Articles

Investigating Preseason Symptoms of Depression and Concussion in Adolescent Athletes

Objective(s): To determine the profile of patients with brain tumors who receive occupational therapy (OT) services after acute care discharge. Design: A retrospective cohort study using the Discharge Abstract Database and the Homecare Database, population based healthcare administrative databases. Setting: Ontario, Canada between fiscal years 2004/05 and 2008/09. Participants: Patients with malignant, benign, and unspecified brain tumors who received post-acute OT services identified by specified International Classification of Diseases Version 10 Codes. Interventions: N/A. Main Outcome Measure(s): Number of brain tumor cases, patient and clinical characteristics, and discharge destinations from acute care of those who received post-acute OT services. Results: During the study period, there were 3,199 patients with brain tumors who received post-acute OT services in the homecare setting; 78.2% had malignant brain tumors, 12.4% had benign brain tumors, and 9.4% had unspecified brain tumors. Of these patients, those with benign brain tumors were older (63.3 years, SDZ17.6 vs. 59 years, SDZ16.4 for malignant tumors and 60.2 years, SDZ20.9 for unspecified brain tumors), a higher percentage were female (65.2% vs. 51.4% for malignant and 47.8% for unspecified brain tumors), and 46% spent at least one day in intensive care units (vs. 28.2% for malignant and 16.6% for unspecified brain tumors. More than 90% of patients received in-home OT services. Conclusions: As survival rates increase, OT may play a greater role in recovery of clients with brain tumors. This paper helps to recognize the characteristics of patients with different types of brain tumors that can assist in the planning and delivery of OT services for this population.

Research Paper A narrative review exploring the effectiveness of Compassion-Focused Therapy

Content & FocusThis narrative review summarises findings of research that has shown use of Compassion-Focused Therapy (CFT) to improve psychological outcomes in clinical populations. This article reviews the research studies that have utilised CFT to treat clients experiencing a variety of mental health issues. The paper begins offering an overview of CFT theory and compassionate mind interventions. A literature search was conducted which included book chapters and articles that discussed compassion focused therapy. Twelve studies were identified which showed significant psychological improvements in clients with diagnosed trauma symptoms, brain injury, eating disorders, personality disorders, schizophrenia-spectrum disorder, chronic mental health problems and psychosis, both within groups and during one-to-one therapy. Within the context of the reviewed studies, CFT has shown itself to be an effective therapeutic intervention when combined with approaches such as Cognitive Behavioural Therapy (CBT).ConclusionThe research design of the majority of the studies examined precluded determining the extent of individual contributions that CFT made towards client recovery. Further research that uses more rigorous approaches are required to evaluate more effectively the role CFT plays in clients’ therapeutic recovery.

Exploration of the Experience of Work Environment in Korean Psychiatric Nurses Working in Mental Hospitals

Purpose: The purpose of this study was to explore psychiatric nurses' experiences of positive and negative factors in the workplace that may influence the nurse to burnout or engagement. Methods: Three focus groups of 15 psychiatric nurses working in 3 mental hospitals were interviewed. Qualitative descriptive methods and qualitative content analysis were used. Results: For negative factors, there were 6 domains (compensation and welfare, manpower, organizational support, duty, work load, role identity), 9 categories (poor benefits, low level of salaries and unreasonable pay system, nurse shortage, lack of nurse competency, poorly prepared assistant staff, lack of support systems for development, irrational duty assignments, work overload, identity crisis as a psychiatric nurse) and 17 subcategories. For positive factors, there were 3 domains (client, colleagues, nurses’role), 4 categories (rapport with client, client recovery, respect and support from colleagues and head nurses, nursing leadership and participation in the treatment process) and 7 subcategories. Conclusion: Results of this study suggest the following: a) further research is needed to identify strategies to improve negative factors, particularly, he establishment of a rational nursing personnel policy b) recognizing and encouraging positive factors to strengthen nurses’work engagement with support from institutions and nurse administrators.

MEETING THE NUTRITIONAL DEMANDS OF HIGH-INTENSITY INTERVAL TRAINING

In Brief LEARNING OBJECTIVE High-intensity interval training is being used by a growing number of clients to improve fitness levels and body composition as efficiently as possible. This article intends to provide health and fitness professionals with nutritional guidelines for maximizing the training effects and recovery of clients engaging in high-intensity interval training. Nutritional considerations should be made for individuals to obtain the greatest benefits from their HIIT sessions. Proper quantities and ratios of carbohydrate and protein can ensure higher intensity, duration, and recovery in HIIT and are important considerations before, during, and after training.

Forgiveness, Flourishing, and Resilience: The Influences of Expressions of Spirituality on Mental Health Recovery

The relationships of spirituality, religion, and health have been the subject of research in a variety of disciplines over the past two decades. Findings have varied: Some findings appear to have strong evidence of relationships while other findings are deemed inconclusive. A few studies have distinguished between religion and spirituality, but most investigators have treated the two as one concept with no clear lines of distinction between them. This theoretical study, focusing on the topic of spirituality, explores several related concepts, including forgiveness, flourishing, and resilience, as a basis for developing approaches to facilitate recovery in mental health clients using spiritual interventions.

Service stakeholders' perspectives on methadone maintenance treatment, Special Community Employment schemes and client recovery pathways

BACKGROUND: Previous Irish research on client perspectives on the ‘lived social world’ of methadone maintenance treatment (MMT) and participation in Special Community Employment (SCE) schemes have illustrated how MMT offers clients the opportunity to commence recovery and community reintegration, with participation in the SCE schemes acting primarily as therapeutic support mechanism with improvement needed in work based support and employment related outcomes. OBJECTIVES: The research aimed to explore service providers’ views on MMT client experiences of participation in SCE vocational training, education and employment seeking. METHODS: Five in depth interviews and three focus groups (n = 14) were conducted with key specialist treatment and rehabilitation service providers’ in Dublin, Ireland. RESULTS: Narratives were thematically analysed, and indicative of the positive role of MMT in recovery pathways in terms of stimulating initial client stabilisation, reducing client chaotic lifestyles, initiating new positive health and social behaviours with partners, children, families, and facilitating renewed vocational training on SCE schemes. Outcomes whilst positive in terms of personal development when in recovery are compromised by lack of employment prospects and dedicated work-based supports on exit. CONCLUSIONS: Recommendations were made around the need for long term integrated community care, vocational certification, supported volunteer, employment planning and back to work schemes.

“We are All Fellow Human Beings”: Mental Health Workers’ Perspectives of Being in Relationships with Clients in Community-Based Mental Health Services

Stable, trusting relationships are at the core of Norwegian community-based mental health services. Being acknowledged and respected may promote a client's recovery. The aim of this study was to explore mental health workers’ experiences of relating to clients. The design involved multi-stage focus groups based on a participatory approach and using interpretative phenomenological analysis. Acknowledging the personhood of a client appears to offer opportunities for growth and development in the client as well as in the health worker, based on reciprocal processes of each person affecting the other and the health workers’ openness to understanding the other person.

Short structured general mental health in service training programme in Kenya improves patient health and social outcomes but not detection of mental health problems - a pragmatic cluster randomised controlled trial.

Trial designA pragmatic cluster randomised controlled trial.MethodsParticipants: Clusters were primary health care clinics on the Ministry of Health list. Clients were eligible if they were aged 18 and over. Interventions: Two members of staff from each intervention clinic received the training programme. Clients in both intervention and control clinics subsequently received normal routine care from their health workers. Objective: To examine the impact of a mental health inservice training on routine detection of mental disorder in the clinics and on client outcomes. Outcomes: The primary outcome was the rate of accurate routine clinic detection of mental disorder and the secondary outcome was client recovery over a twelve week follow up period. Randomisation: clinics were randomised to intervention and control groups using a table of random numbers. Blinding: researchers and clients were blind to group assignment.ResultsNumbers randomised: 49 and 50 clinics were assigned to intervention and control groups respectively. 12 GHQ positive clients per clinic were identified for follow up. Numbers analysed: 468 and 478 clients were followed up for three months in intervention and control groups respectively. Outcome: At twelve weeks after training of the intervention group, the rate of accurate routine clinic detection of mental disorder was greater than 0 in 5% versus 0% of the intervention and control groups respectively, in both the intention to treat analysis (p = 0.50) and the per protocol analysis (p =0.50). Standardised effect sizes for client improvement were 0.34 (95% CI = (0.01,0.68)) for the General Health Questionnaire, 0.39 ((95% CI = (0.22, 0.61)) for the EQ and 0.49 (95% CI = (0.11,0.87)) for WHODAS (using ITT analysis); and 0.43 (95% CI = (0.09,0.76)) for the GHQ, 0.44 (95% CI = (0.22,0.65)) for the EQ and 0.58 (95% CI = (0.18,0.97)) for WHODAS (using per protocol analysis). Harms: None identified.ConclusionThe training programme did not result in significantly improved recorded diagnostic rates of mental disorders in the routine clinic consultation register, but did have significant effects on patient outcomes in routine clinical practice.Trial registrationInternational Standard Randomised Controlled Trial Number Register ISRCTN53515024.

Staff attitudes towards inpatients with borderline personality disorder

This article discusses the negative attitudes of some nursing staff towards inpatients diagnosed with borderline personality disorder (BPD), from the perspective of a third-year mental health nursing student. Factors to support underlying nurses? attitudes are considered, including stigma associated with BPD, the relationship between BPD and self-harm, clients being viewed as manipulative and nurses? lack of optimism for client recovery. Work pressures, poor communication skills and time restraints also contribute to the poor care being delivered by some mental health nurses.The authors suggest ways to improve staff attitudes, based on recommendations in the literature. Further education relating to BPD is discussed, as well as the need for increased supervision of mental health nurses and more time for effective communication between nurse, client and the multidisciplinary team.Double blind peer review

Work and the journey to recovery: Exploring the implications of welfare reform for methadone maintenance clients

BackgroundAn emphasis on welfare reform has been a shared concern of recent UK governments, with the project of transforming the provision of welfare gathering pace over the past six years. Replicating active labour market policies pursued across the globe, successive governments have used welfare-to-work programmes as mechanisms to address worklessness. Since 2008, problem drug users (PDUs) have been added to a list of groups for whom intervention is deemed necessary to encourage, enable, and sometimes coerce them into paid employment. This approach is underpinned by three beliefs relating to paid work: it sustains recovery, has a transformative potential and should be the primary duty of the responsible citizen.Using policy developments in the UK as a case study, the article explores the implications for methadone maintenance clients of connecting drug policy (premised on the belief that work is central to recovery) with welfare policy (which at present is preoccupied with reducing worklessness). MethodsA critical analysis of policy documents, including drug strategies, Green and White papers and welfare reform legislation, alongside a review of relevant academic literature. ResultsThe ‘work first’ approach which underpins current labour market activation policies in the UK and elsewhere is insufficiently flexible to accommodate the diverse needs of PDUs in recovery, and is particularly particular problematic when combined with a ‘social deficit’ model which concentrates on individual rather than structural barriers to employability. The use of payment-by-results mechanisms to provide employment services, coupled with the use of sanctions for those who do not engage, is likely to be particularly problematic for methadone maintenance clients. ConclusionWelfare reform in the UK is likely to undermine the recovery of methadone maintenance clients. Further research is urgently needed to explore its impact on this sub-group of PDUs, alongside comparative studies to determine best practice in integrating drug and welfare policies.

Assessment and Support Consultation: Enhancing Social Support for Sexual Offenders

Social support is a known predictor of both sexual offender recidivism (Andrews & Bonta, 2010) and client recovery from numerous clinical disorders (Drake, O’Neal, & Wallach, 2008; Schön, Denhov, & Topor, 2009). Interventions that engage social supports have demonstrated positive outcomes in many clinical treatments for a wide range of psychopathologies (Rea et al., 2003; Shimazu et al., 2011), but have not yet been broadly incorporated into forensic practice. Furthermore, some criminogenic risk assessment measures do not routinely seek collateral information from social supports, despite the benefits of doing so (Bonta, 2002; Doren, 2004). This article reviews extant work, and proposes a methodology—Assessment and Support Consultation (ASC)­—aimed at bringing support systems into the sexual offender assessment and treatment milieu. Aims for this model and suggestions for its development and implementation are discussed.

Assertive community treatment and psychiatric pharmacy

Assertive Community Treatment (ACT) is an intensive, community-based psychiatric service developed by a team of researchers at the Mendota State Hospital in Wisconsin. It was initiated during the movement of deinstitutionalization in the 1960s, allowing for an increase in hospital discharges from state operated institutions into community-based programs. The research team derived ACT from the inpatient psychiatric treatment team model and proposed ACT to be a “hospital without walls.” In addition, the research team hypothesized that providing 24-hour mental health services to newly discharged clients would reduce the amount of rehospitalizations and psychiatric symptom relapses. Since its implementation in the 1970s, it has proven to be an extremely effective evidence-based practice that has grown and flourished in the United States, Canada, Australia, and the United Kingdom. ACT teams are multidisciplinary and consist of a psychiatrist, nurses, social workers, peer specialists, vocational specialists, and substance abuse specialists. ACT services are considered more intensive than case management and the majority of services are provided to clients in the community and at their place of residence. One of the core features of this service model is to promote client recovery and independence in all aspects of their life. As seen in the sample daily ACT schedule below (Table 1), treatment is intended to be comprehensive and may include housing assistance, vocational or educational support, assistance with activities of daily living, substance abuse treatment, medication support, and mental and physical health treatment. Crisis intervention is always available and clients have access to an ACT staff member via telephone 24 hours a day.

Building a Social Media Strategy for Frontenac Community Mental Health & Addiction Services (FCMHS)

Tis case study focuses on how social media applications can assist a local community mental health and addictions agency, Frontenac Community Mental Health & Addiction Services (FCMHAS), in Kingston, Ontario to meet its public relations goals and objectives. It also reviews the potential for social media to be used in the treatment and recovery of clients. The paper features a broad review of relevant literature, a report on the findings of interviews with management staff, and input from clients. It discusses the benefits and risks of social media, how social media might be able to address mental health stigma, and organizational interest and readiness to engage in social media. A recommended social media strategy for the agency appears as an Appendix.

Important components to create personal working alliances with clients in the mental health sector to support the recovery process

Personligt ombud (PO) is a Swedish version of case management that aims to support individuals with psychiatric disabilities. Guidelines to the PO service emphasize the different role that the PO plays with respect to the relationship with clients. The aim of this study was to investigate the components that POs found to be important in the relationship with clients. Telephone interviews with 22 POs across Sweden were carried out. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. The relationship with each client was described as the foundation of the POs' work; it was the only 'tool' they had. The findings were reflected in a main theme, which showed the importance of creating personal working alliances with each client where POs put the client at the center of the work and adjusted their support according to the client's needs at the time. Important components were that the PO and the client trusted each other, that the power between the PO and the client was balanced, and to be a personal support. Many of the components that POs found to be important are shown as essential in recovery-oriented services. POs followed the client in the process and remained as long as necessary and this is one way of bringing hope to the client's recovery process. However, the personal tone can be fraught with difficulties and to maintain professionalism, it is necessary to reflect, through discussions with colleagues, with the leader and in supervision.

Work Stress and Job Satisfaction of Community Mental Health Nurses in South Korea: A Qualitative Content Analysis

Purpose: The purpose of this study was to describe work stress and job satisfaction of community mental health nurses working in community mental health centers. Methods: Data were collected using open-ended questions from 37 mental health nurses working in the 16 centers. Qualitative descriptive methods and qualitative content analysis were used. Results: For work stress there were 148 statements and job satisfaction, 107. Work stress had 5 domains (work environment, policy, work load, operations, compensation and welfare), 14 categories (bureaucratic and unsafe environment, communication, social awareness, lack of support, absurd evaluation, inconsistent policy, excessive work, unrealistic service range, inefficient business means, unreasonable system and budget, job insecurity, low compensation) and 26 subcategories. Job satisfaction had 5 domains (business, client, organization, social awareness and compensation), 8 categories (performance, recognition for the job importance and expertise, business potential, client recovery, team work, improve social awareness, direct compensation), and 14 subcategories. Conclusion: Results of this study suggest the following: a) further research on identifying sources affecting and improving retention of mental health nurses, b) implementing positive factors and supporting identification of sources of work stress as central to development of strategies to encourage nurses’ morale and improve personnel policies.

Eficácia da fonoterapia em um caso de afasia expressiva decorrente de acidente vascular encefálico

O objetivo deste estudo de caso foi relatar e analisar o caso de um paciente afásico adulto em tratamento fonoaudiológico na clínica escola do Curso de Fonoaudiologia de uma instituição federal de ensino. O sujeito estudado é um paciente do sexo masculino, com 68 anos de idade, em tratamento na clínica escola desde maio de 2009, sendo que seu processo terapêutico foi analisado até dezembro de 2010. Quanto à história clínica, o paciente sofreu acidente vascular encefálico isquêmico no hemisfério esquerdo, em janeiro de 2009, quando repentinamente apresentou um quadro de mutismo. Após serem realizadas avaliações fonoaudiológicas, concluiu-se que o mesmo apresentava como hipótese diagnóstica "Afasia de expressão, oral e escrita, decorrente de acidente vascular encefálico isquêmico." Diante disto foi elaborado o planejamento terapêutico. Desde o início do processo de terapia foi possível observar evoluções linguísticas no paciente. O fato de o sujeito ter procurado atendimento fonoaudiológico 15 dias após o acometimento pelo acidente vascular encefálico, provavelmente foi um fator fundamental para sua boa recuperação, pois há um grau de recuperação espontânea em pacientes afásicos, porém a melhora é mínima sem o tratamento adequado. Em aproximadamente um mês de terapia fonoaudiológica, o paciente expandiu consideravelmente seu vocabulário. Apesar de a área lesada ser extensa e fundamental para a linguagem, observou-se avanços bastante positivos com a terapia. Deste modo, acredita-se que a intervenção fonoaudiológica precoce contribuiu, em grande parte, para a reorganização da atividade linguística, visto que o paciente comunica-se satisfatoriamente considerando a grande extensão de sua lesão.

A Professional Judgment and Decision Making Case Study: Reflection-in-Action Research

This case study of an elite judo player recovering from injury provides an exemplification of a practitioner’s Professional Judgment and Decision Making (PJDM) using a ‘reflection-in-action research’ methodology. The process of “reflection-in-action” Schön (1991) and in particular the concept of ‘framing’ offer insight into how professionals think in action. These concepts assisted the practitioner in organizing, clarifying and conceptualizing the client’s issues and forming intentions for impact. This case study exemplifies the influence of practitioner PJDM on implementation at multiple levels of practice including planning the overall program of support, designing specific interventions to aid client recovery and moment-to-moment in-situ decision making session-by session. It is suggested that consideration of practitioner PJDM should be a strong feature of case study reporting and that this approach carries the potential to extend our use of case studies within applied sport psychology practice.

Mental Health Recovery

North Carolina has new opportunities for orienting its mental health care system toward client recovery as the system shifts to managed care with the possibility of offering more innovative services. Ways of accomplishing this reorientation are explored and instances of progress are noted.

Service user involvement in drug treatment programmes: Barriers to implementation and potential benefits for client recovery

Service user forums have the potential for improving awareness of services, empowering service users and strengthening community partnerships within an inclusive treatment and rehabilitation framework. The research aimed to investigate perspectives about service user involvement in order to inform the development of effective service user forum(s) in west Ireland. A total of 30 interviews with key service providers and 12 interviews with service users were conducted, with interview questions focusing on: (1) awareness of the Service User Support Team and (2) barriers to service user involvement and the development of service user forums in the region. An integrated data collection and thematic analysis was undertaken. Current levels of service user involvement were low, restricted by one-way communication and appeared grounded in user-provider power differentials and stigma relating to drug dependency. Service providers queried the actual terms of reference, capacity and training that would be needed for service user forums to advocate and lobby for service users. The use of existing support groups, creation of internet user forums and rotation of rural meetings were recommended to promote engagement among service users. The research underscores the need for transparency, resources and a framework for good practice that reflects a participatory approach.

A Natural Approach in Mental Health Practice: Occupational Adaptation Revealed

A single case study of the stories told by one occupational therapist about her clients in mental health settings is presented in this article. Qualitative analysis revealed key concepts of the role of the occupational therapist as defined by occupational adaptation theory, along with unique perspectives of occupational therapy in mental health settings. The outcome of this study is a demonstration of the unique insight occupational therapy brings to addressing client recovery in mental health settings, specifically from an occupational adaptation perspective. This insight should enlighten others as to the necessity of skilled occupational therapy in mental health settings.