Routine Service Settings Research Articles

An Evaluation of Parent Training Interventions in Scotland: The Psychology of Parenting Project (PoPP)

Early-onset behavioural difficulties persisting into the pre-school years, can make young children vulnerable to poor long-term outcomes including the development of conduct disorders, which are linked to significantly higher societal costs. Several parenting interventions have been shown to reduce behavioural difficulties in children and this evaluation presents outcomes from the Psychology of Parenting Project (PoPP), a national implementation programme delivered in early years services in Scotland. This evaluation of service implementation reports on a large cohort of children (2204, age: 2–5 years) whose parents/caregivers participated in PoPP group-based parenting interventions. We explored change in parent-reported Strengths and Difficulties Questionnaire (SDQ) scores following either the Incredible Years Pre-school Basic or the Level 4 Group Triple P interventions. Latent profile analysis (LPA) was used to identify statistically distinct sub-groups of children based on SDQ subscale scores (emotional, conduct, hyperactivity, peer problems and prosocial). Pre- and post-intervention SDQ scores were available for 58% of children. Large intervention effects were reported and analyses showed that 60% of “at-risk” children were no longer scoring in the at-risk range post-interventions. LPA identified four statistically-distinct profiles of children. Children from “low” and “moderate” behavioural problem profiles benefited more from Triple P, whereas “severe” and “hyperactivity-focused” problem profiles displayed better outcomes following Incredible Years. When delivered through a robust implementation scheme, these parenting interventions can be effective in routine service settings and produce clinically important improvements. These findings and the identification of distinct profiles of children who may respond differentially to interventions could guide the planning of future dissemination schemes.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services.

Client engagement in services is a critical element of effective community-based child and family mental health service delivery. Caregiver engagement is particularly important, as caregivers often serve as gatekeepers to child mental health care and typically must consent for services, facilitate service attendance, and are often the target of intervention themselves. Unfortunately, caregiver engagement has been identified as a significant challenge in community-based child mental health services. To address this gap, the Parent And Caregiver Active Participation Toolkit (PACT), which includes therapist training and participation tools for caregivers and therapists, was developed. Stakeholders' perspectives regarding the delivery of interventions designed to improve the quality and effectiveness of community-based care are essential to understanding the implementation of such interventions in routine service settings. As such, this mixed methods study examined the perspectives of 12 therapists, 8 caregivers, and 6 program managers who participated in a community-based randomized pilot study of PACT. Therapists, caregivers, and program managers agreed that PACT was acceptable, appropriate, and feasible to use in community settings and that both changes in therapist practices and caregiver participation resulted from implementing PACT. Some variable perceptions in the utility of the therapist training components were identified, as well as barriers and facilitators of PACT implementation. Results expand the parent pilot study's findings as well as complement and expand the literature on training community providers in evidence-based practices. (PsycINFO Database Record

Surgical Outcomes of Newly Trained ShangRing Circumcision Providers.

Background:Devices can potentially accelerate scale-up of voluntary medical male circumcision in sub-Saharan Africa. Studies have demonstrated advantages of the ShangRing device over conventional circumcision. With the need to train providers rapidly for scale-up, concerns arise about the transferability of techniques and the expertise of new trainees.Methods:We compared outcomes of ShangRing circumcisions conducted in Kenya by experienced providers (experience with more than 100 ShangRing circumcisions) and newly trained providers (trained in Kenya by the experienced providers before the study began). During training, trainees performed at least 7 ShangRing circumcisions and 3 removals. Newly trained providers received intermittent clinical mentoring initially during the study but otherwise conducted circumcisions on their own.Results:Four hundred six and 115 ShangRing procedures were performed by the new trainees and the experienced providers, respectively. The mean duration of circumcisions was 6.2 minutes for both trained and experienced provider groups (P = 0.45), whereas the mean pain score (on an 11-point scale) was 2.5 and 3.2, respectively (P = 0.65). There was no difference in the proportion of participants healed by the day 42 visit (P = 0.13) nor in the incidence of moderate and severe adverse events observed (P = 0.16). Participants in both groups were equally satisfied with final wound cosmesis.Discussion:Results demonstrate that the ShangRing circumcision technique is easy to learn and master. Newly trained providers can safely conduct ShangRing circumcisions in routine service settings. The ShangRing can facilitate rapid rollout of voluntary medical male circumcision for HIV prevention in sub-Saharan Africa.

Therapist Perspectives on Training in a Package of Evidence-Based Practice Strategies for Children with Autism Spectrum Disorders Served in Community Mental Health Clinics

Therapist perspectives regarding delivery of evidence-based practice (EBP) strategies are needed to understand the feasibility of implementation in routine service settings. This qualitative study examined the perspectives of 13 therapists receiving training and delivering a package of EBPs to children with autism spectrum disorders (ASDs) in community mental health clinics. Therapists perceived the training and intervention delivery as effective at improving their clinical skills, the psychotherapy process, and child and family outcomes. Results expand parent pilot study findings, and add to the literature on training community providers and limited research on training providers to deliver EBPs to children with ASD.

Evaluation of a cognitive behaviourally oriented service for relapse prevention in schizophrenia

There is little work demonstrating the effectiveness of cognitive behaviourally oriented interventions in routine service settings. This pragmatic trial is designed to test the impact of a group treatment service on relapse rates under the conditions of routine health care. A total of 169 schizophrenia patients were randomly allocated either to a comprehensive cognitive behaviourally oriented service (CBOS) or to treatment as usual (TAU). The primary outcome is the time until the first relapse after discharge from hospital. Relapse was defined as an increase in positive or negative symptoms as assessed with the Positive and Negative Syndrome Scale. Survival analysis has been conducted up to the 6-month assessment. The mean time to relapse after discharge from hospital in the CBOS group was significantly longer than in the TAU group (log rank test, P = 0.033). This was due to less exacerbations regarding negative symptoms in the CBOS condition (log rank test, P = 0.014). The number of social contacts was improved in the CBOS group only. The CBOS intervention appears to be beneficial in reducing early negative symptom exacerbations.

Team climate and quality of care in primary health care: a review of studies using the Team Climate Inventory in the United Kingdom

BackgroundAttributes of teams could affect the quality of care delivered in primary care. The aim of this study was to systematically review studies conducted within the UK NHS primary care that have measured team climate using the Team Climate Inventory (TCI), and to describe, if reported, the relationship between the TCI and measures of quality of care.FindingsThe databases MEDLINE, EMBASE, and CINAHL were searched. The reference lists of included article were checked and one relevant journal was hand-searched. Eight papers were included. Three studies used a random sample; the remaining five used convenience or purposive samples. Six studies were cross sectional surveys, whilst two were before and after studies. Four studies examined the relationship between team climate and quality of care. Only one study found a positive association between team climate and higher quality care in patients with diabetes, positive patient satisfaction and self-reported effectiveness.ConclusionWhile the TCI has been used to measure team attributes in primary care settings in the UK it is difficult to generalise from these data. A small number of studies reported higher TCI scores being associated with only certain aspects of quality of care; reasons for the pattern of association are unclear. There are a number of methodological challenges to conducting such studies in routine service settings. Further research is needed in order to understand how to measure team functioning in relation to quality of care.

Stability of the CORE‐OM and the BDI‐I prior to therapy: Evidence from routine practice

It is important to know the stability of standard outcome measures prior to therapy over differing periods of time that map onto the realities of waiting times in routine service settings. We studied 1,684 clients who completed one or both the targeted measures Clinical Outcomes in Routine Evaluation-Outcome Measures (CORE-OM) and Beck Depression Inventory-I (BDI-I) two times, at intervals of up to 12 months, prior to beginning psychotherapy. We also selected an additional 1,623 clients who completed the CORE-OM (N=1,623), BDI-I (N=980) or both at referral, but had no records of further contact with the service. There was little change in the mean CORE-OM or BDI-I scores between referral and clinical assessment. The test-retest correlations showed substantial stability on both measures, declining only moderately at the longer intervals studied. The high test-retest correlations for periods of up to 6 months suggest that psychological disturbance was both reliably measured by the CORE-OM and the BDI-I, and reasonably stable among clients waiting to be assessed. Implications for routine practice are discussed.

Evaluation of molecular techniques in prediction and diagnosis of cytomegalovirus disease in immunocompromised patients

OBJECTIVES: To evaluate selected molecular tests in diagnosis and screening of cytomegalovirus (CMV) infection in immunosuppressed patients. DESIGN: Clinical and cost-effectiveness were assessed through a prospective two-stage trial of CMV screening regimes in a routine service setting. Different molecular test results were fed back to clinicians in each stage, plus antigenaemia results. The technical performance of the molecular methods was assessed through an independent masked comparison of each molecular test against the established (antigenaemia) test. Scientists performing a particular test were blind to the other test results for that sample. Diagnostic and therapeutic impact were recorded prospectively for all tests, to include any effect on diagnostic certainty, changes to CMV therapy and any other reported impact on patient management. The cost of each test was estimated under different laboratory conditions. Prospective patients undergoing CMV screening were compared with consecutive historical controls in the same unit. Towards the end of the study, a survey of all UK virology laboratories was undertaken to identify current CMV screening practice and test preferences. In addition, all UK renal transplant surgeons and haematology transplant centres were surveyed in order to identify current clinical practice and perceptions of the benefits of CMV screening. SETTING: Study patients were recruited from University Hospital Wales (UHW), Cardiff. Staff in the Cardiff Public Health Laboratory Service virology laboratory performed the tests. PARTICIPANTS: A consecutive series of transplant patients was recruited to the prospective study over a 42-month period, totalling 98 renal and 140 haematology patients. A consecutive series of historical controls was identified, with 199 renal and 136 haematology patients who underwent transplants in the UHW during the 29 months prior to the prospective CMV screening trial.

A core approach to practice‐based evidence: A brief history of the origins and applications of the CORE‐OM and CORE System

AbstractThis article reviews the development of the CORE‐OM and CORE System from 1995 to 2005 in the context of the need to measure, monitor, and manage the delivery of counselling and the psychological therapies in service of providing best quality care for clients. The origins and philosophy of these tools are summarised and practical aspects of how to use them in routine service settings are set out, including an easy to use look‐up table of differing ways of presenting CORE‐OM scores and their associated meaning. The wider family of CORE outcome measures is briefly outlined to show the relationship between the various versions and how each is designed for a specific purpose. These outcome tools are set within the broader context of the CORE System. In turn, the CORE‐OM and CORE System are placed within the paradigm of practice‐based evidence and examples are provided of how these tools have been applied in routine as well as more traditional evaluative settings.The aim of the present article is two‐fold. The first aim is to provide a background to the origins and development of the CORE‐OM and its role as part of the broader‐based CORE System during the period 1995 to 2005. The second aim is to consider the applications of both the CORE‐OM and CORE System within the context of the developing paradigm of practice‐based evidence up to 2005.

Evaluating psychological therapies services: A review of outcome measures and their utility

We describe the use of a number of outcome measures that have been used over the past eight years to evaluate adult psychological therapies services in the Wakefield & Pontefract locality of the South West Yorkshire Mental Health NHS Trust. The psychological therapies service now has a unique database of outcome measures completed by 5563 clients, which has been used nationally and internationally for service evaluation and research purposes. Internally, the database has informed the clinical service, allowing prioritising of referrals and feedback to clinicians and referral agencies on the quality of the service and appropriateness of referrals. We describe the properties and intended use of the measures, the way results are fed back to the service and evaluate the usefulness of the measures in routine service settings. Implications for psychological therapies and other mental health services are discussed including: • Choice of generic or specific outcome measures • How the measures relate to one another • Clinical usefulness of the measures, including risk assessment • Interpretation of results, including availability of norms and how to assess change • Practical utility, including cost

PMTCT from research to reality--results from a routine service.

Assessment of the efficacy of a prevention of mother-to-child transmission (PMTCT) programme in a routine service setting in comparison to a research environment. Descriptive study over a 13-month period utilising retrospective data obtained from hospital records complemented by prospective data on a sample of patients enrolled in a study to determine an affordable HIV diagnostic protocol for infants. Routine PMTCT service at Coronation Women and Children's Hospital (CWCH) situated in Johannesburg and affiliated to the University of the Witwatersrand. Pregnant women known to be HIV infected who delivered at CWCH from 1 October 2001 to 31 October 2002. The HIV transmission rate to infants, which reflects nevirapine (NVP) delivery and infant feeding practices, and follow-up rates of perinatally exposed children. Of the 8,221 deliveries, 1,234 (15%) occurred in women known to be HIV infected. HIV transmission rates of 8.7% at 6 weeks and 8.9% at 3 months of age in the study population verifies the high rate of NVP administration and the ability of women to formula-feed their babies and abstain from breast-feeding. More than one-third of infants never return for follow-up and more than 70% are lost to follow-up by 4 months of age. The low HIV transmission rate confirms the efficacy of this routine service PMTCT programme. HIV-infected children are not being identified for medical management as part of PMTCT follow-up. It is imperative that record keeping is improved to facilitate ongoing monitoring.

Is training in psychosocial interventions worthwhile? Report of a psychosocial intervention trainee follow-up study

A follow-up study of psychosocial intervention (PSI) trainees from the Sheffield and Maudsley training centres was undertaken in three stages. In Stage 1, 141 students, at two PSI training centres, were sent a simple postal questionnaire to elicit career trajectory following PSI training. A response rate of 82% was achieved. The sub-group, who had been trained and who still engaged in clinical practice were identified and followed-up in more detail ( n=96). The effect of PSI training in a range of domains was investigated. The impact of training may not be to equip students with formal technical skills in CBT and family work. What is more likely is that trainees acquired proficiency in: working effectively using a case management model; conveying ‘therapeutic optimism’; enabling users to meet their own goals and helping them to develop better coping strategies; using ‘stress vulnerability’ and formal outcome measures as means of structuring this approach. The secondary aim of the study was to identify and prioritise the barriers that impede the effective implementation of PSI skills in routine service settings. For the second phase of the survey the response rate was again 82%. This group's service managers were identified and surveyed for the same information and 59% responded. The aim was to gather information about implementation issues from both the clinical and service perspectives. The results of the survey indicate that PSI training has a positive impact on the development of services for people with serious mental health problems although there are serious organisational hurdles for managers, trainees and organisations to overcome if PSI skills are to be properly implemented. Key factors that impact upon faithful implementation are related to resource issues (caseload size), organisational factors (the existence of an implementation plan and training strategy), and the extent to which the trainee's team is supportive.

Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia

Family interventions are effective in reducing relapse in patients with schizophrenia, but there is little work demonstrating the effectiveness of the interventions in routine service settings. To test the effectiveness of a needs-based family intervention service for patients recruited as out-patients and their carers, including those of low expressed emotion status. Carers of out-patient schizophrenia sufferers selected only on illness history factors were randomly allocated to receive either family support alone or in combination with systematic psychosocial interventions based on an assessment of need. Delivery of family interventions attempted to involve the clinical team. Relapse outcomes were superior for family-treated patients at six-month follow-up, although most of the clinical and symptom patient variables assessed remained stable, as did measures of carer burden. The study demonstrated the effectiveness of family interventions in routine service settings. Problems with staff, patient and carer engagement and participation were identified.

A comprehensive evaluation of a train-the-trainers model for training education staff to assemble adaptive switches

We evaluated a train-the-trainers program for training education staff to assemble adaptive switch mechanisms. The adaptive switches were designed to assist persons with severe mental and physical handicaps in operating various electrical apparata. In Phase 1, a five-step training program (written and verbal instructions, modeling, performance practice and feedback) was used to train four teachers to assemble an adaptive switch. Also in Phase 1 social validity data were collected which supported the importance of adaptive switches for persons with severe physical impairment, as well as the need to train switch assembly skills to human service personnel. In Phase 2, the four teachers used the same five-step training program to train 22 teacher assistants to assemble an adaptive switch. Acceptability measures indicated that training was well received by the teachers (trainers) and assistants (trainees), and time efficiency measures indicated an average of less than two hours of training time was necessary for every two trainees. Effects of the training program were replicated in Phase 3 with two staff from another school. Results of the program are discussed in regard to using a train-the-trainers model as a means of upgrading staff skills, and helping reduce the gap between educational technology presented in the professional literature and that reflected in routine service settings.

Evaluating and Increasing Meal-Related Choices Throughout a Service Setting for People with Severe Disabilities

An area of concern regarding quality of life among people with severe disabilities is the amount of choice individuals make during their daily routine. This investigation examined a means of evaluating and increasing meal-related choices in an adult education service setting. A choice provision program was implemented in each of four classrooms in which there was a lack of student choices during break periods relative to other classrooms. The program included stepwise procedures for quantitatively evaluating choice making and systematically presenting choice opportunities along with a supervision component for assisting staff in providing such opportunities. The program was accompanied by increased choices in each classroom. Additionally, a social validity comparison indicated: (a) in four other settings serving people with severe disabilities there were minimal choices, especially when compared with choices reported by adults without disabilities; and (b) the increased choice making accompanying the program in this study was well above the level in the four comparison settings and was comparable to the level reported by people without disabilities. Results are discussed in regard to extending advances in choice making reflected in the literature into routine service settings and using quantifiable assessments of choice making as part of agency best-practices evaluation.