An ethnographic study of the implementation of a transitional discharge model: peer supporters' perspectives.

BACKGROUND: Over the last three decades, there has been worldwide recognition of peer support contributions to improve mental healthcare provision. However, in the current literature, little attention has been paid to exploring perspectives of peer supporters on their involvement in mental health services provision. The purpose of the present study was to examine peer supporters' perspectives on the implementation of a transitional discharge model (TDM), an intervention for the community integration of people with mental illness. METHODS: This paper represents ethnographic qualitative data collected as part of a study that used mixed methods to evaluate the implementation of TDM across nine hospitals from the Province of Ontario, in Canada. The study involved a sample of 66 peer supporters, who were recruited from participating Consumer/Survivor Initiative Organizations and Peer Support Programs. The study collected data using two sets of focus groups, which were held at 6 months and 1-year post implementation. Data analysis used an ethnography model of qualitative analysis. RESULTS: Peer supporters expressed that their involvement in mental healthcare enhanced clients' autonomy and hope about their recovery, as well as established a safety net and reduced hospital readmissions. Peer supporters articulated that they assumed several roles to facilitate clients' transition from hospital to the community. These roles included: assisting clients in building their capacity and developing healthy routines; attending regular on-ward and community meetings; accompanying clients to their appointments; and working with clients to set goals for their recovery. The study showed hindrances to effective implementation of peer support programs, such as a lack of understanding and appreciation of peer supporter roles, lack of careful allocation of peer supporters to clients, and an absence of appropriate protocols for ensuring the safety and supervision of the peer supporters. CONCLUSIONS: Results of the TDM implementation demonstrated that involving peer supporters in mental healthcare delivery may benefit clients by enhancing autonomy and hope about their recovery, as well as establishing a safety net and reducing hospital readmissions. Results from the study have the potential to inform healthcare professionals and managers of strategies for developing effective peer support programs.

Healthcare professionals' perceptions of the implementation of the transitional discharge model for community integration of psychiatric clients.

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one-year post-implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four-step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes.

The use of technology for mental healthcare delivery among older adults with depressive symptoms: A systematic literature review.

Depression has been identified as the single largest contributor to poor health and functioning worldwide. Global estimates indicate that 4.4% of the world's population lives with depression, equating to about 322 million individuals. Research demonstrates that telehealth interventions (i.e. delivering therapy by phone or videoconferencing) have potential for improving mental health care among community-based older adults. This review analyses scholarly literature on telehealth interventions among older adults with depressive symptoms. Following PRISMA guidelines, a systematic search of peer-reviewed papers was conducted using the following key terms: telemedicine, telepsychogeriatrics, telepsychiatry, eHealth, mental health, depression, and geriatric. The review included nine articles examining telehealth for mental health care, published in English between 1946 and 26 September 2017. Telehealth for mental health care among older adults demonstrates a significant impact on health outcomes, including reduced emergency visits, hospital admissions, and depressive symptoms, as well as improved cognitive functioning. Positive or negative influences on the use of telehealth among older adults are identified. This review highlights keys aspects to consider in using telehealth interventions, including levels of education, cognitive function, and prior technology experience. The review highlights vital factors for designing interventions which aim to capitalize on the benefits of the use of telehealth for mental healthcare service delivery, especially in older adults with depressive symptoms.

Retaining a Sample of Homeless Youth.

OBJECTIVE: Hard to reach populations need to be included in research studies to ensure proper representation of the general population. This paper explores tracking strategies used in the Youth Matters in London project to retain a sample of homeless youth. METHOD: A total of 187 youth, aged between 16 and 24 years, homeless or precariously housed, and experiencing a serious mental health issue were recruited at a community drop-in center, by word of mouth and by snowball sampling. After the initial interview, three repeat interviews were conducted six months apart. RESULTS: The most successful strategy for contacting participants was through a local agency and e-mail. An analysis of the contact data identified participant retention rates as 88%, 86%, and 82% for each successive interview. This longitudinal retention rate is very high compared with research in other vulnerable populations, suggesting a strong willingness to participate in the Youth Matters in London project. CONCLUSIONS: Retaining a sample of homeless youth is difficult, however, with time, patience and effort it has proven possible. This research underscores the importance of relationships with community agencies to retain vulnerable youth samples in longitudinal research designs.

OBJECTIF: Les populations difficiles à atteindre doivent être incluses dans les études de recherche afin d'assurer une représentation adéquate de la population générale. Cet article explore les stratégies de suivi utilisées dans le projet Youth Matters in London pour retenir un échantillon de jeunes sans abri. MÉTHODE: Un total de 187 jeunes, de 16 à 24 ans, sans abri ou ayant un logement précaire, et présentant un problème de santé mentale sérieux ont été recrutés dans une halte-accueil communautaire, par le bouche à oreille et par sondage en boule de neige. Après l'entrevue initiale, trois entrevues répétées ont été menées à un intervalle de 6 mois. RÉSULTATS: La stratégie la plus fructueuse pour contacter des participants était par l'intermédiaire d'un organisme local et par courriel. Une analyse des données des coordonnées a indiqué les taux de rétention des participants comme étant 88 %, 86 %, et 82 % pour chaque entrevue successive. Ce taux de rétention longitudinal est très élevé comparativement à la recherche dans d'autres populations vulnérables, ce qui suggère une forte volonté de participer au projet Youth Matters in London. CONCLUSIONS: Il est difficile de retenir un échantillon de jeunes sans abri, cependant, avec le temps, de la patience et des efforts cela s'est révélé possible. Cette recherche souligne l'importance des relations avec les organismes communautaires pour garder les échantillons de jeunes vulnérables dans des méthodes de recherche longitudinale.

Nursing Students' Perceptions of Participatory Action Research.

BACKGROUND: This article evaluates the experience of students engaged in a participatory action research project. METHOD: Nursing students were assigned to research activities addressing poverty and social inclusion in the lives of individuals with mental health issues. Focus group interviews were held with 25 students, representing 58.1% of eligible students. RESULTS: Themes and subthemes were categorized from the transcripts, with two overarching themes emerging: (a) aspects that worked well, and (b) aspects that could be improved. The range of activities students engaged in while assigned to the project and students' perceptions, both positive and negative, about their overall exposure to participatory action research are identified and discussed. CONCLUSION: Findings in the literature with regard to perceived benefits and limitations of participatory action research projects involving students are supported by those found in this study. Based on the findings of this study, curriculum development for an interdisciplinary graduate-level course is in process. [J Nurs Educ. 2018;57(5):282-286.].

Client perceptions of the mental health engagement network: a qualitative analysis of an electronic personal health record.

BACKGROUND: Information technologies such as websites, mobile phone applications, and virtual reality programs have been shown to deliver innovative and effective treatments for mental illness. Much of the research studying electronic mental health interventions focuses on symptom reduction; however, to facilitate the implementation of electronic interventions in usual mental health care, it is also important to investigate the perceptions of clients who will be using the technologies. To this end, a qualitative analysis of focus group discussions regarding the Mental Health Engagement Network, a web-based personal health record and smartphone intervention, is presented here. METHODS: Individuals living in the community with a mood or psychotic disorder (n = 394) were provided with a smartphone and access to an electronic personal health record, the Lawson SMART Record, for 12 to 18 months to manage their mental health. This study employed a delayed-implementation design and obtained both quantitative and qualitative data through individual interviews and focus group sessions. Participants had the opportunity to participate in voluntary focus group sessions at three points throughout the study to discuss their perceptions of the technologies. Qualitative data from 95 focus group participants were analysed using a thematic analysis. RESULTS: Four overarching themes emerged from focus group discussions: 1) Versatile functionality of the Lawson SMART Record and smartphone facilitated use; 2) Aspects of the technologies as barriers to use; 3) Use of the Mental health Engagement Network technologies resulted in perceived positive outcomes; 4) Future enhancement of the Lawson SMART Record and intervention is recommended. DISCUSSION: These qualitative data provide a valuable contribution to the understanding of how smarttechnologies can be integrated into usual mental health care. Smartphones are extremely portable andcommonplace in society. Therefore, clients can use these devices to manage and track mental health issuesin any place at almost any time without feeling stigmatized. CONCLUSIONS: Assessing clients' perspectives regarding the use of smart technologies in mental health care provides an invaluable addition to the current literature. Qualitative findings support the feasibility of implementing a smartphone and electronic personal health record intervention with individuals who are living in the community and experiencing a mental illness, and provide considerations for future development and implementation.

Moving forward: evaluating a curriculum for managing responsive behaviors in a geriatric psychiatry inpatient population.

PURPOSE: The Gentle Persuasive Approaches (GPA) curriculum was developed as an adjunct to other educational initiatives that were part of Ontario, Canada's Alzheimer Strategy. GPA emphasizes that an individual's unique personal history has a direct application to the interpretation of and response to their behavior. It incorporates strategies into geriatric patient care to assist staff to respond effectively to verbal and physical expressions of need. DESIGN AND METHODS: A pre- and postintervention approach was used to evaluate the effectiveness of GPA: (a) Staff Satisfaction Surveys immediately after GPA training and after 3 months, (b) risk event profiling to monitor aggressive behavior rates, (c) occupational health and safety records pre- and post-GPA training, and (d) Residential Assessment Instrument-Mental Health indicators pre- and post-GPA training. RESULTS: Surveys revealed that GPA training significantly improved staff's response to challenging behaviors, understanding of how brain changes impact behavior, and learning strategies to respond to challenging behaviors. Specific body containment techniques were less employed on geriatric patients who experience responsive behaviors. Pre- and postphysical aggression rates declined over the 6-month period following GPA training. The training did not appear to impact occupational injury rates. IMPLICATIONS: GPA appears to be a useful and positive approach for providing care to an inpatient geriatric psychiatry population. Specific body containment techniques may be less useful when employed with patients who have responsive behaviors. The program evaluation suggests that application of the GPA curriculum may be extended to patients with diagnoses other than dementia.