Staff Perceptions and Implementation Fidelity of an Autism Spectrum Disorder Care Pathway on a Child/Adolescent General Psychiatric Inpatient Service.

While youth with autism spectrum disorder (ASD) are psychiatrically hospitalized at high rates, general psychiatric settings are not designed to meet their unique needs. Previous evaluations of an ASD-Care Pathway (ASD-CP) on a general psychiatric unit revealed sustained reductions in crisis interventions (intramuscular medication use, holds/restraints; Cervantes et al. in J Autism Dev Disord 49(8):3173-3180, https://doi.org/10.1007/s10803-019-04029-6 , 2019; Kuriakose et al. in J Autism Dev Disord 48(12):4082-4089, https://doi.org/10.1007/s10803-018-3666-y , 2018). The current study investigated staff perceptions of the ASD-CP (N = 30), and examined rates of ASD-CP implementation fidelity in relation to patient outcomes (N = 28). Staff identified visual communication aids and reward strategies as most helpful. The number of days of reward identification early in the inpatient stay was associated with fewer crisis interventions later in a patient's stay.

Psychological First-Aid Experiences of Disaster Health Care Workers: A Qualitative Analysis.

OBJECTIVE: Disaster health care workers experience much greater stress providing psychological first-aid and suffer from the indirect experience of traumatic events. This study examines how disaster health care workers experience disaster mental health. METHODS: Twenty-one disaster health care workers recruited from fire stations, community mental health service centers, and disaster trauma centers in Korea participated in this study. Data were collected via in-depth interviews and qualitatively analyzed according to Colaizzi's phenomenological approach. RESULTS: Disaster health care workers' experiences of disaster mental health can be analyzed according to 4 theme categories: (1) commitment to one's duty as a disaster health care worker; (2) powerlessness and lack of confidence; (3) incident shock and burnout; and (4) incomplete and inadequate healing. CONCLUSIONS: In order to prevent mental health problems and support the disaster health care workers, it is necessary to develop and provide effective, nationwide psychological first-aid training, as well as disaster trauma recovery programs that are tailored to Korean sociocultural context and use immersive digital health care/education technology.

Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time-series analysis.

AIM: To evaluate the impact of the introduction and withdrawal of financial incentives on alcohol screening and brief advice delivery in English primary care. DESIGN: Interrupted time-series using data from The Health Improvement Network (THIN) database. Data were split into three periods: (1) before the introduction of financial incentives (1 January 2006-31 March 2008); (2) during the implementation of financial incentives (1 April 2008-31 March 2015); and (3) after the withdrawal of financial incentives (1 April 2015-31 December 2016). Segmented regression models were fitted, with slope and step change coefficients at both intervention points. SETTING: England. PARTICIPANTS: Newly registered patients (16+) in 500 primary care practices for 2006-16 (n = 4 278 723). MEASUREMENTS: The outcome measures were percentage of patients each month who: (1) were screened for alcohol use; (2) screened positive for higher-risk drinking; and (3) were reported as having received brief advice on alcohol consumption. FINDINGS: There was no significant change in the percentage of newly registered patients who were screened for alcohol use when financial incentives were introduced. However, the percentage fell (P < 0.001) immediately when incentives were withdrawn, and fell by a further 2.96 [95% confidence interval (CI) = 2.21-3.70] patients per 1000 each month thereafter. After the introduction of incentives, there was an immediate increase of 9.05 (95% CI = 3.87-14.23) per 1000 patients screening positive for higher-risk drinking, but no significant further change over time. Withdrawal of financial incentives was associated with an immediate fall in screen-positive rates of 29.96 (95% CI = 19.56-40.35) per 1000 patients, followed by a rise each month thereafter of 2.14 (95% CI = 1.51-2.77) per 1000. Screen-positive patients recorded as receiving alcohol brief advice increased by 20.15 (95% CI = 12.30-28.00) per 1000 following the introduction of financial incentives, and continued to increase by 0.39 (95% CI = 0.26-0.53) per 1000 monthly until withdrawal. At this point, delivery of brief advice fell by 18.33 (95% CI = 11.97-24.69) per 1000 patients and continued to fall by a further 0.70 (95% CI = 0.28-1.12) per 1000 per month. CONCLUSIONS: Removing a financial incentive for alcohol prevention in English primary care was associated with an immediate and sustained reduction in the rate of screening for alcohol use and brief advice provision. This contrasts with no, or limited, increase in screening and brief advice delivery rates following the introduction of the scheme.

["VigilanSeu.r.se": A new profession?] / « VigilanSeu.r.se ¼ : un nouveau métier ?

In January 2015, in accordance with decades of scientific work based on maintaining contact, was born an innovative device for suicide prevention: VigilanS. To ensure this link, the choice was made to build a team with an equal number of nurses and psychologists, all located within the medical regulation. Nowadays, they are named "VigilanSeur": an original entity that highlights the emergence of this new profession, at the crossroads of several disciplines.

Beyond the Medical Model: Future Directions for Suicide Intervention Services.

The medical model continues to dominate research and shape policy and service responses to suicide. In this work we challenge the assumption that the medical model always provides the most effective and appropriate care for persons who are suicidal. In particular, we point to service user perspectives of health services which show that interventions are often experienced as discriminatory, culturally inappropriate, and incongruent with the needs and values of persons who are suicidal. We then examine "humanistic" approaches to care that have been proposed as a corrective to an overly medical model. We argue that the focus on improving interpersonal relations set out in humanistic approaches does not mitigate the prevailing risk management culture in contemporary suicide prevention and may impede the provision of more effective care. Finally, we draw attention to the tradition of non-medical approaches to supporting persons who are suicidal. Using Maytree (a U.K. crisis support service) as a case study, we outline some of the key features of alternative service models that we consider central to the design of more culturally appropriate and effective interventions. We conclude by making three key recommendations for improving services to persons who are suicidal.

Aportación de Cataluña al proyecto europeo MEntally Disturbed Inmates Care and Support (MEDICS) / Catalan contribution in the European project MEntally Disturbed Inmates Care and Support (MEDICS)

Objetivo: Conocer la opinión de los trabajadores penitenciarios sobre las causas, métodos de manejo y propuestas de mejora en la atención de los reclusos que presentan trastornos mentales no graves. Material y métodos: Actividad realizada de marzo a mayo de 2015. En Cataluña participaron tres prisiones. Se distribuyeron siete modelos diferentes de cuestionarios anónimos, diseñados por Italia, y dirigidos a directores, técnicos de los equipos de tratamiento, funcionarios de vigilancia, profesores, médicos, enfermeros y voluntarios. Para estudiar la asociación entre variables cualitativas se utilizaron la prueba de ji al cuadrado y el test exacto de Fisher. Resultados: Se distribuyeron 744 cuestionarios y hubo 174 cumplimentaciones (23,4%). La participación fue mayor en sanitarios y profesionales del equipo de tratamiento (88% y 36%, respectivamente). Los médicos tenían más edad media que otros grupos, con diferencias estadísticamente significativas (p <0,001). El 40,7% eran hombres y el 57,7% mujeres. El 70% de los funcionarios de vigilancia tenían estudios superiores. La mayoría (62,4%) consideró que el mayor conocimiento en salud mental lo había obtenido por el trabajo penitenciario. Se presentan las principales respuestas obtenidas de cada colectivo. Discusión: Casi un cuarto de los trabajadores participaron en el proyecto MEDICS. El 67% del total de participantes eran licenciados universitarios. Hay preocupación profesional sobre los trastornos mentales, pero no discriminación, y algunos grupos (médicos y, sobre todo, profesionales no sanitarios) consideran básica la formación continuada en este ámbito y el trabajo en equipo interprofesional

Objective: To know the criteria of penitentiary professionals about the causes, management methods and improvement proposal, in the attention and care of inmates suffering non-serious mental disorders. Material and methods: Activity developed from March to May 2015. In Catalonia, three prisons participated. Seven different models of anonymous and written questionnaires were distributed, designed by Italy, and aimed at directors, treatment teams, correctional officers, teachers, doctors, nursing staff and volunteers. They presented the degree of participation, descriptive characteristics of groups and main answers given. To study the association between qualitative variables, the Chi squared and the exact Fisher test was used. Results: Questionnaires distributed among the 744 employees and there were obtained 174 filled (23.4%). There was more participation among health staff and treatment teams (88% and 36%). About the age of participants, doctors were the most senior group with meaningful differences (p <0.001). 40.7% were men and 57.7% women. Among the non-health staff 70% of correctional officers held a degree. Most of the total (62.4%) had their work as their main sources of knowledge about mental health. The main answers given are presented. Discussion: Almost 25% of penitentiary professionals participated in the MEDICS project. Most of them (67%) held a degree. There is a professional concern about mental disorders but not discrimination. Some groups (doctors and, specially, non-health professionals) believe as basic a continuing training and working in multidisciplinary teams

La necesidad de superar la «carga mundial de obstáculos» para poner fin a las restricciones físicas en la atención psiquiátrica pediátrica / The need to overcome the «global burden of obstacles» to end physical restraints in pediatric psychiatric care

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Peer-Debriefing After Distressing Patient Care Events: A Workshop for Pediatric Residents.

Introduction: When confronted with a distressing patient care event, physicians experience feelings of failure, inadequacy, and self-doubt that negatively impact emotional well-being and have been linked to burnout and premature exit from the medical profession. A need exists within the medical community for improved emotional processing of distressing patient care events, particularly for resident physicians at the beginning of their careers. Methods: To encourage physicians to communicate as a means of initiating emotional processing after a distressing patient care event, a workshop was developed for pediatric residents providing training on a peer-debriefing model taken from the bereavement counseling literature. The workshop is designed to take 60 minutes, including dedicated opportunities to observe and conduct debriefing sessions based on the residents' own distressing patient care experiences. Included are the workshop facilitation guide, the adapted peer-debriefing model, hypothetical patient care scenarios, and pre- and postsession survey evaluation forms. Results: Pre- and posttraining survey metrics revealed statistically significant and meaningful increases in pediatric residents' self-reported comfort with and likelihood of leading a peer-debriefing session in an appropriate clinical setting. Discussion: This workshop is a well-received, effective intervention that provides pediatric residents with a tool to aid in the timely emotional processing of distressing patient care events. It has been adopted into the standard educational curriculum of our home institution's pediatric residency program. This workshop may be extended throughout the field, helping physicians at all levels of practice process the inevitable distress inherent in caring for the sick.

Cuestionamiento de los vínculos y crisis / The questioning of bonds and the crisis

La relación entre la demanda de atención en salud mental infantojuvenil y la provisión de servicios habitualmente se articula entono a una crisis relacional individual y del grupo familiar. En ella se hace más evidente el tipo de vínculos establecidos entre los miembros de la familia y se entienden mejor las adaptaciones defensivas del niño/a/a o el adolescente a las presiones conscientes e inconscientes de su grupo familiar. Un análisis en profundidad de la psicopatología de niño/as/ as y adolescentes muestra que en la mayor parte de los casos nos encontramos ante un conjunto de reacciones normales frente a situaciones excepcionales que dificultan la consecución de alguna de las tareas evolutivas del desarrollo. En este contexto adquiere relevancia el tipo de relación terapéutica que los servicios de salud mental infantojuvenil establecen con los usuarios, así como la reflexión sobre sus potencialidades y sus límites (AU)

The relationship between mental health requests made by clients and professional service provision often revolves around an individual or family relational crisis. Former attachment patterns become more evident during crisis and children and adolescent defensive adaptive reactions to conscious and unconscious family group pressures are better understood at crisis time. Deep analysis of children and adolescent psychopathology show that in most cases we are dealing with normal reactions to exceptional situations that make it difficult for the child to achieve some developmental tasks in emotional maturation. In this context is highly relevant the kind of therapeutic relationship that mental health teams establish with clients, being very important to reflect about its potentialities and limits (AU)

Pain related catastrophizing on physical limitation in rheumatoid arthritis patients. Is acceptance important?

The experience of Rheumatoid Arthritis (RA) includes significant suffering and life disruption. This crosssectional study examined the associations between pain, catastrophizing, acceptance and physical limitation in 55 individuals (11 males and 44 female; Mean age = 54.37; SD = 18.346), from the Portuguese population with (RA) 2 years after the diagnosis; also explored the role of acceptance as a mediator process between pain, catastrophizing and physical limitation. Results showed positive correlation between pain and catastrophizing (r = .544; p ≤ .001), and also between pain and 2-years' physical limitation (r = .531; p ≤ .001) Results also showed that acceptance was negatively correlated with physical limitation 2 years after the diagnosis (r = -.476; p ≤ .001). Path-analysis was performed to explore the direct effect of pain (ß = -.393; SD = .044; Z = 3.180; p ≤ .001) and catastrophizing (n.sig.) on physical limitation and also to explore the buffer effect of acceptance in this relationship (indirect effect ß = -.080). Results showed that physical limitation is not necessarily a direct product of pain and catastrophizing but acceptance was also involved. Pain and catastrophizing are associated but the influence of catastrophizing on physical limitation is promoted by low levels of acceptance. Results emphasize the relevance of acceptance as the emotional regulation process by which pain and catastrophizing influence physical functioning and establish the basic mechanism by which pain and catastrophizing operate in a contextual-based perspective. Also the study results offer a novel approach that may help behavioral health and medical providers prevent and treat these conditions (AU)

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Intervenciones psicoterapéuticas con el entorno de niños con problemas psiquiátricos graves desde un centro de día / Psychotherapeutic interventions with the environment of children with serious mental problems from a day care centre

A través de esta exposición y valiéndome de un caso clínico, me gustaría acercar el trabajo realizado con el entorno familiar de niños con problemas psiquiátricos graves en un centro terapéutico-educativo (AU)

Through this exhibition and availing myself of a clinical case, I would bring the work done with the family environment of children with serious psychiatric problems in a therapeutic-educational center (AU)

Participatory and action research as a transformative praxis: responding to humanitarian crises from the margins.

This article reports on a small set of community-based participatory projects designed collaboratively by and for survivors directly affected by armed conflict in Guatemala and some of their family members in the North (i.e., in New Orleans, Louisiana, and New England). Local protagonists deeply scarred by war and gross violations of human rights drew on indigenous beliefs and practices, creativity, visual performance arts, and participatory and action research strategies to develop and perform collaborative community-based actions. These initiatives constitute a people's psychosocial praxis. Through their individual and collective narratives and actions, Mayan and African American women and Latinas perform a psychology from the "two-thirds world," one that draws on postcolonial theory and methodology to retheorize trauma and resilience. These voices, creative representations, and actions of women from the Global South transform earlier, partial efforts to decenter EuroAmerican epistemologies underlying dominant models of trauma that reduce complex collective phenomena to individual pathology, refer to continuous trauma as past, are ahistorical, and universalize culturally particular realities.

Alternativas a la psiquiatría / Alternatives beyond Psychiatry

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Aportaciones de la medicina forense a la investigación de la conducta suicida / Contributions of forensic medicine to research of suicidal behaviour

El suicidio es la principal causa de muerte violenta en España, por delante de los accidentes de tráfico, y se estima que cada año se suicidan cerca de 3.500 personas. Los factores de riesgo identificados de la conducta suicida se basan, principalmente, en estudios de intentos de suicidio. La centralización de las autopsias en los Institutos de Medicina Legal facilita la homogenización del método de trabajo y la consistencia de los resultados a nivel práctico-judicial y de investigación. La medicina forense debe proyectarse en la investigación en general y de la conducta suicida en particular, en colaboración con otros equipos de investigación. La investigación debe efectuarse según la normativa ética y administrativa vigente y ser aprobada por el Comité Ético de referencia. Con respecto a la investigación de los factores de riesgo del suicidio, el reclutamiento de casos y controles, la obtención de muestras biológicas, la colaboración en la realización de autopsias psicológicas y los estudios epidemiológicos, son aportaciones esenciales de la medicina forense(AU)

In Spain, suicide is the leading cause of violent death, ahead of motor vehicle accidents, with about 3,500 people dying by this mean in Spain. The risk factors identified are primarily based on studies of suicide attempts. The centralization of autopsies in the Institutes of Legal Medicine allows the homogenization of working methods and the consistency of results for both research and legal purposes. Forensics should focus on medical research in general and on suicidal behaviour in particular, in collaboration with other research teams. Research must be conducted according to existing ethical and administrative legislation. All must be approved by the Ethics Committee of reference. With regard to the investigation of risk factors for suicide, forensics are essential in the recruitment of cases and controls-obtaining biological samples, collaborating in conducting psychological autopsies and epidemiological studies(AU)

Trends in behavioral health care service provision by community health centers, 1998-2007.

OBJECTIVE: The federal government boosted support for community health centers in medically underserved areas in 2002-2007. This investigation compared trends in behavioral health services provided by community health centers nationwide during the first several years of that initiative with immediately prior trends. METHODS: Data were extracted from the Health Resources and Services Administration's Uniform Data System on community health centers for 1998-2007 (2007, N=1,067). Regression analyses revealed trends in individual community health centers' likelihood of providing on-site specialty mental health care, crisis services, and substance abuse treatment. Aggregate data were used to show national trends in numbers of behavioral health encounters, patients, and encounters per patient. RESULTS: The number of federally funded community health centers increased 43% between 2001 and 2007, from 748 to 1,067, over twice the annual growth rate between 1998 and 2001. However, trends in individual community health centers' likelihood of providing different types of behavioral health care were generally consistent across the two time periods. In 2007, 77% of community health centers offered specialty mental health services, 20% offered 24-hour crisis intervention services, and 51% offered substance abuse treatment. The mean number of mental health encounters per mental health patient at community health centers in 2007 was 2.9. CONCLUSIONS: The behavioral health care safety net has widened through rapid recent growth in the number of community health centers as well as a continuing increase in the proportion offering specialty mental health services.

Interventions to reduce the use of seclusion and restraint in inpatient psychiatric settings: what we know so far a review of the literature.

INTRODUCTION: In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction programmes. A total of 29 papers were included in the review. RESULTS: Seven key strategy types emerged from the analysis: (i) policy change/leadership; (ii) external review/debriefing; (iii) data use; (iv) training; (v) consumer/family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction programmes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment. CONCLUSION: The development of new seclusion and restraint reduction programmes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.

Crisis intervention and acute psychiatry in Amsterdam, 20 years of change: a historical comparison of consultations in 1983 and 2004-2005.

AIM: There has been a striking increase in the number of compulsory admission proceedings in the Netherlands since 1992, to such an extent that treatment in Amsterdam's psychiatric clinics is in danger of being dominated by coercive treatment. Our aim was to establish a picture of the changes in emergency psychiatry that have contributed to the increase in the number of acute compulsory admissions. METHODS: A cohort (N = 460) of psychiatric emergency consultations with the city crisis service in 1983 was compared with a similar cohort (N = 436) in 2004-2005. The study focused on the following variables: patient characteristics, crisis-service procedures and consultation outcomes. RESULTS: Compared with 1983, there are now more services involved in crisis support in the public domain for psychiatric patients. The number of patients referred by the police has risen from 29% to 63%. In 1983, all consultations took place where the patients were located; at present, 60% take place at the crisis service premises. The number of psychotic patients in the cohort has increased from 52.0% and 63.3 %. There has been an increase in the proportion of compulsory admissions and a sharp decrease in the proportion of voluntary admissions from 61% to 28% of all admissions. Overall, the percentage of consultations leading to a psychiatric admission has fallen from 42% to 27%. CONCLUSION: The front-line outreach service of 1983 has changed into a specialist psychiatric emergency department with a less pronounced outreach component. Voluntary admissions to psychiatric hospitals have almost disappeared as a feature of the crisis service.