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1.
JMIR Ment Health ; 11: e53894, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38771630

RESUMO

BACKGROUND: The National Health Service (NHS) Talking Therapies program treats people with common mental health problems in England according to "stepped care," in which lower-intensity interventions are offered in the first instance, where clinically appropriate. Limited resources and pressure to achieve service standards mean that program providers are exploring all opportunities to evaluate and improve the flow of patients through their service. Existing research has found variation in clinical performance and stepped care implementation across sites and has identified associations between service delivery and patient outcomes. Process mining offers a data-driven approach to analyzing and evaluating health care processes and systems, enabling comparison of presumed models of service delivery and their actual implementation in practice. The value and utility of applying process mining to NHS Talking Therapies data for the analysis of care pathways have not been studied. OBJECTIVE: A better understanding of systems of service delivery will support improvements and planned program expansion. Therefore, this study aims to demonstrate the value and utility of applying process mining to NHS Talking Therapies care pathways using electronic health records. METHODS: Routine collection of a wide variety of data regarding activity and patient outcomes underpins the Talking Therapies program. In our study, anonymized individual patient referral records from two sites over a 2-year period were analyzed using process mining to visualize the care pathway process by mapping the care pathway and identifying common pathway routes. RESULTS: Process mining enabled the identification and visualization of patient flows directly from routinely collected data. These visualizations illustrated waiting periods and identified potential bottlenecks, such as the wait for higher-intensity cognitive behavioral therapy (CBT) at site 1. Furthermore, we observed that patients discharged from treatment waiting lists appeared to experience longer wait durations than those who started treatment. Process mining allowed analysis of treatment pathways, showing that patients commonly experienced treatment routes that involved either low- or high-intensity interventions alone. Of the most common routes, >5 times as many patients experienced direct access to high-intensity treatment rather than stepped care. Overall, 3.32% (site 1: 1507/45,401) and 4.19% (site 2: 527/12,590) of all patients experienced stepped care. CONCLUSIONS: Our findings demonstrate how process mining can be applied to Talking Therapies care pathways to evaluate pathway performance, explore relationships among performance issues, and highlight systemic issues, such as stepped care being relatively uncommon within a stepped care system. Integration of process mining capability into routine monitoring will enable NHS Talking Therapies service stakeholders to explore such issues from a process perspective. These insights will provide value to services by identifying areas for service improvement, providing evidence for capacity planning decisions, and facilitating better quality analysis into how health systems can affect patient outcomes.


Assuntos
Procedimentos Clínicos , Mineração de Dados , Medicina Estatal , Humanos , Medicina Estatal/organização & administração , Estudos Retrospectivos , Procedimentos Clínicos/organização & administração , Inglaterra , Masculino , Feminino , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Pessoa de Meia-Idade
2.
Violence Against Women ; 29(3-4): 752-772, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-35938478

RESUMO

This article argues for a new approach to making sense of mass murder, emphasizing the urgency of recognizing the proliferation and significance of misogyny and domestic violence among perpetrators of this type of homicide. It is vital that scholarship recognizes the political economy of neoliberal patriarchy and seeks to better understand how harmful subjectivity develops in this context. We propose a new multilevel framework for the analysis of mass murder and issue a call to action for a global program of independent qualitative research and activism to tackle its drivers, prevent further harm, and save lives.


Assuntos
Violência Doméstica , Homicídio , Humanos , Feminismo
3.
Violence Against Women ; 27(11): 1840-1861, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33143567

RESUMO

This research investigated cases of femicide in Great Britain where perpetrators claimed that victims died in "sex games gone wrong." Forty-three femicides that resulted in a conviction for murder, manslaughter, or culpable homicide were examined in relation to victim-perpetrator sociodemographic characteristics, victim-perpetrator relationship, homicide details, and criminal justice outcomes. Key patterns within the data were identified. The research highlights that the "sex game gone wrong" narrative has gained traction against a cultural backdrop of normalized bondage, domination, and sadomasochism (BDSM) within neoliberal political economy.


Assuntos
Vítimas de Crime , Homicídio , Direito Penal , Feminino , Humanos , Reino Unido
4.
Violence Against Women ; 27(10): 1479-1498, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-32757887

RESUMO

This article presents a new theoretical framework around technology-facilitated domestic abuse (TFDA) in identifying four distinct types of omnipresent behavior. Perpetrators are increasingly drawing upon networked technologies like smartphones, social media, and GPS trackers in monitoring, controlling, and abusing survivors. There is considerable academic literature developing in response to this. While this scholarship is valuable, this article argues that TFDA must be understood as a neoliberal manifestation of patriarchal legacies of misogyny and sexism. A failure to recognize this will serve to prioritize abusers' freedom to do harm over rights of survivors to be protected from harm.


Assuntos
Violência Doméstica , Sexismo , Humanos , Tecnologia
5.
Int J Offender Ther Comp Criminol ; 59(2): 159-79, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24122020

RESUMO

This article reports on qualitative research with Alan, a former resident of the therapeutic communities at Her Majesty's Prison (HMP) Grendon, England, exploring narrative identity beyond therapy. The study emphasises the complexity inherent in the five identities on which Alan draws-the Achiever, the Liminal Man, the Lucky Man, the Puppet, and the Wise Man. We suggest that narrative identities are adapted and reconstructed as they are taken outside of the therapeutic community into a less supportive social environment. This process continues to present challenges for the ex-resident, who may struggle to reconcile the redemptive identities nurtured in therapy with condemnatory ones that have echoes of a criminal past, which may be reignited by personal and social circumstances.


Assuntos
Conflito Psicológico , Transtornos Mentais/terapia , Narração , Prisioneiros/psicologia , Prisões , Autoimagem , Comunidade Terapêutica , Adulto , Crime/psicologia , Inglaterra , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pesquisa Qualitativa , Ajustamento Social , Meio Social , Apoio Social , País de Gales
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