Characterizing the direct care health workforce in the United States, 2010-2019.

BACKGROUND: To describe the growth and characteristics of the direct care health workforce, encompassing home health aides, personal care aides, nursing assistants, and orderlies and psychiatric aides from 2010 to 2019 in the United States. METHODS: Using nationally representative data from the 2010 to 2019 American Community Survey, we described the growth in the direct care health workforce overall and by type of direct care health worker. In addition, we examined the distribution of direct care workers by geographic region of the country, age categories, citizenship, world area of birth, income, health insurance status, and other characteristics. RESULTS: From 2010 to 2019, the number of direct care health workers in the United States per 10,000 individuals decreased slightly from 135.81 in 2010 to 133.78 in 2019. Personal care aides made up 42.1% of the direct care health workforce in 2019, followed by nursing assistants (39.5%) and home health aides (16.3%). In 2019, the number of direct care health workers who were not U.S. citizens accounted for roughly 10% of all workers in each year. The relative percentage of direct care health workers that were not a citizen of the United States was highest among home health aides (16.3%). Among workers born outside of the United States, the majority were from Latin America, followed by Asia. CONCLUSION: From 2010 to 2019, there was little growth in the direct care health workforce despite growing demand for direct care health workers. In the midst of the current and projected shortage of direct care health workers-particularly during the COVID-19 pandemic, longer-term solutions to improve retention of direct care health workers and increase the supply of direct care health workers may be needed.

Psychiatric staff perceptions of patient attachments: a pilot study to investigate differences in and predictors of psychiatric staff perceptions of patient attachments.

OBJECTIVES: We explored the extent to which a group of psychiatric staff differed in their ratings of patients' attachment styles and whether deviations in mean ratings were related to education, clinical experience, familiarity with patients, or staff attachment styles. METHOD: Fifteen mental healthcare workers assessed the attachment styles of nine patients with schizophrenia or schizoaffective disorder using the Psychosis Attachment Measure. Staff also reported on their own attachment styles. Similarity in ratings was investigated using two-way random interclass correlation coefficients (ICCs). An index showing how much each rater's assessments of attachment style deviated from the mean attachment style rating for each of the patients was used to investigate possible predictors of deviations from mean ratings. RESULTS: Average staff ICCs for attachment anxiety and avoidance suggested reasonable levels of convergence between staff perceptions. Deviations from mean ratings were unrelated to staff qualifications or years of experience in mental health. However, staff who had known patients for longer periods tended to rate patients more similarly, whereas staff who had higher levels of attachment anxiety and avoidance tended to deviate from colleagues' ratings. CONCLUSIONS: Attachment styles in psychosis are observable characteristics that can be rated by mental health professionals, although length of time staff have known patients, as well as their own attachment styles are likely to influence perceptions.

Attitudes of ward attendants towards mental illness: comparisons and predictors.

BACKGROUND: In India few studies exist that explore attitudes of mental health professionals, especially psychiatric ward attendants, towards psychiatric illnesses. This study aimed to explore attitudes of psychiatric ward attendants since they work closely with psychiatric patients in the hospital ward, and which may differ given their cultural and social background. METHODS: Five hundred psychiatric ward attendants were targeted and a 100 sample size chosen based on systematic random sampling. A control group from guardians attending the outpatient department of Central Institute of Psychiatry was selected using the same methods. Attitudes of both groups were assessed using Community Attitudes towards Mental Illness (CAMI) after written informed consent. RESULTS: There were no significant differences noted in Authoritarianism and Benevolence domains of CAMI. However, there were significant differences in the domains of Social Restrictiveness and Community Mental Health Ideology with psychiatric ward attendants scoring higher than the general attendants. Among the socio-demographic variables, there was significant correlation between age, duration of contact and educational background and various domains of CAMI. CONCLUSIONS: Psychiatric ward attendants had more positive attitudes than general attendants towards psychiatric illnesses. Socio-demographic variables like older age, higher education and longer duration of contact with the psychiatrically ill predicted more favourable attitudes.

Violence in public sector psychiatric hospitals. Benchmarking nursing staff injury rates.

1. Violence toward healthcare workers, particularly psychiatric nursing staff, has only recently been identified as a workplace health hazard. An occupational health perspective underscores the need for proactive monitoring and heightens incentives for prevention through the introduction of external regulation. 2. Nursing staff injury rates from violence alone are higher than injuries seen in industries traditionally considered high risk such as mining, lumber, and heavy construction. Nursing employment categories at particular risk include psychiatric technicians, male staff, and on-unit supervisory personnel. 3. It is exceedingly difficult to accurately measure the extent of violence in a given facility and injury rates are known to underestimate the actual number of violent events that occur. Nursing staff, labor organizations, and managers must work toward more reliable monitoring and risk prevention programs.

Nursing staff educational preparation and patient inflicted injuries in a 160 bed psychiatric hospital.

This is a retrospective study of the incidence and severity of patient inflicted injuries upon nursing staff in a 160 bed psychiatric hospital over a period of two years. The investigation explored possible relationships between the basic educational preparation of the injured staff members, the severity of their injuries, and whether they used the behavior management techniques learned in the Mandt System classes. (The Mandt System has been used at Alaska Psychiatric Institute since 1979 to train nursing staff in how to safely deal with assaultive people.)

Training paraprofessionals for psychiatric support. New supports in expanding care for the elderly.

The need for mental health services for the elderly continues to grow while access to those services is critically limited. Gaps in service delivery become even more pronounced as elderly services increasingly shift from acute care and long-term care to the home. Home care aides could serve pivotal roles in providing support for clients experiencing mental health problems, as evidenced by the following results of implementing a training and demonstration grant for preparing psychiatric home care aides.

Enriching lives. Mental health supportive home care aides.

The emotional and social support of paraprofessionals can profoundly affect the quality of life of those in need. This model program for supportive home care aides received accolades for its contributions to the welfare of clients during an audit conducted by the Massachusetts Department of Public Health.

Staffing of forensic inpatient services in the United States.

Data on patient census, bed capacity, and staffing levels in state-operated forensic psychiatric inpatient programs in 1986 were collected from forensic mental health directors of the 50 states and the District of Columbia. Of the 75 programs identified, 54 were based in units within larger psychiatric hospitals and 21 in freestanding hospitals. For all programs, direct-care staff-patient ratios ranged from .35 to 4, with a mean of 1.3. The ratio of filled beds to bed capacity ranged from .5 to 1.54, with a mean of .95. Nearly a fourth of the programs were over capacity. A negative relationship between filled-bed ratios and direct-care staff-patient ratios was found.

Psychiatric attendant-led rehabilitation groups.

Because active treatment is indicated as a patient care priority by both staff and regulatory agencies, innovative ways to utilize available staff to provide treatment needs to be further developed. The Logansport Hospital program provides one example for training experienced attendants in conducting exercise, relaxation, and discussion groups. It has enabled increased programming for patients and has been positively evaluated by our staff.

Consultation to line staff and its impact on the care of chronic patients.

This study was carried out to determine whether long term chronic deteriorated patients could be taught skills in activities of daily living by therapy aides to improve their quality of life in the hospital. It was designed as a controlled trial comparing active intervention in the experimental wards with routine nursing care in the control wards. The results showed that, even in such a short period as 3 months, active treatment produced results which were statistically significantly better than the controls. It is concluded that mental hygiene therapy aides, given adequate support and encouragement, can make measurable and observable improvements in the behavior of long term patients. The implications of the results are considered.

Citizen participation in community mental health center service delivery.

Citizen involvement in CMHC service delivery has two bases: (a) volunteerism and (b) identification with clients and citizens who may need services. This identification is expressed two ways, as cultural similarity to clients or social activism in their behalf. Paraprofessionals have been portrayed as a major mechanism. Current practice shows some discrepancy from the theoretical program goals. While CMHCs include an appreciable number of volunteers and mental health workers with less than a BA degree, the extent to which they augment services with community or social activism values is doubtful.

The development of a psychiatric rehabilitation service: a two year pilot project.

In the history of psychiatry, one can discern conflicting trends with regard to hospitalization of people suffering from severe mental disturbances. From the beginning of the 19th century, the standard method for dealing with such people has been to take them away from their homes and work and put them in hospitals. However, since the discovery of antipsychotic drugs in the 1950's, there has developed a new movement to treat mentally disturbed people in their communities, either avoiding hospitalization altogether, or at least greatly shortening it. In many hospitals there has been a synthesis of these two trends, reflected in an upgrading of the importance of the rehabilitation function. In Shalvata Psychiatric Center, a medium-sized psychiatric hospital in Hod Hasharon, Israel, a two-year pilot project to introduce a centralized Rehabilitation Service was recently completed. The present Rehabilitation Service is based on the rehabilitation/activity therapy model in which the hospital is conceptualized as a setting in which patients may develop or recover social and vocational skills needed to function adequately in the community. It has drawn on existing, motivated staff from all mental health professions represented at the hospital, and works closely with all in-hospital wards and the day hospital. The authors discuss six areas of vocational and social rehabilitation with which the Rehabilitation Service has attempted to deal: 1. activity therapy/rehabilitation groups, 2. vocational guidance unit, 3. after-care therapeutic social club, 4. in-hospital rehabilitation consultation, 5. liaison activities with community-based facilities, 6. job placement.

[Models for the integration into therapy of work performed by helpers within the framework of psychiatric wards (author's transl)]. / Modelle zur Integration pflegerischer Arbeit in die Therapie auf psychiatrischen Stationen.

Several models for the integration of the work done by nurses and attendants into therapy are presented. In particular, the use of the "Scale for Behavioral Observation in Wards" is described. Important modes of behavior, which are relevant for therapy, can be trained for the benefit of nurses and attendants by observing the patients' behavioral patterns. The approach described in this article can improve the co-operation between the psychiatrist and nurses or helpers.

A first Volunteer Case Aid programme in a mental hospital. Revealing the voluntary helper's role of reality testing between staff and patients.

A pilot Voluntary Case Aid programme in an English Mental Hospital using National Health Service resources is described. The selection of ten volunteers and ten patients and the preparation of all personnel was followed by regular contacts for at least a year. Subsequent evaluation suggested high motivation with both Case Aids and patients. Changes towards improved social functioning were evident in most cases by the end of the project. A relationship starting, continuing and finishing is reported in detail and from this study it is clear that the volunteer was a reality tester for staff and patient alike, constructively disturbing and modifying their mutual projections. This was true of most of the Case Aid interventions and the implications are discussed. A method of group supervision for Case Aids is reported.

Psychiatric Decision Making.

Questionnaire replies from 43 experienced psychiatrists showed wide variation in the ways they would manage a common type of neurotic problem. There were considerable differences in the nature and duration of treatment and in the use of other members of the psychiatric team. The conclusions have implications for training and for the use of health care resources.

Recent results of behavioural treatments of phobias and obsessions.

The basic principle of treatment of phobias and obsessions is exposure of the patient to the evoking stimulus. Utilizing this principle, exposure in vivo seems an effective treatment for many, but not all, obsessional patients. The role of tricyclic drugs is at present being investigated. Nurse therapists have been found to be very competent in delivering treatment. Similar results, using an exposure in vivo model, have been obtained in the managment of phobias. Some reasons why patients do not comply with, or adhere to, treatment recommendations are put foward. Finally, the vexed question of the cost-effectiveness of treatment is considered.