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PubMed1982

Co-therapy in a clinic for schizophrenia.

In the outpatient treatment of schizophrenia, the routine practice of providing each patient with two co-therapists results in several benefits: reduced dependency, increased expertise, objective monitoring, added support and morale for the therapists, more obvious and therefore more reversible countertransference, more obvious and therefore more treatable "splitting" and "projecting." Despite these benefits, problems arise in the two-therapist arrangement. They are discussed under the following headings: loyalty conflicts; limit setting; crisis management; family work. The authors report on techniques of co-therapy problem prevention and problem resolution. Though not always successful, co-therapy continues to be a useful model of service delivery to schizophrenic outpatients.

Ambulatory Care↗
PubMed2002

Supporting families of preschool children with autism: what parents want and what helps.

This paper describes a local education authority project to provide support to the families of preschool children with autistic spectrum disorders. As part of an evaluation study, all parents were interviewed when their children entered full-time education and left the service's caseload. The report outlines key findings regarding levels of satisfaction with the service provided and describes parental responses to the different components of the support offered. All parents rated the input of the support worker as 'very useful'. Parents particularly valued the following: support to 'make sense' of their child's development and needs; practical strategies for facilitating language and engaging in interactive play; and support to the nurseries and playgroups attended by their children. The interviews also looked at parents' experience of diagnosis and their needs in the immediate aftermath. Key implications of these findings, and of this model of service delivery, are also discussed.

Adolescent↗
PubMed2002

Psychosocial primary care - what patients expect from their General Practitioners A cross-sectional trial.

BACKGROUND: Psychosocial Primary Care (PPC) is a model of service delivery for patients with mental disorders and psychosocial problems which was established in Germany in 1987. This study was performed as part of the evaluation of a PPC training program. We investigated patients' expectations of the psychosocial treatment offered by GPs trained in PPC. METHODS: Ten general practitioners trained in PPC were randomly selected. Two hundred and twenty patients were surveyed in the waiting room regarding their expectations concerning psychological treatment. RESULTS: Eighty-five per cent of patients could envisage making use of psychosocial treatments. Counselling by the GP was considered most important (65%). Fifty-four per cent of patients indicated that there was sufficient counselling, but further distinctions revealed dissatisfaction with both the extent and content of the counselling. Lack of time was the most frequent reason (53%) cited for insufficient counselling. A willingness to discuss the psychological aspects of illness was exhibited by between 55% (current illness) and 79% of patients. Two-thirds of patients believed that discussing psychological aspects and counselling by the doctor could exert a healing effect or contribute to symptomatic improvement in physical illnesses. Younger patients and patients with experience in psychotherapy expected referral to mental health services. CONCLUSIONS: Primary care patients desire and accept psychological treatment from their GP. Training in psychosocial competence in primary care should be offered more frequently.

Adult↗
PubMed2005

An exploration of family carers' experience of respite services in one specialist palliative care unit.

BACKGROUND: Changing patterns of care for terminally ill people mean that 90% of patients in the UK now spend the majority of their last year of life at home. It is now widely accepted that supporting individuals to die at home relies heavily on the availability of family carers to provide the majority of the care needed. However, one of the most common reasons for unplanned admissions near the end of life is carers' inability to provide continuing care. One strategy to overcome these challenges has been to offer planned respite care. Despite recent studies, in reality little is known about respite services for patients with life limiting illness, in particular how respite is experienced by the caregivers or to what extent respite services address their needs. METHODS: This prospective study, comprising mixed methods of data collection, explored the experiences of 25 family carers whose relative had been admitted to the local hospice for inpatient respite care. Semi-structured interviews were conducted at two time points: pre- and post-respite. The Relative Stress Scale Inventory was administered at both interviews. RESULTS: Just over half of the sample were caring for a relative with a diagnosis of cancer (n=13); the majority of the others had a number of neurological conditions (n = 12). The data demonstrate that managing care for relatives with a life limiting illness was perceived to be hard work, both physically and mentally. Inpatient respite care was considered important as it enabled family carers to have a break from the ongoing care-giving responsibilities, as well as being an opportunity to experience 'normal life' independently. The majority of family carers felt that their expectations of respite for themselves had been achieved. The respite service was well evaluated in relation to: standard of nursing care; alternative facilities on offer, atmosphere; and other care homes. DISCUSSION: Currently, inpatient respite services are provided to two patient groups--those in the last year of life and those with a chronic life limiting illness. However, on closer analysis, the current model of service delivery, a two-week inpatient stay, may not be best suited to those caring for a relative in the last year of life. Similarly, it might be questioned whether an inpatient hospice is the most suitable setting for those patients needing supportive care, rather than specialist palliative care. The study has raised many issues that need to be considered in the support of carers caring for relatives with a life limiting illness with uncertain trajectories.

Adult↗
PubMed1997

Evaluating models of working at the interface between mental health services and primary care.

BACKGROUND: This paper examines the feasibility of evaluating innovative models of working at the interface between primary care and secondary mental health services. METHOD: Methodological problems relevant to evaluation of innovative models of working at the interface are discussed. RESULTS: Although there is some evidence that neurotic disorders can be more cost-effectively treated in primary care, many general practitioners (GPs), and possibly some patients, prefer referral to community mental health teams and community psychiatric nurses, which are provided by the secondary health care services. Since the latter are provided with the intention of improving serious mental illness their involvement in the care of neurotic illness can lead to tensions between GPs, local health authorities and service providers. There is little evidence to suggest that psychiatrists working in health centres using the 'shifted out-patient' model have eased this problem. By contrast the 'consultation-liaison' (C-L) model has a number of theoretical advantages; referrals to secondary care should be limited to those most in need of this level of expertise and GP management skills should improve, so leading to better quality of care for patients who are not referred. CONCLUSION: Studies comparing the different models of service delivery are required to address the tensions that have arisen following changes in government policy. Further work is also needed to develop the necessary research tools.

Ambulatory Care↗
PubMedDate not supplied

Living with sickle cell disease: the perspective of young people.

The study aimed to explore the lived experience of young people with sickle cell disease as they transferred to adult services. A cross-sectional study using semistructured questionnaires is described. Eleven young people (12-16 years) attending a sickle cell and thalassaemia centre as they approached transition from paediatric to adult services were successfully recruited to the study. Sickle cell disease was reported to interfere with various aspects of their 'normal' lives. Fatigue and pain were common symptoms. Reported adherence to prophylaxis was variable. It was concluded that young people with sickle cell disease require support drawing on a range of expertise and that the medical model of service delivery may not meet all their needs.

Adaptation, Psychological↗
PubMed1989

Alzheimer's disease support groups: an analysis of their structure, format and perceived benefits.

The focus of this article is the identification and assessment of the strengths and weaknesses of Alzheimer's disease support groups' predominant model of service delivery. Based on information from 47 support group leaders and 301 members, Alzheimer's disease support groups' structure, format, member composition and perceived benefits are examined. The data suggest that support groups have primarily focused on education and peer support and less attention has been directed towards caregivers' own emotional needs and the effects of the disease on the whole family system. Findings also revealed that families with relatives in the early disease stages are underrepresented in support groups. Practice implications of the findings are discussed.

Alzheimer Disease↗
PubMed1999

Itinerant teaching: the inside story.

The number of students who are deaf or hard of hearing attending local neighborhood schools has increased steadily over the past 20 years (Holden-Pitt & Diaz, 1998). This increase has led to larger numbers of teachers serving these students as itinerant teachers. However, little research has been conducted to examine the efficacy of this model of service delivery (Brelje, 1992; Luckner & Miller, 1994). Qualitative research methods were used to investigate itinerant teachers' perceptions of their responsibilities, job satisfaction, and effectiveness. Individual interviews were conducted with 10 itinerant teachers. Participants reported they preferred working directly with students rather than consulting with general education teachers and families. They noted the primary advantages of working as an itinerant teacher were variety, autonomy, time for reflection, and the diversity of students with whom they worked. Some of the most significant disadvantages they cited were isolation, time and budget constraints, and the distances required to travel from school to school. Essential skills and challenges to being an effective itinerant teacher are identified, recommendations for future itinerant teachers are discussed, and suggestions for future research are presented.

Adult↗
PubMed2006

Power and client-centred practice: an insider exploration of occupational therapists' experiences.

BACKGROUND: Although problems with power sharing are frequently described in discussions about client-centred practice, little research has explored occupational therapists' experiences with this model of service delivery. To critically examine this aspect of occupational therapy, an insider study was conducted. PURPOSE: The objectives of the study were to explore therapists' experiences with client-centred practice and to reveal how power works within this practice and in the health service environment. METHOD: Semi-structured interviews with 9 therapists were conducted, and a thematic analysis of these transcripts was completed. A variety of institutional documents were reviewed and analysed. RESULTS: Three main themes were identified: the different interpretations of occupational therapy discourse, the power of context, and the continuum of client-therapist interactions. CLINICAL IMPLICATIONS: It is important to consider the various competing discourses and institutional practices that frame the therapeutic relationship when evaluating methods to improve client-centred practice.

Adult↗
PubMed1995

A programme of intervention for substance abuse following traumatic brain injury.

This article describes a pilot programme initiated in 1991 to address the problems of substance abuse among persons who have experienced traumatic brain injury (TBI). The model of treatment is community-based, using an interdisciplinary staff with expertise in TBI, vocational rehabilitation, and substance abuse treatment, to support and enhance existing services in the client's own community. The primary method of intervention is resource and service coordination. Six principles that serve as the underpinnings of the model are described, as are core and supplemental services and staffing patterns. Innovative components of the programme include the theoretical model of changing addictive behaviours used to guide treatment, and the development of community teams to facilitate a coordinated and integrated approach. The programme has relatively low start-up costs and can serve both urban and rural populations. Clinical experience and initial programme evaluation results suggest that substance abuse and vocational rehabilitation goals can be effectively attained using this model of service delivery.

Brain Damage, Chronic↗
PubMed1997

Community-based care: back to the future!

Home- and community-based care are deeply rooted in the United States and worldwide. Public and private organizations have provided formal in-home and community health services for more than a century. Today they are an integral part of the care continuum, ranging from highly technical and professional services to simple forms of non-professional and voluntary support in homes. Because the roles and functions of community workers have expanded and diversified, organizations must successfully recruit, train and support workers with widely differing skills. In health care's new economic era, health has re-emerged as a community rather than individual concern. Non-traditional models of service delivery will be the cornerstone of community-based health care. Providers and policy-makers must find new ways to refocus from treating illness to achieving and maintaining health.

Community Health Services↗
PubMed1998

An audit tool for health visitors and SLTs working with the pre-school population.

This paper will present the preliminary findings of a national Royal College of Speech and Language Therapists audit of speech and language therapy and health visiting services to the pre-school population. The audit was carried out in six districts of the United Kingdom, representing a broad range of locations and models of service delivery. The purpose of the audit was to evaluate specific aspects of the management of children with speech and language difficulties. Audit tools were applied to referral and selection procedures, inservice training and parent programmes. Preliminary findings and their implications are discussed.

Child, Preschool↗
PubMed1998

An audit of clinical placements.

Clinical teaching of students is a requirement of the majority of practicing therapists in the UK and yet there is little guidance as to the nature of the placement which needs to be offered. As models of service delivery change, placements must change to prepare the student for working life whilst also meeting the need for solid foundation experiences. The audit reported here examined current placements including the physical setting, level of supervision provided and the responsibilities described by the professional body (Royal College of Speech and Language Therapists 1996) The results are discussed in the context of their implications for the educational establishment and the clinical teaching setting.

Humans↗
PubMed1998

The complexities embedded in family-centered care.

The recent movement toward family-centered care, which has been propelled by the implementation of the Education for All Handicapped Children Amendments of 1986, poses considerable challenges to professionals trained in client-centered models of service delivery. These challenges are compounded by the fact that our understanding of family-centered care lags considerably behind our attempts to implement responsive and efficacious services. When practitioners include family members more integrally as collaborators in pediatric treatment, their perceptions about families and the nature of the therapeutic experience is affected. In this article, we present a number of critical dilemmas that are based on data drawn from ethnographic research, descriptive studies, and training seminars we conducted with pediatric practitioners and parents of children with special health care needs. These dilemmas highlight the complexities involved in building effective partnerships among all the key players, the influence of multiple cultural worlds on everyday practices, and the need to provide supports to practitioners for the emotional and social dimensions of practice. Implications for practice and future research are presented.

Adolescent↗
PubMed2006

Stories of resistance and healing in the process of leaving abusive relationships.

This article examines the unexpected outcomes of a research project that explored the informal support needs of women leaving abusive relationships. The women not only identified informal supports, they also appreciated the time the research offered them to talk about the violent situations, as well as their healing journeys of leaving relationships to sustain their lives without violence. The women's healing journeys were complex and unstable and the feminist approach used in this research empowered participants to acknowledge their abuse, resist the effects of that abuse, and begin their journeys of recovery. The implications of the findings for best nursing practice and models of service delivery are provided.

Australia↗
PubMed2003

"A planning guide": Developing a consensus document for palliative care service provision.

Over the past 30 years, palliative care services have developed in an ad-hoc way in Australia and around the world. Community expectations for palliative care have grown in recent years. As palliative care has evolved, the World Health Organization definition of palliative care has changed substantially. The changes challenge those who are involved in planning, funding and provision of services to meet new expectations. Many services have not attracted adequate nursing, medical and allied health resources to provide interdisciplinary palliative care. A national consensus document ("a planning guide") has been developed in consultation with key stakeholders and organisations. It outlines the minimum needs for service provision, independent of fundholders and models of service delivery.

Australia↗
PubMedDate not supplied

Crime scene.

Nurses in Chichester are carving out new roles as forensic nurse practitioners (FNPs). Working closely with the police, they are making a significant contribution to the safety and welfare of detainees. The role of FNP attracts nurses from diverse disciplines. Nursing skills translate well to the need for accurate documentation. They work closely with forensic medical examiners. There are several models of service delivery around the UK.

Career Mobility↗
PubMed1997

Community-led services for mental health care: a study.

This paper reports findings from a study into the effects of relocating untrained personnel from the hospital into the community, over a nine-month period. The study measured the dependent variables of hospital admissions, length of stay, resultant cost savings and community caseloads. Non-significant decreases occurred in bed occupancy as well as increases in bed occupancy, more demanding community psychiatric nurse (CPN) caseloads and an increasing use of the community services by females. Future studies will need to distinguish the most appropriate models of service delivery in a community setting. The findings, verified nationally, have major ramifications for mental health nurses if they are to provide effective care to the seriously mentally ill patient.

Community Health Nursing↗