Journal of Integrated Care, 30(1), 2022, pp.42-51.
Publisher:
Emerald
Purpose: This study examined effectiveness of an integrated care program on emergency department visits within a longitudinal sample of patients with both primary care and behavioural health diagnoses. Design/methodology/approach: Patients with co-occurring disorders enrolled in an integrated care clinic and were followed over time to determine whether participation in the clinic, including engagement in wellness/peer services, predicted decreases in Emergency Department (ED) use. Associations between socio-demographic characteristics of patients and ED use were also analysed. Findings: After 6 months, clinic patients had decreases in ED use that continued for twelve months, albeit to a lesser degree. Demographics and program services were not related to ED use; however, multiple associations existed between high ED utilizers, severe mental illness (SMI), substance use disorders (SUD) and non-retention in services. Research limitations/implications: The study lacked a comparison group and there was no distinction between avoidable and unavoidable ED visits. A small sample size across time points led to inconclusive post hoc findings. Originality/value: This study explored effectiveness of primary care integration into a behavioural health clinic for persons with multiple morbidities. Although initial decreases in ED visits were present, results indicate that these models may not be effective for persons with SMI or SMI/SUD who are already high ED users. This study provides support for integrated care in reducing ED use among persons with multiple morbidities and calls for further research on designing effective integrated models for persons with SMI and SUD.
(Edited publisher abstract)
Purpose: This study examined effectiveness of an integrated care program on emergency department visits within a longitudinal sample of patients with both primary care and behavioural health diagnoses. Design/methodology/approach: Patients with co-occurring disorders enrolled in an integrated care clinic and were followed over time to determine whether participation in the clinic, including engagement in wellness/peer services, predicted decreases in Emergency Department (ED) use. Associations between socio-demographic characteristics of patients and ED use were also analysed. Findings: After 6 months, clinic patients had decreases in ED use that continued for twelve months, albeit to a lesser degree. Demographics and program services were not related to ED use; however, multiple associations existed between high ED utilizers, severe mental illness (SMI), substance use disorders (SUD) and non-retention in services. Research limitations/implications: The study lacked a comparison group and there was no distinction between avoidable and unavoidable ED visits. A small sample size across time points led to inconclusive post hoc findings. Originality/value: This study explored effectiveness of primary care integration into a behavioural health clinic for persons with multiple morbidities. Although initial decreases in ED visits were present, results indicate that these models may not be effective for persons with SMI or SMI/SUD who are already high ED users. This study provides support for integrated care in reducing ED use among persons with multiple morbidities and calls for further research on designing effective integrated models for persons with SMI and SUD.
(Edited publisher abstract)
Subject terms:
comorbidity, integrated care, evaluation, emergency health services, intervention, outcomes, primary care;
Online resource bringing together data and evidence about what works in removing health inequalities experienced by people living with mental illness. The resource sets out the scale of the problem and looks at some of the factors that drive health inequalities. It then outlines some of the actions that local areas can take to reduce health inequalities, so that people with mental illness can achieve the same health outcomes and life expectancy as the rest of the population. These include addressing the social factors and improving living and working conditions; building stronger communities and social connectors; early intervention; and improving access to services; and building a competent workforce. The resource is aimed at health and care professionals, local commissioners and system partners, including the community and voluntary sector. The focus is on adults with more severe and enduring mental health problems, but many of the actions will be of benefit to all people experiencing mental illness.
(Edited publisher abstract)
Online resource bringing together data and evidence about what works in removing health inequalities experienced by people living with mental illness. The resource sets out the scale of the problem and looks at some of the factors that drive health inequalities. It then outlines some of the actions that local areas can take to reduce health inequalities, so that people with mental illness can achieve the same health outcomes and life expectancy as the rest of the population. These include addressing the social factors and improving living and working conditions; building stronger communities and social connectors; early intervention; and improving access to services; and building a competent workforce. The resource is aimed at health and care professionals, local commissioners and system partners, including the community and voluntary sector. The focus is on adults with more severe and enduring mental health problems, but many of the actions will be of benefit to all people experiencing mental illness.
(Edited publisher abstract)
Subject terms:
severe mental health problems, comorbidity, health inequalities, prevention, intervention, mental health problems, health needs;
This report looks at trends in emergency admissions over the past decade and summarises evidence behind some of the interventions aimed at reducing them. It finds that one in three patients admitted to hospital in England as an emergency in 2015/16 had five or more health conditions. This is up from one in ten in 2006/07. It also identifies that patients arriving at A&E are now more likely to need admission and that hospitals are attempting to manage these pressures by shortening length of stay. The report highlights a lack of well-evidenced examples of interventions achieving sustained reductions in emergency admissions. Approaches that could have potential for reducing emergency admissions include: better patient access to primary care, improving care within social care settings such as care homes, and the level of informal social support available to individuals and people’s ability to manage their own health and health care.
(Edited publisher abstract)
This report looks at trends in emergency admissions over the past decade and summarises evidence behind some of the interventions aimed at reducing them. It finds that one in three patients admitted to hospital in England as an emergency in 2015/16 had five or more health conditions. This is up from one in ten in 2006/07. It also identifies that patients arriving at A&E are now more likely to need admission and that hospitals are attempting to manage these pressures by shortening length of stay. The report highlights a lack of well-evidenced examples of interventions achieving sustained reductions in emergency admissions. Approaches that could have potential for reducing emergency admissions include: better patient access to primary care, improving care within social care settings such as care homes, and the level of informal social support available to individuals and people’s ability to manage their own health and health care.
(Edited publisher abstract)
Subject terms:
hospital admission, emergency health services, prevention, intervention, complex needs, comorbidity;
... with people who are managing multiple health conditions in work. Evidence from the existing literature found a higher risk of comorbidity for specific groups, such as older workers, those from low socio-economic backgrounds and for women. Analysis of data from the Health Survey found that people with two or more long-term health conditions are: less likely to be in employment; are more likely to be doing
(Edited publisher abstract)
This report examines the effect of multiple long term conditions on employment and looks at ‘what works’ in terms of managing and supporting people to remain, and to be productive, in work. The report draws evidence from the literature, analysis of data from the Health Survey for England 2013 which covered people of working age with at least two long-term health conditions, and interviews with people who are managing multiple health conditions in work. Evidence from the existing literature found a higher risk of comorbidity for specific groups, such as older workers, those from low socio-economic backgrounds and for women. Analysis of data from the Health Survey found that people with two or more long-term health conditions are: less likely to be in employment; are more likely to be doing unskilled work; and likely to have lower levels of job satisfaction. Musculoskeletal disorders and mental health problems were also found to have a substantial impact on employment outcomes. In terms of support, the report found that adjustments by employers, such as changes in working hours or break patterns; support provided by GPs and Occupational Health Services were found to be helpful for staff retention. The report makes recommendations focused on improving the prevention, recognition and management of multiple long term conditions during working age, and particularly in the working population. These include recommendations for individuals, employers, the health sector and government.
(Edited publisher abstract)
Subject terms:
comorbidity, employment, health needs, long term conditions, mental health problems, physical illness, intervention;
MANCHESTER METROPOLITAN UNIVERSITY. Substance Use Open Education Resources team
Publisher:
Manchester Metropolitan University
Publication year:
2015
Place of publication:
Manchester
Website bringing together a range of open access educational resources on substance use for social care and health practitioners, educators and academics. Resources are grouped into three broad areas: Knowledge, Skills and how to help people living with problematic substance misuse. Topics covered include: co-morbidity and co-existing issues (including dual diagnosis, physical health problems and domestic violence); the effects of substance misuse; physical and psychological health risks, safeguarding, recovery and family support. The resources include a range of different media including slideshare presentations, film and audio clips from service users and professionals, animations, individual and group exercises, and practice scenarios to help apply learning. Resources also offer suggestions for future study and personal development. Topics included were identified by a range of experts including people from the community who use, or have problems with, substances; to academics who teach nurses and social care professionals; and health and social care practitioners themselves. The website has been developed by the Substance Use Open Education Resources team at Manchester Metropolitan University.
(Edited publisher abstract)
Website bringing together a range of open access educational resources on substance use for social care and health practitioners, educators and academics. Resources are grouped into three broad areas: Knowledge, Skills and how to help people living with problematic substance misuse. Topics covered include: co-morbidity and co-existing issues (including dual diagnosis, physical health problems and domestic violence); the effects of substance misuse; physical and psychological health risks, safeguarding, recovery and family support. The resources include a range of different media including slideshare presentations, film and audio clips from service users and professionals, animations, individual and group exercises, and practice scenarios to help apply learning. Resources also offer suggestions for future study and personal development. Topics included were identified by a range of experts including people from the community who use, or have problems with, substances; to academics who teach nurses and social care professionals; and health and social care practitioners themselves. The website has been developed by the Substance Use Open Education Resources team at Manchester Metropolitan University.
(Edited publisher abstract)
Subject terms:
substance misuse, drug misuse, alcohol misuse, comorbidity, dual diagnosis, intervention;
... collaborative depression care in a specialty physical health clinic setting with a population that has a high prevalence of depression and mental health comorbidity. The paper describes: the formative evaluation conducted prior to implementation; the process used to adapt the primary care collaborative care model for depression to specialty HIV clinics; and the intervention itself. Baseline assessments were
This paper describes the evaluation of collaborative depression care in HIV clinics in a project called HIV Translating Initiatives for Depression into Effective Solutions (HITIDES), a randomised trial in United States Department of Veterans Affairs HIV clinics comparing the depression collaborative care intervention to usual depression care. The HITIDES study provided the opportunity to evaluate collaborative depression care in a specialty physical health clinic setting with a population that has a high prevalence of depression and mental health comorbidity. The paper describes: the formative evaluation conducted prior to implementation; the process used to adapt the primary care collaborative care model for depression to specialty HIV clinics; and the intervention itself. Baseline assessments were completed by 249 depressed HIV participants. Summaries of key interviews with eight HIV patients who were receiving depression treatment and 25 HIV or mental health providers were presented to each site. Evidence-based quality improvement methods were used to tailor the HITIDES intervention to each site while following the evidence base for depression collaborative care.
Subject terms:
HIV AIDS, intervention, multidisciplinary services, depression, evaluation, health care, comorbidity;
British Journal of Forensic Practice, 12(1), February 2010, pp.33-37.
Publisher:
Emerald
This paper explores the high prevalence of patients with dual diagnosis, defined as having comorbid or co-occurring substance misuse with severe mental illness, in medium secure units in England. Examining the interventions accessible, and the outcome measurements used to evaluate treatment, this article highlights the challenges faced by medium secure units and proposes alternative measures such as measures of motivation, stages of change, beliefs, knowledge, group satisfaction, therapeutic alliance or coping strategies, which the authors suggest may prove more valuable in evaluating dual diagnosis interventions in medium secure units. In conclusion, further research is needed to study users who receive treatment and are discharged into the community, to determine whether these alternate measures are able to predict future levels of abstinence, re-hospitalisation or re-conviction rates.
This paper explores the high prevalence of patients with dual diagnosis, defined as having comorbid or co-occurring substance misuse with severe mental illness, in medium secure units in England. Examining the interventions accessible, and the outcome measurements used to evaluate treatment, this article highlights the challenges faced by medium secure units and proposes alternative measures such as measures of motivation, stages of change, beliefs, knowledge, group satisfaction, therapeutic alliance or coping strategies, which the authors suggest may prove more valuable in evaluating dual diagnosis interventions in medium secure units. In conclusion, further research is needed to study users who receive treatment and are discharged into the community, to determine whether these alternate measures are able to predict future levels of abstinence, re-hospitalisation or re-conviction rates.
Journal of Dual Diagnosis, 17(4), 2021, pp.333-343.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Objective: Economic evaluations of interventions for dual diagnosis patients are scarce. A recent randomized controlled trial has supported the effectiveness of the Self-wise, Otherwise, Streetwise (SOS) training to reduce victimization in dual diagnosis patients. The purpose of the current study was to analyse the cost-effectiveness and cost-utility of the SOS training as an add-on to care as usual (CAU). Methods: the researchers performed an economic evaluation from a societal perspective alongside the SOS trial. Participants were 250 dual diagnosis patients recruited at three locations from a large urban psychiatric service in the Netherlands. The main outcomes were treatment response for victimization and quality-adjusted life years (QALYs). Both costs and effects were measured across a 14-month follow-up. Results: There was no significant difference between CAU + SOS and CAU in total costs (mean difference €4,859; 95% CI [−€4,795 to €14,513]) and QALY gains (mean difference 0.0012; 95% CI [−0.05 to 0.05]). Significantly more participants in CAU + SOS achieved treatment response for victimization compared to CAU (68% vs. 54%; mean difference 0.14; 95% CI [0.02 to 0.26]). The cost-effectiveness analysis indicated an 83% likelihood that CAU + SOS resulted in a higher treatment response rate for victimization at higher costs compared to CAU. The cost-utility analysis indicated that adding SOS-training to CAU is probably not cost-effective at conventional willingness-to-pay levels for QALYs. Conclusions: At a societal willingness-to-pay of €38,000 or more per extra treatment responder, adding SOS-training to usual care is probably more attractive than usual care alone with regard to cost-effectiveness. This is a considerable willingness to pay. However, the direct costs of offering the SOS training are expected to be minor. Our findings should be interpreted with caution due to the short follow-up period and absence of data on potential reductions in police and judicial costs other than prison costs.
(Edited publisher abstract)
Objective: Economic evaluations of interventions for dual diagnosis patients are scarce. A recent randomized controlled trial has supported the effectiveness of the Self-wise, Otherwise, Streetwise (SOS) training to reduce victimization in dual diagnosis patients. The purpose of the current study was to analyse the cost-effectiveness and cost-utility of the SOS training as an add-on to care as usual (CAU). Methods: the researchers performed an economic evaluation from a societal perspective alongside the SOS trial. Participants were 250 dual diagnosis patients recruited at three locations from a large urban psychiatric service in the Netherlands. The main outcomes were treatment response for victimization and quality-adjusted life years (QALYs). Both costs and effects were measured across a 14-month follow-up. Results: There was no significant difference between CAU + SOS and CAU in total costs (mean difference €4,859; 95% CI [−€4,795 to €14,513]) and QALY gains (mean difference 0.0012; 95% CI [−0.05 to 0.05]). Significantly more participants in CAU + SOS achieved treatment response for victimization compared to CAU (68% vs. 54%; mean difference 0.14; 95% CI [0.02 to 0.26]). The cost-effectiveness analysis indicated an 83% likelihood that CAU + SOS resulted in a higher treatment response rate for victimization at higher costs compared to CAU. The cost-utility analysis indicated that adding SOS-training to CAU is probably not cost-effective at conventional willingness-to-pay levels for QALYs. Conclusions: At a societal willingness-to-pay of €38,000 or more per extra treatment responder, adding SOS-training to usual care is probably more attractive than usual care alone with regard to cost-effectiveness. This is a considerable willingness to pay. However, the direct costs of offering the SOS training are expected to be minor. Our findings should be interpreted with caution due to the short follow-up period and absence of data on potential reductions in police and judicial costs other than prison costs.
(Edited publisher abstract)
Journal of the Society for Social Work and Research, 12(3), 2021, pp.545-568.
Publisher:
Society for Social Work and Research
Objective: Solution-focused brief therapy (SFBT) has shown promise as an effective intervention with substance-abusing adults. This study expands on a preliminary study by Kim et al. (2018) by examining the results from the complete sample on substance abuse and trauma-related problems. Method: Child-welfare-involved parents were randomly assigned to either the SFBT (N = 90) or treatment-as-usual (N = 89) control group. Mixed linear models tested changes using intent-to-treat analysis, and effect sizes examined the magnitude of treatment effects. Results: Both the SFBT and control groups decreased on most of the Addiction Severity Index-SR (ASI-SR) measures and on all Trauma Symptom Checklist-40 (TSC-40) measures, indicating improvements. Between-group effect sizes favoured the control group for two ASI-SR subscales - medical status and drug use - and favoured SFBT for the TSC-40 subscale measures, although none was statistically significant except for the TSC-40 depression subscale. Conclusions: Further exploration of SFBT as an intervention to treat substance abuse and trauma among parents involved in the child welfare system is warranted.
(Edited publisher abstract)
Objective: Solution-focused brief therapy (SFBT) has shown promise as an effective intervention with substance-abusing adults. This study expands on a preliminary study by Kim et al. (2018) by examining the results from the complete sample on substance abuse and trauma-related problems. Method: Child-welfare-involved parents were randomly assigned to either the SFBT (N = 90) or treatment-as-usual (N = 89) control group. Mixed linear models tested changes using intent-to-treat analysis, and effect sizes examined the magnitude of treatment effects. Results: Both the SFBT and control groups decreased on most of the Addiction Severity Index-SR (ASI-SR) measures and on all Trauma Symptom Checklist-40 (TSC-40) measures, indicating improvements. Between-group effect sizes favoured the control group for two ASI-SR subscales - medical status and drug use - and favoured SFBT for the TSC-40 subscale measures, although none was statistically significant except for the TSC-40 depression subscale. Conclusions: Further exploration of SFBT as an intervention to treat substance abuse and trauma among parents involved in the child welfare system is warranted.
(Edited publisher abstract)
Journal of Social Work Practice in the Addictions, 21(4), 2021, pp.317-332.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
The Seven Challenges (7C) is a program for adults and adolescents with substance use disorders and co-occurring problems. The aim of this systematic review was to examine the methodological characteristics and substantive findings of studies evaluating the effectiveness of 7C. This study identified seven studies via searches of seven electronic databases. Our results suggest that 7C is associated with reduced substance use, decreased mental health-related problems, and reduced criminal behavior. However, further research is needed to determine whether 7C is superior to alternative interventions for substance misuse and to explore the efficacy of the 7C program among adult populations.
(Edited publisher abstract)
The Seven Challenges (7C) is a program for adults and adolescents with substance use disorders and co-occurring problems. The aim of this systematic review was to examine the methodological characteristics and substantive findings of studies evaluating the effectiveness of 7C. This study identified seven studies via searches of seven electronic databases. Our results suggest that 7C is associated with reduced substance use, decreased mental health-related problems, and reduced criminal behavior. However, further research is needed to determine whether 7C is superior to alternative interventions for substance misuse and to explore the efficacy of the 7C program among adult populations.
(Edited publisher abstract)
Subject terms:
systematic reviews, intervention, evaluation, substance misuse, young people, addiction, comorbidity, mental health problems;