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A culture of enquiry: research evidence and the therapeutic community
- Editor:
- LEES Jan
- Publisher:
- Jessica Kingsley
- Publication year:
- 2004
- Pagination:
- 336p.,bibliogs.
- Place of publication:
- London
Research is an increasing priority for workers throughout the mental health sector, and therapeutic communities are no exception. Those working in TCs increasingly have to justify the success and efficiency of their methods to outside bodies, and the prime means of doing so is through research. This volume collects a wide range of papers by contributors discussing all aspects of TC research. They consider questions of which methods are most appropriate in the unique environment of TCs, how research studies affect the TC environment, as well as practical and ethical questions. The book also includes accounts of several research studies undertaken at, among other places, the Cassel Hospital.
The usefulness of aggregate routine clinical outcomes data: The example of HoNOS65+
- Author:
- McDONALD Alastair J. D.
- Journal article citation:
- Journal of Mental Health, 11(6), December 2002, pp.645-656.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
There is increasing interest in whether observational data can usefully supplement, enhance, or even replace clinical trials evidence for the efficacy of interventions. To an understanding of the practical and cultural changes necessary for this in psychiatry must be added appreciation of the importance of feedback of appropriately analysed aggregated outcomes data to clinicians. This article describes the development of methods of analysis of routine clinical outcomes data (using ICD10, HoNOS65+ and a developing intervention coding system) in an old age psychiatry service in South London. The minimum dataset necessary, the construction of a database and some core analyses are described.
Commentary: the challenge of nonexperimental interventions studies in social work
- Author:
- SCHILLING Robert
- Journal article citation:
- Research on Social Work Practice, 20(5), September 2010, pp.550-552.
- Publisher:
- Sage
This commentary reviews two articles from Watson and from Kubiak et al. in this special issue of this journal. The challenging context of social work interventions require that most intervention studies will be derived from nonexperimental research designs. These two evaluation studies employed nonrandomised designs to examine the efficacy of two programmes, a police crisis intervention team designed to enhance officers’ responses to mental health crisis and a programme for pregnant incarcerated women. Each of these studies is a laudable effort to examine important intervention outcomes in insular settings. The design and execution problems explicated in both studies are familiar to researchers who venture into such practice arenas. Disappointing outcomes, as in these two studies, can sometimes be attributed to the problems of nonequivalent comparison designs or to unanticipated events. Intervention researchers must also recognise that programmes often fail to demonstrate differences and can even result in adverse outcomes.
Comparison of methods for analyzing longitudinal binary outcomes: cognitive status as an example
- Authors:
- KUCHIBHATLA M., FILLENBAUM G. G.
- Journal article citation:
- Aging and Mental Health, 7(6), November 2003, pp.403-408.
- Publisher:
- Taylor and Francis
Longitudinal data generate correlated observations. Ignoring correlation can lead to incorrect estimation of standard errors, resulting in incorrect inferences of parameters. In the example used here, standard logistic regression, a population-averaged (PA) model fit using generalized estimating equations (GEE), and random-intercept models are used to model binary outcomes at baseline, three and six years later. The outcomes indicate cognitive impairment versus no cognitive impairment in a sample of community dwelling elders. The models include both time-invariant (age, gender) and time-varying (time, interactions with time) covariates. The absolute estimates from random-intercept models are larger than those of both standard logistic and GEE models. Compared to the model fit using GEE that accounts for time dependency, standard logistic regression models overestimate standard errors of time-varying covariates (such as time, and time by problems with activities of daily living), and underestimate the standard errors of time-invariant covariates (such as age and gender). The standard errors from the random-intercept model are larger than those from logistic regression and GEE models. The choice of models, GEE or random-intercept, depends on the research question and the nature of the covariates. Population-averaged methods are appropriate when between-subjects effects are of interest, and random-effects are useful when subject-specific effects are important.
Evidence based mental health policy: a critical appraisal
- Author:
- COOPER Brian
- Journal article citation:
- British Journal of Psychiatry, 183(8), August 2003, pp.105-113.
- Publisher:
- Cambridge University Press
Arguments for and against evidence-based psychiatry have mostly centred on its value for clinical practice and teaching. Now, however, use of the same paradigm in evaluating health care has generated new problems. The aim of this article is to outline the development of evidence-based health care; to summarise the main critiques of this approach; to review the evidence now being employed to evaluate mental health care; and to consider how the evidence base might be improved. The following sources were monitored: publications on evidence-based psychiatry and health care since 1990; reports of randomised trials and meta-analytic reviews to the end of 2002; and official British publications on mental health policy. Although evidence-based health care is now being promulgated as a rational basis for mental health planning in Britain, its contributions to service evaluation have been distinctly modest. Only 10% of clinical trials and meta-analyses have been focused on effectiveness of services, and many reviews proved inconclusive. The current evidence-based approach is overly reliant on meta-analytic reviews, and is more applicable to specific treatments than to the care agencies that control their delivery. A much broader evidence base is called for, extending to studies in primary health care and the evaluation of preventive techniques.
Standardised risk assessment: why all the fuss?
- Author:
- MADEN Anthony
- Journal article citation:
- Psychiatric Bulletin, 27(6), June 2003, pp.201-204.
- Publisher:
- Royal College of Psychiatrists
Standardised or actuarial risk assessment is not an alternative to clinical skills, but it should be used to improve clinical practice. The extent to which it will be useful depends on the context. In general psychiatry, most services will want a minimum data set, amounting to a simple, structured assessment to inform care planning.
Risk assessment: 'numbers' and 'values'
- Author:
- SZMUKLER George
- Journal article citation:
- Psychiatric Bulletin, 27(6), June 2003, pp.205-207.
- Publisher:
- Royal College of Psychiatrists
Risk assessment has two components, which may be termed 'numbers' and 'values'. 'Numbers' refer to the estimation of the likelihood that an adverse event will occur in a stated period of time. The methods are mathematical and statistical. 'Values' refer to the processes of attaching a value to the risk and deciding what should be done about it. Benefits are weighed against costs in what is largely a moral enterprise.
How are you? Further development of a generic quality of life outcome measure
- Authors:
- CLIFFORD Paul I., et al
- Journal article citation:
- Journal of Mental Health, 11(4), August 2002, pp.389-404.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
The methods described in the 'How Are You?' measures are designed to meet the need for a broad-based self-report tool that integrates the recording of health and social problems and the measurement of quality of life outcomes within routine practice. This article describes the process of revising the original How Are You? Utilizing a series of factor analyses, we hoped to confirm that items that were theoretically coherent aggregated empirically, with the goal of refining the measure for outcome analyses and comparisons with other outcomes measures. Based upon data from both the USA and the UK, the factor analyses confirmed the How Are You? theoretical structure and identified a new factor, referred to as 'Risk' that measures emotional dyscontrol and symptoms that can be associated with psychosis. The advantages of the refined scale include shorter length, a broad set of quality of life domains and the instruction to the respondent to identify key problems that are of most concern. The revisions will allow for a more valid assessment of outcome.
Measuring the impact of supporting people: a scoping review
- Author:
- PLEACE Nicholas
- Publisher:
- Welsh Government Social Research
- Publication year:
- 2013
- Pagination:
- 63
- Place of publication:
- Merthyr Tydfil
The Aylward Review of Supporting People (Welsh Assembly Government, 2010) recommended that outcomes measurement and monitoring of Supporting People projects in Wales be reviewed. This scoping study was designed to inform a national level ‘main evaluation’ of Supporting People project outcomes. It was commissioned to provide an overview of the nature and extent of Supporting People projects, and to scope the options for the commissioning of a large scale research project to evaluate the impact of the Supporting People programme. The scoping study used four methods. First, a rapid evidence assessment of existing studies of Supporting People projects and evaluations of the effectiveness and costs of Supporting People conducted throughout the UK. Second, an exercise designed to understand the nature and extent of Supporting People project provision at national level. Third, an online survey of service providers to gain an overview of the people using Supporting People projects (as at 30th April 2012) and to understand current data collection by service providers. Lastly, consultation with service providers and key agencies on data collection and providing and collecting information on service users (via a single focus group conducted in Cardiff). This report reviews the data collected on the extent and nature of Supporting People project provision, also the data collected on the characteristics of service users. It considers both the findings and the lessons from the attempt to collect data on services and services for the design of the main evaluation. It reviews existing data collection and outcomes monitoring by service providers; and considers the implications of patterns of existing data collection for the main evaluation. It reviews existing attempts to monitor Supporting People project and programme outcomes; and considers good practice in evaluation and how this should be drawn upon for the main evaluation. It concludes by discussing possible approaches for the main evaluation. (Edited publisher abstract)
An assessment of outcomes in outdoor behavioural healthcare treatment
- Author:
- RUSSELL Keith
- Journal article citation:
- Child and Youth Care Forum, 32(6), December 2003, pp.355-381.
- Publisher:
- Springer
Outdoor behavioural healthcare (OBH) is an emerging treatment that utilizes wilderness therapy to help adolescents struggling with behavioural and emotional problems. The approach involves immersion in wilderness or comparable lands, group living with wilderness leaders and peers, and individual and group therapy sessions facilitated by licensed therapists in the field. OBH also offers educational and psychoeducational curriculum all designed to reveal and address problem behaviors, foster personal and social responsibility, and enhance the emotional growth of clients. The extant studies on the effectiveness of OBH and wilderness therapy reveal consistent lack of theoretical basis, methodological shortcomings and results that are difficult to replicate. This publication reports the results of an outcome assessment for adolescent clients who received treatment in seven participating OBH programmes programs that averaged 45 days in length from May 1, 2000 to December 1, 2000. Adolescent client well-being was evaluated utilizing the Youth Outcome Questionnaire (Y-OQ) and the Self Report-Youth Outcome Questionnaire (SR Y-OQ) (Burlingame, Wells, & Lambert, 1995). Complete data sets at admission and discharge were collected for 523 client self-report and 372 parent assessments. Results indicated that at admission clients exhibited presenting symptoms similar to inpatient samples, which were on average significantly reduced at discharge. Follow-up assessments using a random sample of clients found that on average, outcomes had been maintained at 12-months posttreatment.