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Objections to routine clinical outcomes measurement in mental health services: any evidence so far?
- Authors:
- MACDONALD Alastair J. D., TRAUER Tom
- Journal article citation:
- Journal of Mental Health, 19(6), December 2010, pp.517-522.
- Publisher:
- Taylor and Francis
- Place of publication:
- London
Routine clinical outcomes measurement (RCOM) is gaining importance in mental health services. Warnings about RCOM, particularly relating to selection, attrition and detection bias, were published when RCOM was at an early stage of development. The aim of this study was to examine whether these criticisms still apply by looking at data from a recent RCOM programme. An observational study in an old age psychiatric service in a SE London NHS Trust examined routine ratings using HoNOS65+ at admission and again at discharge from 1997 to 2008. Testable hypotheses were generated from each criticism amenable to empirical examination. Inter-rater reliability estimates were applied to observed differences between scores between community and ward patients using resampling. A total of 5,180 community inceptions and 862 admissions had HoNOS65+ ratings at admission and discharge. Analysis of these found no evidence of gaming (artificially worse scores at inception and better at discharge), selection, attrition or detection bias, and ratings were consistent with diagnosis and level of service. Anticipated low levels of inter-rater reliability did not vitiate differences between levels of service. The article concludes that no evidence of the alleged biases was found, and that RCOM seems valid and practical in mental health services.
Evaluating an education project in mental health of older people
- Author:
- BUTLER Rose
- Journal article citation:
- Nursing Times, 31.8.04, 2004, pp.38-40.
- Publisher:
- Nursing Times
Describes the development and evaluation of an education and training pathway for older people's mental health aiming to increase the knowledge and skills of non-specialist NHS-registered and support staff working on acute wards for older people. Concludes the workshops were successful because learning outcomes appear to have been achieved. Summarises factors affecting success and makes recommendations to improve training.
The challenge of evaluating mental health services for older people
- Authors:
- McCRAE Niall, BANERJEE Sube
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(6), June 2011, pp.551-557.
- Publisher:
- Wiley
Despite a consensus on the need to expand service capacity and function in mental health care for older people, evidence on models of service development is limited. The authors suggest that while clinicians move towards evidence-based practice, health service management and commissioning tends to continue to be driven by political expediency. In attempting to answer the question “Does it work?” it is necessary to remember that programmes do not work; people make them work. Evaluators need to look beyond the formal aspects of the programme and understand change from each participant’s perspective. Mixed methods were applied to evaluating two developments in mental health services for older people run by the South London and Maudsley NHS Foundation Trust: Improving Quality of Care for Older People in Lambeth, and Croydon Memory Service. Drawing on these two case studies, the authors consider how evaluation of service innovations can inform policy and practice. They suggest that combining formative and summative methodology improves the contribution of evaluation of service development to the evidence base and that the realist evaluation model is useful in generating theory from complex interventions in a unique context. It is concluded that evaluation should involve both measurement and meaning when judging the value of an intervention.
Evaluating mental health services for older people
- Author:
- FINCH Jenny
- Publisher:
- Radcliffe
- Publication year:
- 2004
- Pagination:
- 212p.,bibliog.
- Place of publication:
- Oxford
This book provides an account of the current developments in mental health services for older people and describes a robust model for evaluating health and social care to improve these services. Drawing on international experience, it provides accounts of the development of mental health services for older people in the UK, Europe, the USA, Canada and Australia. The approaches to evaluating health and social care in these countries are all outlined, and a comparative analysis is given. The services currently offered are patchy, so there is a pressing need for effective mechanisms to be introduced in order to monitor quality.
Editorial: psychiatric services for elderly people: evaluating system performance
- Journal article citation:
- International Journal of Geriatric Psychiatry, 9(4), 1994, pp.259-272.
- Publisher:
- Wiley
Aims to clarify some of the concepts and terminology of health system evaluation; to draw on published literature to exemplify these concepts; and to discuss some of the implications of routinely evaluating a system rather than scientifically evaluating particular interventions or programmes. Concludes by arguing that the evaluation of psychiatric services for elderly persons is best achieved by the construction of relatively simple models from an array of complex knowledge.
The development and implementation of a peer support model for a specialist mental health service for older people: lessons learned
- Authors:
- COATES Dominiek, LIVERMORE Patrick, GREEN Raichel
- Journal article citation:
- Mental Health Review Journal, 23(2), 2018, pp.73-85.
- Publisher:
- Emerald
Purpose: There has been a significant growth in the employment of peer workers over the past decade in youth and adult mental health settings. Peer work in mental health services for older people is less developed, and there are no existing peer work models for specialist mental health services for older people in Australia. The authors developed and implemented a peer work model for older consumers and carers of a specialist mental health service. The purpose of this paper is to describe the model, outline the implementation barriers experienced and lesson learned and comment on the acceptability of the model from the perspective of stakeholders. Design/methodology/approach: To ensure the development of the peer work model met the needs of key stakeholders, the authors adopted an evaluation process that occurred alongside the development of the model, informed by action research principles. To identify stakeholder preferences, implementation barriers and potential solutions, and gain insight into the acceptability and perceived effectiveness of the model, a range of methods were used, including focus groups with the peer workers, clinicians and steering committee, consumer and carer surveys, field notes and examination of project documentation. Findings: While the model was overall well received by stakeholders, the authors experienced a range of challenges and implementation barriers, in particular around governance, integrating the model into existing systems, and initial resistance to peer work from clinical staff. Originality/value: Older peer workers provide a valuable contribution to the mental health sector through the unique combination of lived experience and ageing. The authors recommend that models of care are developed prior to implementation so that there is clarity around governance, management, reporting lines and management of confidentiality issues. (Edited publisher abstract)
Falls prevention in hospitals and mental health units: an extended evaluation of the FallSafe quality improvement project
- Authors:
- HEALEY Frances, et al
- Journal article citation:
- Age and Ageing, 43(4), 2014, pp.484-491.
- Publisher:
- Oxford University Press
Background: Inpatient falls are a major patient safety issue causing distress, injury and death. Systematic review suggests multifactorial assessment and intervention can reduce falls by 20–30%, but large-scale studies of implementation are few. This paper describes an extended evaluation of the FallSafe quality improvement project, which presented key components of multifactorial assessment and intervention as a care bundle. Methods: Data on delivery of falls prevention processes were collected at baseline and for 18 months from nine FallSafe units and nine control units. Data on falls were collected from local risk management systems for 24 months, and data on under-reporting through staff surveys. Results: In FallSafe units, delivery of seven care bundle components significantly improved; most improvements were sustained after active project support was withdrawn. Twelve-month moving average of reported fall rates showed a consistent downward trend in FallSafe units but not controls. Significant reductions in reported fall rate were found in FallSafe units (adjusted rate ratio (ARR) 0.75, 95% confidence interval (CI) 0.68–0.84 P < 0.001) in the 12 months following full implementation but not in control units (ARR 0.91, 95% CI 0.81–1.03 P = 0.13). No significant changes in injurious fall rate were found in FallSafe units (ARR 0.86, 95% CI 0.71–1.03 P = 0.11), or controls (ARR 0.88, 95% CI 0.72–1.08 P = 0.13). In FallSafe units, staff certain falls had been reported increased from 60 to 77%. Conclusion: Introducing evidence-based care bundles of multifactorial assessment and intervention using a quality improvement approach resulted in improved delivery of multifactorial assessment and intervention and significant reductions in fall rates, but not in injurious fall rates. (Publisher abstract)
Dealing with distrust and power dynamics: asymmetric relations among stakeholders in responsive evaluation
- Authors:
- BAUR Vivianne E., et al
- Journal article citation:
- Evaluation, 16(3), July 2010, pp.233-248.
- Publisher:
- Sage
Asymmetric relations among stakeholders create challenges in participatory evaluation processes. The aim of responsive evaluation is to include the issues of as many stakeholder groups as possible in the evaluation by engaging them in evaluative interaction. However, power and conflict may hinder equal and genuine communication about the value of the practices evaluated. This article discusses the use of a specific interpretation of responsive evaluation as an approach to foster dialogues among stakeholders in politically laden contexts. It aims to illustrate how asymmetric relations can be dealt with constructively, focusing on inclusion of marginalised groups, mutual learning and good dialogue. The article uses two reflective case narratives, conducted in a residential elderly care setting and in a psychiatric hospital, as examples of responsive evaluation projects in settings with marginalised groups. These case studies illustrate the changing, active roles of responsive evaluators. Both evaluation settings shed light on how to go about making social relations among stakeholders and the evaluator ‘the point’ in evaluation, and how to exploit these relations constructively in order to establish practice improvements.
Integrating mental health services for older people in England - from rhetoric to reality
- Authors:
- TUCKER Sue, et al
- Journal article citation:
- Journal of Interprofessional Care, 23(4), July 2009, pp.341-354.
- Publisher:
- Taylor and Francis
The provision of integrated, person-centred care is particularly important for older people with mental health problems. Nevertheless, a series of reports at the end of the last century highlighted unacceptable differences in collaborative working practices in England, variations that a national service framework specifically aimed to address. This study utilised a cross-sectional survey of old age psychiatrists to explore the extent to which, some three years after the publication of this guidance, structures to deliver integrated care across the interfaces between specialist old age mental health and primary, acute and social care services were in place. Three hundred and eighteen (72%) consultants responded. Measures to facilitate integrated practice were generally poorly developed: many areas missed targets to agree protocols for the management of older people with mental health problems with primary care; more than 45% of respondents reported the presence of fewer than two of four indicators of integration with the acute sector; and approaching 30% of respondents reported the presence of fewer than four of 13 markers of integration with social care. The implications of these findings and the challenges inherent in providing integrated care for this client group are discussed.
Are the Health of the nation outcome scales (HoNOS) useful for measuring outcomes in older people's mental health services?
- Author:
- TURNER S.
- Journal article citation:
- Aging and Mental Health, 8(5), September 2004, pp.387-396.
- Publisher:
- Taylor and Francis
The Health of the Nation Outcome Scales (HoNOS) were developed to provide a single index in order to enable the government target 'to improve significantly the health and social functioning of mentally ill people' to be quantified. They were intended to be applicable to all adults (including older people), across a wide range of settings so that services in different localities could be compared and changes both within individuals and within services could be measured. In 1999 the HoNOS65+ was launched with a modified glossary for older people. The HoNOS has been formally adopted as the preferred outcome measure for adults of working age. There has been no such formal adoption of the HoNOS65+, or any other outcome measure, for mental health services for older people. This review summarises how the HoNOS was originally developed and validated. Studies with older people, which have used both the original definitions and those developed for the HoNOS65+ are reviewed focusing on data on the reliability and validity of the HoNOS and HoNOS65+ with older people. Finally the question of whether the HoNOS or HoNOS65+ is suitable as an outcome measure in routine clinical practice in services for older people is addressed.