Introducing the New England 4G framework of guided self-health for people in rural areas with physical and psychological conditions
The New England Framework, based on 50 years combined clinical practice, has been recently consolidated as an adaptation of the United Kingdom's 'Improving Access to Psychological Therapies' to include physical conditions. Founded on a collaborative approach in helping, health workers assist individuals to select and use self-administered cognitive and behaviourally based (CB) interventions specific to health problems. Heart disease and depression are the leading causes of disability worldwide. Obesity, diabetes, renal disease, respiratory conditions, chronic pain and addictions constitute another large percentage of suffering. Cognitive behavioural therapy (CBT) is the most effective non-pharmacological evidence-based treatment for most of all mental disorders and a wide range of physical health conditions. While CBT was originally developed as a self management tool to help reduce the negative impact that particular thinking and behaving patterns have on health, it evolved into a specific domain practice of professionals. Because of this, access to CBT has been impeded because of lack of available help, cost of treatment and time required - issues compounded for rural populations. With the rapid expansion of freely available online, virtual and print-based CBT, the value of self-directed minimal-assisted first-line treatments has been established.
Increasing confidence of emergency department staff in responding to mental health issues: An educational initiative
Introduction: This paper reports on one major finding of an educational initiative aimed at improving the care of persons presenting to emergency departments (EDs) with mental health issues. This goal, to improve care, was based on the premise that enhanced knowledge and skills of ED staff in mental health, including drug and alcohol issues, would result in increased confidence and competence of staff. The outcome of this would be that they could provide more effective and efficient service and thus better facilitate triage of persons with these problems. Objective: To increase the confidence of staff in working with increasing numbers of mental health presentations in EDs. Methods: Pre and post Emergency Mental Health Alcohol and Other Drugs (EMHAD) course questionnaires assessed self-ratings of clinical confidence in working with people with mental health issues. Follow-up interviews assessed if new found confidence in mental health had been integrated into daily ED practice. Results: Self ratings of clinical confidence, including knowledge and skills, showed a significant improvement on all questions following the course. Responses to the follow-up interviews suggest that participants in the course had retained and integrated information into practice. This was especially evident in their ability to talk to people about mental health problems and to triage more appropriately. Conclusion: Since attending the course staff feel more confident and competent to deal with mental health, including alcohol and other drug presentations, in the emergency department.
Background for the Development of the New England 4G Framework of Guided Self-Health for People in Rural Areas with Physical and Psychological Conditions
In this paper we describe the development of the New England 4G Framework of Guided Self-health including rural health and workforce issues, models of care, and the United Kingdom's (UK) 'Improving Access to Psychological Therapies' (IAPT) initiative from which the Framework was derived. With a long history in the UK of CBT delivery by workforces such as mental health nurses, we have adapted the IAPT model to fit rural environments of Australia and included physical as well as mental health conditions as part of a low intensity approach to helping. Health workers in the New England Framework assist individuals to select and use self-administered cognitive and behaviorally-based (CB) interventions specific to health problems. The worker in the New England Framework goes beyond dispensing health information or brokering services and guides the person to identify a specific problem and make change. The framework includes information gathering information, generating a CB plan, giving self-health materials and guiding with follow-up.
The South East Essex model for Integrated COPD care: A collaborative scheme involving PCT, Hospital, Community Service, General Practice, University and Breathe Easy
South East Essex PCT has commissioned an integrated COPD service. At the core is the philosophy of patient centered care to achieve high quality care, equality of care for all patients with COPD, ease of access so patients receive the appropriate care, producing an educational programme which ensures a sustainable service, improved patient information and patient involvement. The aims are also to reduce hospital follow up attendances and hospital admissions. This service has been planned through the local COPD network group where all stakeholders are involved. It was agreed that the Respiratory Consultants would provide clinical leadership for the whole COPD service across boundaries. The network has developed guidelines for managing COPD, a self-management plan and patient pathway. The agreed patient pathway is particularly important in developing the philosophy of the service. A manager has taken on the role of Project manager. The job plans of the Respiratory Consultants have changed and they have started doing clinics in the community. Two thirds of the clinics are conventional and the other thirds are multidisciplinary clinics where staff (usually Community Matrons) bring cases to be discussed without the patients having to attend. This arrangement is outside of tariff and operates through a contract variation. Both these initiatives have moved care closer to home. Community Matrons see many of the patients with severe COPD at home, protocols have been agreed as to whether patients remain on the active case load. Integrated services include the hospital at home service. This is both a prevention of admission and early discharge scheme service.
A Process Evaluation of a Self-Exclusion Program: A Qualitative Investigation from the Perspective of Excluders and Non-Excluders
This paper draws on a process evaluation of Queensland' self-exclusion program to examine how people use the program, motivations for self-excluding, barriers to use, experiences and perceptions of program elements, and potential improvements. Detailed, reflective, first-person accounts were gathered through interviews with 103 problem gamblers, including excluders and non-excluders. Identified strengths include the program's widespread availability. Many self-excluders reported positive experiences with responsive, knowledgeable, respectful venue staff. Major weaknesses include low publicity, limited privacy and confidentiality, the need to exclude individually from venues, and deficiencies in venue monitoring for breaches, which hinder the program's capacity to meet harm minimisation objectives. While the program reaches some problem gamblers, others are delayed or deterred from self-excluding by low awareness, shame and embarrassment, difficulties of excluding from multiple venues, and low confidence in venue staff to maintain confidentiality and provide effective monitoring. Potential improvements include wider publicity, off-site multi-venue exclusion, and technology-assisted monitoring.
Final report: Mental Health Needs in Clacton, Part of the Tendring Region of Essex
There is a clear link between levels of social deprivation, health inequalities and corresponding increases in mental health problems (Acheson 1998). In this context, key specific areas in Tendring stand out as experiencing high levels of deprivation in one form or another. In calculating area level deprivation, the Index of Multiple Deprivation (IMD) is the main indicator of deprivation. The most recent assessment of these indices was completed in 2007. However, many reports still draw on the previous index, which was compiled in 2004 (see, for example, the Joint Strategic Needs Assessment (JSNA) - Tendring Profile 2008). This report will draw from the most recent available data whenever possible, but will also draw from older data when necessary.
The Effectiveness of Gambling Exclusion Programs in Queensland
This study assessed the effectiveness of Queensland gambling exclusion programs as a mechanism to minimise gambling-related harm, whether these effects are sustained over time and whether self exclusion is more effective when combined with counselling and support. Research methods comprised a literature review, desktop review of Australian and international exclusion programs, interviews with peak gambling industry associations, interviews with 18 Queensland Gambling Help counsellors, and interviews and surveys with 103 problem gamblers at three assessment periods approximately six months apart. In contrast to recent international trends, Australian self-exclusion programs including those in Queensland are typically venue-administered, require on-site exclusion from individual venues, do not enable exclusion from multiple venues in one application, rely on photographs for detection, impose penalties for excluders for breaches and for venues that fail to detect breaches, and provide comparatively minimal connections to counselling.
Measurement Issues in Problem Gambling: Inclusion of a Gambling Specific Psychopathology Measure, the Gambling Impact Scale (GIS)
Problem gambling is becoming an increasing issue throughout the world with greater numbers of people presenting to treatment services with gambling problems. However, many cases are still missed, due in part, to a lack of general screening tools that are able to be used by non-specialist gambling services. This paper presents the findings of a gambling screening tool (Gambling Impact Scale - GIS) which was designed to identify problem gambling behavior, associated psychopathology and impact to self and others. The principle aim was to devise a tool that could be used by all potential treatment agencies that may come into contact with people experiencing problems with their gambling. The Gambling Impact Scale (GIS) consists of three sub-scales. Both internal and concurrent validity of the tool have been established with a help seeking gambling population. Discussed are further refinements of the GIS in general mental health and counseling populations.