Dataset Information

Re-imagining crisis care: experiences of delivering and receiving the Assured brief psychological intervention for people presenting to Emergency Departments with self-harm.

ABSTRACT:

Background

Risk of suicide is increased immediately following emergency department (ED) attendance for self-harm. Evidence suggests that brief psychological interventions delivered in EDs are effective for self-harm. The Assured intervention comprises an enhanced biopsychosocial assessment in the ED, collaborative safety planning and three rapid solution focused follow-up sessions.

Aim

We addressed the following research questions: What were ED mental health liaison practitioners' and patients' experiences of the Assured intervention? What were the barriers and facilitators? What might the mechanisms be for improving experiences and outcomes?

Methods

We conducted a feasibility study of the Assured intervention in four EDs in Southeast England. Semi-structured interviews were conducted with 13 practitioners and 27 patients. Interviews were transcribed, coded line-by-line in Nvivo and thematically analysed using an inductive approach. Inter-rater reliability was calculated with a kappa coefficient of 0.744.

SUBMITTER: Shah N

PROVIDER: S-EPMC11004764 | biostudies-literature | 2024

REPOSITORIES: biostudies-literature

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Publications

Re-imagining crisis care: experiences of delivering and receiving the Assured brief psychological intervention for people presenting to Emergency Departments with self-harm.

Shah Neha N O'Keeffe Sally S Hayward Sam S Suzuki Mimi M McCabe Rose R

Frontiers in psychiatry 20240326

<h4>Background</h4>Risk of suicide is increased immediately following emergency department (ED) attendance for self-harm. Evidence suggests that brief psychological interventions delivered in EDs are effective for self-harm. The Assured intervention comprises an enhanced biopsychosocial assessment in the ED, collaborative safety planning and three rapid solution focused follow-up sessions.<h4>Aim</h4>We addressed the following research questions: What were ED mental health liaison practitioners' ...[more]

PMID: 38600980

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Project description:BackgroundPatients presenting to emergency departments (EDs) following an episode of self-harm are at risk of future suicide. There are few evidence-based interventions for self-harm in the ED context in England. This study sought to assess the feasibility of a trial of a newly developed brief psychological intervention, the Assured approach. This approach consisted of an enhanced psychosocial assessment, collaborative safety planning and three rapid solution-focussed follow-up sessions. Phase 1 was a feasibility study, and phase 2 was an internal pilot trial of a cluster randomised controlled trial to assess whether progression to a full-scale trial was warranted.MethodsIn phase 1, patients were recruited and allocated to a study arm, the Assured arm or treatment as usual, depending on the allocation of their assessing practitioner, in four EDs in England. They were invited to research assessments after consent and at 6 months. Phase 2 was the internal pilot of a cluster randomised controlled trial conducted in six EDs in England. Practitioners were randomised to deliver the Assured approach or treatment as usual. Patients were recruited and allocated to a study arm depending on the allocation of their assessing practitioner. They were invited to complete research assessments after consent and at 3, 9 and 18 months.ResultsSixty-one patients were recruited into the Assured (n = 46) and treatment as usual (n = 15) arms in phase 1. Findings showed we could recruit and follow up patients over a 6-month period. The research procedures were acceptable to patients and practitioners, and the intervention was delivered with acceptable fidelity to the intervention manual. Forty-seven patients were recruited into the phase 2 internal pilot trial, falling substantially short of our target of 491 in the stop-go criteria, indicating that the trial was not feasible in its current design.ConclusionThe feasibility study indicated that both the intervention and research processes were acceptable. However, the internal pilot trial revealed substantial challenges in recruiting patients and delivering the intervention in the ED context. Adaptations to the trial design and intervention are proposed to enable the Assured approach to be tested in a future trial, to improve care for this underserved population.Trial registrationISRCTN16003313, 04/02/2020; ISRCTN13472559, 18/11/2021.

Project description:ImportanceMedical treatment settings such as emergency departments (EDs) present important opportunities to address problematic substance use. Currently, EDs do not typically intervene beyond acute medical stabilization.ObjectiveTo contrast the effects of a brief intervention with telephone boosters (BI-B) with those of screening, assessment, and referral to treatment (SAR) and minimal screening only (MSO) among drug-using ED patients.Design, setting, and participantsBetween October 2010 and February 2012, 1285 adult ED patients from 6 US academic hospitals, who scored 3 or greater on the 10-item Drug Abuse Screening Test (indicating moderate to severe problems related to drug use) and who were currently using drugs, were randomized to MSO (n = 431), SAR (n = 427), or BI-B (n = 427). Follow-up assessments were conducted at 3, 6, and 12 months by blinded interviewers.InterventionsFollowing screening, MSO participants received only an informational pamphlet. The SAR participants received assessment plus referral to addiction treatment if indicated, and the BI-B participants received assessment and referral as in SAR, plus a manual-guided counseling session based on motivational interviewing principles and up to 2 "booster" sessions by telephone during the month following the ED visit.Main outcomes and measuresOutcomes evaluated at follow-up visits included self-reported days using the patient-defined primary problem drug, days using any drug, days of heavy drinking, and drug use based on analysis of hair samples. The primary outcome was self-reported days of use of the patient-defined primary problem drug during the 30-day period preceding the 3-month follow-up.ResultsFollow-up rates were 89%, 86%, and 81% at 3, 6, and 12 months, respectively. For the primary outcome, estimated differences in number of days of use (95% CI) were as follows: MSO vs BI-B, 0.72 (-0.80 to 2.24), P (adjusted) = .57; SAR vs BI-B, 0.70 (-0.83 to 2.23), P (adjusted) = .57; SAR vs MSO, -0.02 (-1.53 to 1.50), P (adjusted) = .98. There were no significant differences between groups in self-reported days using the primary drug, days using any drug, or heavy drinking days at 3, 6, or 12 months. At the 3-month follow-up, participants in the SAR group had a higher rate of hair samples positive for their primary drug of abuse (265 of 280 [95%]) than did participants in the MSO group (253 of 287 [88%]) or the BI-B group (244 of 275 [89%]). Hair analysis differences between groups at other time points were not significant.Conclusions and relevanceIn this sample of drug users seeking emergency medical treatment, a relatively robust brief intervention did not improve substance use outcomes. More work is needed to determine how drug use disorders may be addressed effectively in the ED.Trial registrationclinicaltrials.gov Identifier:NCT01207791.

Project description:ObjectivesThis study aims to examine the proportions of patients referred to mental health, social and voluntary, community and social enterprise (VCSE) services and general practice and to assess care gaps among people presenting to the hospital following self-harm.DesignPopulation-based observational study. Data were extracted from hospital records.SettingThree emergency departments (EDs) in Manchester, UK.Participants26 090 patients aged 15+ years who presented to participating EDs following self-harm and who received a psychosocial assessment by a mental health specialist.Primary and secondary outcome measuresPrimary outcome measures are as follows: care gaps, estimated from the proportion of patients with evidence of social and mental health needs with no new or active referral to mental health, social and VCSE services. Secondary outcome measures are as follows: proportions of referrals by groups of patients, estimated mental health and social needs of patients. Indicators of mental health and social need were developed with academic clinicians (psychiatrist, general practitioner and social worker) and expert lived experience contributors.Results96.2% (25 893/26 909) of individuals were estimated as having mental health needs. Among this group, 29.9% (6503/21 719) had no new or active referral to mental health services (indicating a care gap). Mental healthcare gaps were greater in men and those who were aged under 35 years, from a black, South Asian or Chinese ethnic group, living in the most deprived areas and had no mental health diagnosis, or alcohol, substance misuse, anxiety or trauma-related disorder. 52.8% (14 219/26 909) had social needs, with care gaps greater for men, individuals aged 45-64 and those who were unemployed or had a diagnosed mental disorder.ConclusionsCare gaps were higher among hospital-presenting groups known to have increased risks of suicide: men, those in middle age, unemployed individuals and those misusing substances. Improved access to mental health, social and VCSE services and general practice care is vital to reduce inequities in access to self-harm aftercare.

Project description:BackgroundHypertensive crisis is among the causes of morbidity and mortality in adult patients with hypertension in Sub-Saharan Africa. We aimed to determine the burden, risk factors and describe the management strategies of hypertensive crisis among adult patients seen at emergency departments of district and regional hospitals in Tanzania.MethodsThis was a prospective multicenter longitudinal study which included all 162 district and regional hospitals in Tanzania. It was part of the Tanzania Emergency Care Capacity Survey (TECCS), a large assessment of burden of acute illness and emergency care capacity in Tanzania. Adult patients who presented to emergency departments with blood pressure ≥ 180/110mmHg were enrolled. Demographics, clinical presentation, management, and 24-hours outcomes were recorded using a structured case report form. Descriptive statistics were summarized in frequency and median, while logistic regression was used to evaluate the association between risk factors and presence of hypertensive crisis.ResultsWe screened 2700 patients and enrolled 169 adults, henceforth proportion of adult patients with hypertensive crisis was 63 per 1000. Median age was 62 years (IQR 50-70 years) and predominantly females, 112 (66.3%). Majority 151(89.3%) were self-referred with two-wheel motorcycle being the commonest 46 (27.2%) mode of arrival to the hospital. Hypertensive emergency was found in over half 96 (56.8%) of the patients with hypertensive crisis, with oral medications administered in more than half of them, 71 (74%) as means to control the high blood pressure, and one-third 33 (34.4%) were discharged home. On multivariate analysis increasing age (AOR 4.53, p < 0.001), use of illicit drug (AOR 4.14, p-0.04) and pre-existing hypertension (AOR 8.1, p < 0.001) were independent risk factors for hypertensive crisis occurrence.ConclusionHypertensive crisis among adult patients attending district and regional hospitals is common (63 patients per every 1000 patients). Increasing age, use of illicit drug and pre-existing hypertension are independent associated factors for developing hypertensive crisis.

Dataset Information

Re-imagining crisis care: experiences of delivering and receiving the Assured brief psychological intervention for people presenting to Emergency Departments with self-harm.

Background

Aim

Methods

Publications

Re-imagining crisis care: experiences of delivering and receiving the Assured brief psychological intervention for people presenting to Emergency Departments with self-harm.

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