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A mixed methods evaluation of an integrated adult mental health service model.

ABSTRACT: BACKGROUND:The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a 'one-stop' mental health service hub. METHODS:We conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale - Domains and Stages (RAS-DS) scores at intake and review (n?=?108); (2) RAS-DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n?=?37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n?=?20); and (4) program documentation. RESULTS:Interviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS-DS measurements, averaging 5 months apart. RAS-DS 'total recovery' scores improved significantly (M?=?63.3%, SD?=?15.6 vs. M?=?69.2%, SD?=?16.1; p?

SUBMITTER: Beere D

PROVIDER: S-EPMC6791005 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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A mixed methods evaluation of an integrated adult mental health service model.

Beere Diana D Page Imogen S IS Diminic Sandra S Harris Meredith M

BMC health services research 20191014 1

<h4>Background</h4>The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a 'one-stop' mental health service hub.<h4>Methods</h4>We conducted an independent mixed-methods evaluation o ...[more]

PMID: 31610790

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Project description:IntroductionA common problem low-income and middle-income countries face is the scarcity of community-based rehabilitation (CBR) resources and low service utilisation among persons with severe mental illness (SMI). Despite this problem, the factors and pathways followed influencing one's decision on service utilisation in China have not been fully comprehended. This study aims to develop a theory-based model that systematically describes the integrated decision-making process of mental health CBR utilisation among persons with SMI in China.Methods/designThis cross-sectional, mixed-methods study involves three main stages and is expected to last 3 years, from January 2018 to December 2020. In stage 1, the Social Exchange Theory is deployed as an analytical framework to comprehensively capture factors associated with tendency to use CBR services in China using semistructured interview methodology involving patients with SMI, their primary caregivers and CBR service providers. In stage 2, interpretive structural modelling will be applied to analyse the relationships between factors in different dimensions, at different levels and with different levels of impact. Stage 3 involves a multiregion survey among at least 300 family decision-makers (either the patient or their caregivers) in six communities in three cities to statistically validate the initial model derived in stage 2 using a further structural equation modelling.Ethics and disseminationEthical approval was granted by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (No 2017S319). All interviewees will be provided with written information about the study, and a signed consent will be retrieved prior to the interview. Rules on confidentiality and anonymity of data will be strictly followed. The findings of this study will be disseminated via international and domestic peer-reviewed journals, reports, conference presentations and symposium discussions. Reports will be submitted to the National Natural Science Foundation of China.

Project description:INTRODUCTION:Responsiveness to service users' views is a widely recognised objective of health systems. A key component of responsive health systems is effective interaction between users and service providers. Despite a growing literature on patient feedback from high-income settings, less is known about effectiveness of such systems in low-income and middle-income countries. METHODOLOGY AND ANALYSIS:This paper disseminates the protocol for an 18-month 'RESPOND' project that aims to evaluate the system of collecting and responding to user feedback in Bangladesh. This mixed-method study uses a realist evaluation approach to examine user feedback systems at two Upazila health complexes in Comilla District of Bangladesh, and comprises three steps: (1) initial theory development; (2) theory validation; and (3) theory refinement and development of lessons learnt. The project also uses (1) process evaluation to understand causal mechanisms and contexts of implementation; (2) statistical analysis of patient feedback to clarify the nature of issues reported; (3) social science methods to illuminate feedback processes and user and provider experiences; and (4) health policy and systems research to clarify issues related to integration of feedback systems with quality assurance and human resource management. During data analysis, qualitative and quantitative findings will be integrated throughout to help achieve study objectives. Analysis of qualitative and quantitative data will be done using a convergent mixed-methods model, involving continuous triangulation of multiple data sets to facilitate greater understanding of the context of user feedback systems including the links with relevant policies, practices and programmes. ETHICS AND DISSEMINATION:Ethics approvals were obtained from the University of Leeds and the Bangladesh Medical Research Council. All data collected for this study will be anonymised, and identifying characteristics of respondents will not appear in a final manuscript or reports. The study findings will be presented at scientific conferences and published in peer-reviewed journals.

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A mixed methods evaluation of an integrated adult mental health service model.

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A mixed methods evaluation of an integrated adult mental health service model.

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