Secondary school practitioners' beliefs about risk factors for school attendance problems: a qualitative study.
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SUBMITTER: Finning K
PROVIDER: S-EPMC7254525 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundSchool attendance problems (SAPs) are common among children and adolescents with autism spectrum disorder (ASD). Currently, there is a lack of guidelines for treatment or interventions aimed at this group.MethodTwelve clinical practitioners were interviewed via in-depth interviews using a semi-structured question guide. Interviews were audiotaped, transcribed verbatim, and initially independently coded by two coders. The interviews were analyzed according to thematic analysis.ResultsThe majority of the clinicians reported that it was common that children and adolescents with ASD at CAP had prolonged SAPs. A total of four themes and 22 sub-themes were identified in the analysis: the treatment situation; treatment goals at CAP; treatment interventions; and desired development. Insufficient adaptations in response to core impairment of ASD and lack of support in their daily life could be factors to the development of SAPs. Prolonged social isolation in combination with severe psychiatric comorbidities was reported as a treatment barrier. Also, insufficient collaboration between mental health care services, school and social services obstructed the return to school for this group of students. Favorable factors for positive treatment outcome were: early detection, accurate assessment and coordination between mental health care and schools and environmental adaptation at school as well as at home, parent support and sometimes change of school. Concerning useful therapeutic techniques, exposure from cognitive-behavioral treatment was reported.ConclusionChildren and adolescents with ASD with limited societal support tend to develop SAPs. Important factors that impact the outcome of treatment were the length of the absence from school and the severity of psychiatric comorbidities. Tailored and adapted interventions at school, parent support and mental health care are needed. Research about assessment and treatment for children and adolescents with ASD and SAPs is needed.
| S-EPMC8958765 | biostudies-literature
Project description:ObjectivesTo investigate general practitioners' (GPs) experiences in managing patients with intellectual disabilities (ID) and mental and behavioural problems (MBP).DesignQualitative study using in-depth interviews.SettingGeneral practice in Hedmark county, Norway.Participants10 GPs were qualitatively interviewed about their professional experience regarding patients with ID and MBP. Data were analysed by all authors using systematic text condensation.ResultsThe participants' knowledge was primarily experience-based and collaboration with specialists seemed to be individual rather than systemic. The GPs provided divergent attitudes to referral, treatment, collaboration, regular health checks and home visits.ConclusionsGPs are in a position to provide evidence-based and individual treatment for both psychological and somatic problems among patients with ID. However, they do not appear to be making use of evidence-based treatment decisions. The GPs feel that they are left alone in decision-making, and find it difficult to find trustworthy collaborative partners. The findings in this study provide useful information for further research in the field.
| S-EPMC3612780 | biostudies-literature
Project description:BackgroundThe COVID-19 pandemic resulted in school closures worldwide and unexcused absences have increased since schools reopened.AimsDrawing on multiple stakeholders' perspectives, we aimed to (i) develop a detailed understanding of how school attendance problems (SAPs) have manifested for primary school-aged children in the context of COVID-19; and (ii) identify promising community-based intervention strategies.MethodsWe used a qualitative design with two sequential phases of data collection. Phase 1 involved insight generation using qualitative surveys with parents and professionals working in primary education settings. These results were used to guide in-depth stakeholder interviews in Phase 2.SamplePhase 1 included 29 parents of primary-school children experiencing SAPs and 19 professionals. Phase 2 included 10 parents and 12 professionals. Parents were recruited through social media; professionals were identified through schools and associated networks in Southern England.ResultsAttendance was particularly challenging for children with special educational needs and pre-existing anxiety problems. Compounding factors included COVID-related anxiety, difficulties adapting to new school routines, poor home-school communication and collaboration, and concerns about academic catch-up. Effective support was characterized by schools and families working closely together. Recommendations for practice improvements centred on early intervention, re-building parent-school relationships, peer support for parents, and improving special educational provision.ConclusionNew interventions for SAPs must be sensitive to the ongoing COVID-19 context. Help should be easily accessible in the community and address modifiable risk and protective factors for individual children, in family systems, and at the home-school interface.
| S-EPMC10099830 | biostudies-literature
Project description:BackgroundKnowledge of school attendance problems (SAPs) is needed to inform treatments targeting SAPs and protecting youths from negative outcomes associated with SAPs.ObjectivesThis study examined the school absence, absence categories (i.e., absence due to illness, excused, non-excused), sociodemographic characteristics, and mental health problems among youths seeking psychological treatment for SAPs.MethodsThe study used a cross-sectional design. Sociodemographic and clinical characteristics of 152 help-seeking youths with SAPs (i.e., >10% absenteeism) and their parents were examined. The data were derived from the baseline assessment conducted before treatment start.ResultsOlder youths, youths with mental health problems, and youths whose parents had mental health problems exhibited higher levels of absence. Lower levels of non-excused absence were found among youths with highly educated fathers, and youths living with both parents. Many youths had clinical levels of anxiety, depression, or 'emotional and behavioral difficulties'.ConclusionThe study highlights the need for early intervention, addressing a broad range of mental health problems.Clinical trial registrationClinicalTrials.gov: NCT03459677.
| S-EPMC8791456 | biostudies-literature
Project description:BackgroundEmergency Department attendance is increasing internationally, of which a significant proportion could be managed in general practice. In England, policies backed by substantial capital funding require such patients attending Emergency Departments be directed or 'streamed' to General Practitioners working in or parallel to Emergency Departments. However, evidence for streaming is limited and the processes of streaming patients attending Emergency Departments to General Practitioners lacks exploration.ObjectivesThis paper explores streaming to General Practitioners in and alongside Emergency Departments at ten sites across England. It highlights positive streaming practice, as well as issues that may contribute to poor streaming practice, in order to inform future service improvement.MethodsA longitudinal qualitative study was conducted with data collected between October 2017 and December 2019 across 10 case study sites throughout England as part of a broader mixed methods study. 186 non-participant observations and 226 semi-structured interviews with 191 health professionals working in Emergency Departments or related General Practitioner Services were thematically analysed in relation to streaming processes and experiences.ResultsSix interconnected themes influencing streaming were identified: implementing and maintaining structural support; developing and supporting streaming personnel; implementing workable and responsive streaming protocols; negotiating primary/secondary care boundaries; developing and maintaining interprofessional relationships and concerns for patient safety. Streaming was considered central to the success of General Practitioners in/parallel to Emergency Departments. The importance of the skills of streaming nurses in delivering an optimal and safety critical service was highlighted, as was the skillset of General Practitioners and interprofessional relationships between streamers and General Practitioners. There was no distinct streaming model or method associated with good streaming practice to General Practitioners in/alongside Emergency Departments, instead factors for success were identified and key recommendations suggested. 'Inappropriate' streaming was identified as a problem, where patients streamed to General Practitioners in or parallel to Emergency Departments required Emergency Department management, or patients suitable for General Practitioner care were kept in the Emergency Department.ConclusionDespite adopting differing methods, commonalities across case sites in the delivery of good streaming practice were identified, leading to identification of key recommendations which may inform development of streaming services.Study registrationISRCTN51780222. Tweetable abstract: Workplace culture and the skillset of streamers and General Practitioners is crucial to streaming of patients to General Practitioners in Emergency Departments.
| S-EPMC8299545 | biostudies-literature
Project description:BackgroundRefugees are a particularly vulnerable group in relation to the development of mental illness and many may have been subjected to torture or other traumatic experiences. General practitioners are gatekeepers for access to several parts of the psychiatric system and knowledge of their patients' refugee background is crucial to secure adequate care. The aim of this study is to investigate how general practitioners experience providing care to refugees with mental health problems.MethodsThe study was conducted as part of an EU project on European Best Practices in Access, Quality and Appropriateness of Health Services for Immigrants in Europe (EUGATE). Semi-structured interviews were carried out with nine general practitioners in the vicinity of Copenhagen purposively selected from areas with a high proportion of immigrants. The analysis of the interviews is inspired by qualitative content analysis.ResultsOne of the main themes identified in the analysis is communication. This includes the use of professional interpreters and that communication entails more than sharing a common language. Quality of care is another theme that emerges and includes awareness of possible trauma history, limited possibilities for refugees to participate in certain treatments due to language barriers and feelings of hopelessness in the general practitioners. The general practitioners may also choose different referral pathways for refugees and they report that their patients lack understanding regarding the differences between psychological problems and physical symptoms.ConclusionGeneral practitioners experience that providing care to refugees differs from providing care for patients from the majority population. The different strategies employed by the general practitioners in the health care treatment of refugees may be the result of the great diversity in the organisation of general practice in Denmark and the lack of a national strategy in the health care management of refugees. The findings from this study suggest that the development of conversational models for general practitioners including points to be aware of in the treatment of refugee patients may serve as a support in the management of refugee patients in primary care.
| S-EPMC3568406 | biostudies-literature
Project description:The efficacy of implementing practices based on the best evidence is determined by the limitations and preparedness of the structure and processes of the healthcare system as well as healthcare professionals' (HCP) levels of knowledge and acceptance. Facilitating implementation of such practices also partly depends on HCPs' attitudes.We investigate the attitudes and beliefs of four groups of physicians in the United Arab Emirates on clinical practice guidelines (CPGs), with a focus on applying revisions to these CPGs in a different setting than the one in which they were developed, and where no locally developed guidelines exist.CPGs were the main source of information for revisions. We identified a rising concern in the applicability of the recommendations, which persists due to a lack of locally developed revisions. Other concerns include the pressures of practice management changes and of coping with the rapid development in resources and the growing demand on its use. Some international and government-endorsed CPGs were still accepted as being the best candidates for adoption.This group welcomes evidence-based practice and is supported by electronic medical records, structured care programmes, and ongoing quality monitoring. Barriers and facilitators of clinical practice guidelines are discussed and thoughts on effective implementation strategies are considered.
| S-EPMC5975561 | biostudies-other
Project description:BackgroundThere is consistency of evidence on the link between school culture and student health. A positive school culture has been associated with positive child and youth development, effective risk prevention and health promotion efforts, with extensive evidence for the impact on student mental health. Interventions which focus on socio-cultural elements of school life, and which involve students actively in the process, are increasingly understood to be important for student mental health promotion. This qualitative study was undertaken in three UK secondary schools prior to the implementation of a participative action research study bringing students and staff together to identify changes to school culture that might impact student mental health. The aim was to identify how school culture is conceptualised by students, parents and staff in three UK secondary schools. A secondary aim was to explore which components of school culture were perceived to be most important for student mental health.MethodsAcross three schools, 27 staff and seven parents participated in in-depth interviews, and 28 students participated in four focus groups. The Framework Method of thematic analysis was applied.ResultsRespondents identified elements of school culture that aligned into four dimensions; structure and context, organisational and academic, community, and safety and support. There was strong evidence of the interdependence of the four dimensions in shaping the culture of a school.ConclusionsSchool staff who seek to shape and improve school culture as a means of promoting student mental health may have better results if this interdependence is acknowledged, and improvements are addressed across all four dimensions.
| S-EPMC8964383 | biostudies-literature
Project description:BackgroundThere is growing evidence for the use of social prescribing as a means to improve the mental health of patients. However, there are gaps in understanding the barriers and enablers faced by General Practitioners (GPs) when engaging in social prescribing for patients with mental health problems.MethodsThis study uses a qualitative approach involving one-to-one interviews with GPs from across the UK. The COM-B model was used to elucidate barriers and enablers, and the Theoretical Domains Framework (TDF) and a Behaviour Change Theory and Techniques tool was used to identify interventions that could address these.ResultsGPs recognised the utility of social prescribing in addressing the high levels of psychosocial need they saw in their patient population, and expressed the need to de-medicalise certain patient problems. GPs were driven by a desire to help patients, and so they benefited from regular positive feedback to reinforce the value of their social prescribing referrals. They also discussed the importance of developing more robust evidence on social prescribing, but acknowledged the challenges of conducting rigorous research in community settings. GPs lacked the capacity, and formal training, to effectively engage with community groups for patients with mental health problems. Link workers, when available to GPs, were of fundamental importance in bridging the gap between the GP and community. The formation of trusting relationships was crucial at different points of the social prescribing pathway, with patients needing to trust GPs in order for them to agree to see a link worker or attend a community activity, and GPs requiring a range of strong inter-personal skills in order to gain patients' trust and motivate them.ConclusionThis study elucidates the barriers and enablers to social prescribing for patients with mental health problems, from the perspectives of GPs. Recommended interventions include a more systematic feedback structure for GPs and more formal training around social prescribing and developing the relevant inter-personal skills. This study provides insight for GPs and other practice staff, commissioners, managers, providers and community groups, to help design and deliver future social prescribing services.
| S-EPMC7507286 | biostudies-literature
Project description:IntroductionSchools have an important role in recognising and preventing self-harm and suicidal behaviour in their students, however little is known about which educational factors are associated with heightened risk. We will systematically review the existing evidence on two key educational performance indicators that are routinely collected by school administrative systems: school attendance and exclusion. We will investigate their association with self-harm and suicidal behaviour in school-age children and adolescents. Knowledge of this association could help inform suicide prevention strategies at clinical, school and population levels.Methods and analysisWe will conduct a systematic search of Medline, EMBASE, PsycINFO, British Education Index and Education Resources Information Centre (ERIC) from 1 January 1990, and conduct a manual search for additional references. We aim to identify studies that explore the association between poor school attendance or exclusion and self-harm or suicidal behaviours in school-age children and adolescents. Two independent reviewers will screen titles, abstracts and full-text documents and independently extract relevant data for analysis. Study quality will be assessed using a modified Newcastle-Ottawa Scale. A descriptive analysis will be performed, and where appropriate, results will be combined in meta-analyses.Ethics and disseminationThis is a systematic review of published literature, and therefore ethical approval will not be sought. We will publish reports in health and education journals, present our work at conferences focused on school mental health and communicate our findings to practitioners and managers in public health, education and child mental health.Prospero registration numberCRD42018088608.
| S-EPMC6303662 | biostudies-literature