Chris Attoe

Integrating mental health simulation into routine health-care education

702 www.thelancet.com/psychiatry Vol 3 August 2016 Abigail Moss, H Valerie Curran, Michael A P Bloomfi eld, Sunjeev K Kamboj, Simon E Blackwell, *Tom P Freeman Clinical Psychopharmacology Unit, University College London, WC1E 6BT, UK (AM, HVC, SKK, TPF); Division of Psychiatry, University College London, UK (MAPB); Psychiatric Imaging Group, MRC Clinical Sciences Centre, London, UK (MAPB); MRC Cognition & Brain Sciences Unit, Cambridge, UK (SEB); and Mental Health Research and Treatment Centre, Department of Psychology, Ruhr-Universität Bochum, Germany (SEB) tom.freeman@ucl.ac.uk

Simulation training to support healthcare professionals to meet the health needs of people with intellectual disabilities

Purpose The purpose of this paper is to discuss the role of education and training in addressing health inequalities in intellectual disabilities, before examining innovative approaches to healthcare education. Preliminary findings of a simulation training course to support healthcare professionals to work with people with intellectual disability are then presented. Design/methodology/approach This study employed a mixed methods design to assess the impact of the simulation course. Quantitative data were collected using the Healthcare Skills Questionnaire and a self-report confidence measure; qualitative data were collected using post-course survey with free text responses to open questions. Findings Healthcare skills and confidence showed statistical improvements from pre- to post-course. Qualitative analyses demonstrated that participants perceived improvements to: attitudes, communication skills, reasonable adjustments, interprofessional and multi-disciplinary working, knowledge of key issues in working with people with intellectual disabilities. Practical implications Encouraging findings imply that simulation training to address health inequalities in intellectual disabilities is a valuable resource that merits further development. This training should be rolled out more widely, along with ongoing longitudinal evaluation via robust methods to gauge the impact on participants, their workplaces, and people with intellectual disabilities. Originality/value The authors believe this paper to be the first to assess an interprofessional, high-fidelity simulation course, using actors as simulated patients to address the mental and physical health needs of people with intellectual disabilities. The rigorous use of co-production and co-delivery, alongside promising findings for this training method, represent a useful contribution to the literature.

Actors with intellectual disabilities in mental health simulation training

Purpose People with intellectual disabilities experience poorer health outcomes than the general population, and a significantly increased risk of mental health comorbidity. Their access to healthcare has been consistently shown as inadequate, and their access to mental health support is still largely wanting. Adequate training and education should improve these shortcomings but there is limited evidence available as to the best way to achieve this. The paper aims to discuss these issues. Design/methodology/approach This paper reports on the co-production and co-delivery of a simulation training course to support healthcare professionals to provide care for people with intellectual disabilities, with a particular focus on their mental health needs. This training was designed with actors with intellectual disabilities, who participated as simulated patients in scenarios during the course and subsequently provided feedback on their experience. Findings This paper focusses on the positive experiences of the simulated patients, reporting on and interpreting their direct feedback on their experience of contributing to the development and delivery of the course and being involved as co-educators. Originality/value It is highlighted that the co-production and delivery of this simulation training with people with intellectual disabilities has the potential to realise some of the key principles called upon when attempting to improve how they are treated, by illustrating concrete participation, independence, and access to fulfilling lives. The value and benefits of interprofessional education to achieve these educational aims is further highlighted, particularly for the potential to generate a sense of shared responsibility within mainstream services in caring for people with intellectual disabilities.

G85 Interprofessional simulation to improve collaborative working for young people with physical and mental health needs

Aims A large proportion of young people with mental health needs present to general hospitals. Recent UK government reports have highlighted the importance of joined up care in these cases, whilst there appears a general lack of confidence in paediatric staff when managing them. We developed an interprofessional simulation (IPS) course with the aims of improving joint working between paediatric and CAMHS staff, and increasing participants’ confidence in managing young people with mental health needs. Methods A one day course was developed and piloted. 99 participants attended in all. Participants included: paediatric, GP VTS, emergency medicine and psychiatry trainees, paediatric nurses and healthcare assistants and CAMHS professionals. Scenarios were designed according to clinicians’ difficult past experiences with this patient group. Data was collected from course evaluation forms, pre- and post-course questionnaires exploring participants’ confidence in the assessment and management of such young people, and their attitudes towards their roles and responsibilities in their care, and focus groups. Results Quantitative data demonstrated a statistically significant increase in participants’ confidence scores from pre (M=59.78, SD=15.37) to post course (M=76.81, SD=11.27), t(54)=-9.46, p,.0005 (n = 62). Additionally, participants’ attitudes score improved, from pre (M=27.65, SD=3.68) to post course (M=30.26, SD=3.33), t(53)=5.33, p,.0005. The eta squared statistic indicated large effect sizes,. 62 and. 35 respectively. Thematic analysis of the qualitative data generated several themes. In addition to those relating to knowledge, confidence, and attitudes, participants particularly appeared to have enhanced their capabilities in collaborative working. This comprised of: clarification of roles and responsibilities, improved competency in collaborative decision-making and team functioning, and improved appreciation of different professionals’ perspectives. Conclusion Our findings demonstrate that it is possible to employ IPS to promote collaborative working at the mental-physical interface for the care of young people with both mental and physical health needs. Additionally, participants went away with improved knowledge, confidence and attitudes for working with this demographic. Our hope is that the courses will have a positive impact on patient care and experience for those presenting to general hospitals with mental health needs.

Interprofessional simulation training for community mental health teams: Findings from a mixed methods study

ABSTRACT Community mental health teams (CMHTs) in England face mounting service pressures due to an increased focus on out-of-hospital care. Interprofessional working is essential to providing good mental healthcare in community settings. Simulation training is underused in mental health, despite strong support for its improvement of clinical skills, confidence, teamwork, and interprofessional collaboration in other healthcare settings. This study aims to evaluate the impact of simulation training on community mental health professionals. An interprofessional simulation training course on assessment and team working skills for community mental health professionals was developed and delivered at a time of service reorganisation in South London services, including changes to job roles and responsibilities. In total, 57 course participants completed a survey that measured perceptions of knowledge and confidence, as well as a general view of the course. Eight participants took part in further semi-structured interviews 2–3 months after the course to provide perceptions about this experience’s subsequent impact. There were statistically significant increases in knowledge and confidence scores with large effect sizes. Thematic analyses of open-text survey and interview data identified emergent themes of interprofessional understanding; attitudes in clinical practice; staff well-being; the value of reflection; opportunity for feedback; and fidelity to clinical practice. Simulation training can improve confidence and knowledge in core skills and team working for CMHTs. Participants reported benefits to key areas of community mental healthcare, such as interprofessional collaboration, reflective practice, and staff well-being. Findings represented individual and team learning, as well as subsequent changes to clinical practice, and were related back to the interactive and reflective nature of the simulation. Implications are highlighted concerning the use of interprofessional simulation training in mental health, particularly relating to staff well-being, attitudes, and interprofessional working.

Improving decision-making and cognitive bias using innovative approaches to simulated scenario and debrief design

> The simplest approach to improving doctors’ decision-making is to educate them about the existence of the biases… (Bornstein and Emler, 2001).1 Over the last 20 years, healthcare systems globally have reduced the number of acute inpatient psychiatry beds, diverting resources to community-based teams. This has led to an increased number of patients from all specialities presenting to the emergency department. The Economist Intelligence Unit has projected a global trend of decreases in the number of hospital beds per 1000 population until 2019, despite growing demand from growing and ageing populations as well as the need for community-care and home-care beds.2 This trend is especially noted in mental health. Since 2013, most UK mental health trusts have regularly experienced a lack of inpatient bed availability, with these problems widely described and addressed in national policy and guidance.3 When patients are in crisis, they are assessed by multidisciplinary mental health teams. Mental health professionals must balance the potential costs and benefits of several courses of action. These decisions and their consequences are complex, having significant implications for individuals, families, professionals and healthcare systems. However, clinicians appear not to use the same process to make decisions or agree on treatment options. Clinicians tend to focus on finding the right decision rather than understanding the decision-making process that influences actions. Many different factors, including bias, contribute to variability in clinical decision-making, with some clinical presentations managed more consistently than others.1 To address this subjectivity and bias in practice, bring clinical practice in line with evidence-based guidelines and …

Comparing learning outcomes for mental health simulation training delivered to entire clinical teams versus professionals not working together clinically

Introduction Working effectively with colleagues using a multidisciplinary and interprofessional approach is vital in healthcare, particularly mental health, where the interface between physical and mental health is often missed due to involvement with different specialties. Collaborative clinical practice is essential to provide the best clinical care to people experiencing mental and physical health co-morbidities. Simulation training encourages experiential learning for human factors (or non-technical) skills, such as teamwork and interprofessional collaboration. This study explored the differences in learning outcomes between team and non-team training for physical and mental health co-morbidities. Aims and objectives This project aimed to establish differences in human factors learning, confidence and knowledge, following training for teams that work together versus interprofessional groups from various teams. The project hoped to continue improving mental health simulation training and promote and enhance human factor skills that are basic pillars of multi-disciplinary and interprofessional care. Methods The human factors skills for healthcare instrument (HFSHI), alongside confidence and knowledge measures were administered to all participants pre and post simulation training on interacting mental and physical health. A post-course evaluation survey with open questions was used to collect qualitative feedback on the impact of the training course. Results With data collection ongoing, preliminary results indicate differences between team and non-team simulation training, with particularly interesting qualitative findings. Conclusions Learning outcomes may differ for team versus non-team simulation training, evidencing the different value of these two training set-ups.

Who learns more in interprofessional mental health simulation training? A study comparing learning outcomes of different professionals who work in mental and physical health care settings

Introduction Simulation training has the potential to develop communication and teamwork skills, as well as technical knowledge and competency. Mental health simulation training aims to promote awareness of mental health conditions and to enhance human factors (or non-technical) skills that will enable professionals that work in mental and physical healthcare settings to improve their collaborative and patient-centered clinical practice. This study explored the differences in learning outcomes after a mental health simulation course between different professionals–nursing staff, medical staff, and allied health professionals. Aims and objectives This project examined the different learning outcomes of human factors, confidence and knowledge, for nursing, medical and allied health professionals following mental health simulation training. Methods Course-specific measures of confidence and knowledge were administered pre- and post-training to all participants, in addition to The Human Factors Skills for Healthcare Instrument (HFSHI). A post-course evaluation for with free-text responses to open questions regarding the impact of the training was utilised to collect qualitative data. Results With data collection ongoing, preliminary results indicate differences in learning outcome depending on professional background, both in terms of quantitative measures and qualitative findings. Conclusions Learning outcomes may differ for different professionals despite receiving the same simulation training focusing on mental and physical health, evidencing the importance of sharing individual learning experiences in simulation using a debrief model.

0024 An evaluation of in vivo versus simulation suite delivered simulation-based mental health training for emergency department teams

Background We developed an interprofessional simulation-based training (SBT) to promote collaboration when caring for patients in mental health crisis in the Emergency Department (ED). The intervention was run both in vivo and in a purpose-built simulation suite. The primary analysis of educational outcomes has been presented elsewhere.1 Aims To compare participant learning outcomes and experiences from in vivo versus simulation suite delivered SBT. Methods A SBT was developed in which participants engaged in three scenarios of a simulated patient’s journey through the ED followed by structured debriefs. One course was delivered in vivo whilst three courses, with identical content and format, were delivered in a simulation suite. Participants completed pre- and post-course questionnaires, measuring changes in knowledge, confidence and attitudes. Individual participant overall change in knowledge, confidence and attitudes were compared for both participant groups using Independent-Samples T and Mann Whitney U Tests. Post-course focus groups were conducted to gather qualitative data on participant experience. Results 12 participants engaged in in vivo training versus 25 participants in simulation suite training. The professional mix was similar for both groups. The distribution of change in knowledge and self-rated confidence scores and attitudinal shift was not significantly different for in vivo and simulation suite groups (p = 0.64; p = 00.92; p = 0.58). Views on the relative merits of in vivo versus simulation suite training were divergent. Participants from both groups recognised the tension between achieving environmental fidelity with in vivo simulation and the potential detrimental impact of managing distractions on learning. Conclusion Previous work has demonstrated that SBT effectively increases participants’ self-rated confidence and leads to positive attitudinal changes when caring for patients in mental health crisis in the ED.1 Our results suggest that the effectiveness of learning does not appear to be different for in vivo versus simulation suite delivered training. Reference Humphreys RA, Piette A, Wilson C, Kowalski C, Cross S. Mental health crisis in the emergency department: outcomes from a new interprofessional simulation. Royal College of Psychiatrists International Congress, 2015