Glen E. Randall

Effectiveness of Health System Services and Programs for Youth to Adult Transitions in Mental Health Care: A Systematic Review of Academic Literature

Abstract Youth shifting to adult mental health services often report experiencing frustrations with accessing care that adequately replaces the youth services they had received. This systematic review assesses the peer reviewed evidence on services/programs aimed at addressing youth to adult transitions in mental health services. Findings suggest little data exists on the effectiveness of transition services/programs. While the available evidence supports meetings between youth and youth caseworkers prior to transitions occurring, it also verifies that this is not common practice. Other identified barriers to effective transitions were categorized as logistical (ineffective system communication), organizational (negative incentives), and related to clinical governance.

Deprofessionalization or Postprofessionalization? Reflections on the State of Social Work as a Profession

ABSTRACT Recent literature considering the state of the social work profession has primarily focused on concerns about deprofessionalization. This article provides an overview of the literature on professionalization and professional decline in order to situate the social work profession within a broader context. The article then describes the emergence of a new role for social workers in Canada that crosses the boundaries between clinical, managerial, and legal aspects of client care in the area of mental health forensics. It is argued that the future of social works professionalization project around the world may not be as bleak as has been portrayed in the literature.

Lost in transition or translation? Care philosophies and transitions between child and youth and adult mental health services: a systematic review

Abstract Background: Differences in care philosophies may influence transitions from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Aims: To review literature about CAMHS and AMHS care philosophies and their influence on transitions. Method: MEDLINE, PsycINFO, Embase and CINAHL databases were searched electronically using keywords related to transitions, youth and mental disorders. Content relating to philosophies of care was searched manually. Descriptive themes were extracted and the analysis suggested four hypotheses of how care philosophies influence transitions. Results: Of the 1897 identified articles, 12 met eligibility criteria. Findings reveal consistent differences in care philosophies between CAMHS (developmental approach, involving families and nurturing) and AMHS (clinical/diagnosis-focus, emphasis on client autonomy and individual responsibility). Conclusions: Better understanding of philosophical differences and collaborative planning and service delivery may foster shared approaches in CAMHS and AMHS to better meet the needs of transitioning youth.

A scoping review of evaluated interventions addressing developmental transitions for youth with mental health disorders.

BACKGROUND Youth with mental health disorders often experience challenges when transitioning into adult roles (e.g. independent living, work and community engagement). Health interventions that address the needs of youth with mental health disorders during these challenges in their development (i.e. developmental transitions) have not been reviewed in the literature. This scoping review examines the peer-reviewed research that describes evaluated interventions addressing developmental transitions for youth with mental health disorders. METHODS A search of four prominent health literature databases (CINAHL, Embase, MEDLINE and PsycINFO) was conducted to identify evaluated developmental transition interventions for adolescents and youth (12-25 years) with mental health disorders. Study selection and analysis were guided by a methodological framework for conducting scoping reviews. Selected studies were described, assessed for quality and collated based on ten dimensions from two notable conceptual frameworks in developmental transitions and disability. RESULTS Nine studies met the inclusion criteria. The interventions within these studies demonstrated five specialized and four multi-faceted programmes (i.e. multiple domains). All domains from the two conceptual frameworks were represented differently across studies. The sub-domains from these studies were most frequently related to vocational-focused interventions, least frequently related to social activities and living situation and did not explicitly map onto the sexuality sub-domain. Three multi-faceted interventions incorporated all domains and utilized each intervention approach. Study quality was rated for seven of the nine studies. Quantitative methodology for five of the seven studies was rated as higher quality. CONCLUSIONS Evaluated interventions described in the transitions literature for youth with mental health disorders predominantly focus on vocational needs. The least studied areas were the personal and interpersonal domains. These domains were only incorporated within interventions addressing multiple domains of developmental transitions. These insights can be helpful in guiding evidence-based practice and policy development, as well as informing gaps for future research programmes.

Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub-Saharan Africa: an exploration of ideas, interests and institutions

The vertical transmission of HIV occurs when an HIV-positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organizations (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV-positive mothers in resource-limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub-Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub-Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource-limited settings are not being translated into action by governments and front-line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation.

Clinical Practice Guidelines: The Need for Improved Implementation Strategies

Although substantial resources have been spent developing clinical practice guidelines, little effort has been made to evaluate the effectiveness of their implementation. In the absence of effective implementation, CPGs will have minimal impact on changing behaviours. This article critically reviews the literature and identifies a number of reasons why these guidelines have not been implemented successfully. If CPGs are to have a positive impact upon clinical behaviour and practice, then more aggressive and positive implementation strategies are indicated. Five key ingredients for successful implementation of quality CPGs are identified and recommended.

Competition, Organizational change, and conflict: the changing role of case managers in Ontario's homecare system.

As health care costs climb, governments continue to seek ways of controlling expenditures and improving accountability. One approach recently used by the government of Ontario to reform the delivery of homecare services focused on the introduction of competitive market forces in conjunction with the establishment of greater managerial controls over the activities of frontline health professionals. The purpose of this article is to assess how this “managed competition” model impacted the role of homecare case managers and their relationships with frontline health professionals. Data for this case study were obtained primarily through 36 in-depth key informant interviews with representatives from homecare provider agencies and the community care access centers (CCACs), which contract with the provider agencies for client services. The managed competition reform dramatically altered the role of homecare case managers by requiring them to take on greater responsibility for monitoring budgets and rationing services. This shift from a collaborative to a competitive system promoted conflict between case managers and other health care professionals. In the presence of an increasingly bureaucratized case manager role, interprofessional conflict and a focus on cost containment seems to have left clients without any clear advocate of their interests.

Impact of information and communication technology on interprofessional collaboration for chronic disease management: a systematic review:

Objectives Information and communication technology is often lauded as the key to enhancing communication among health care providers. However, its impact on interprofessional collaboration is unclear. The objective of this study was to determine the extent to which it improves communication and, subsequently, enhances interprofessional collaboration in chronic disease management. Methods A systematic review of academic literature using two electronic platforms: HealthSTAR and Web of Science (core collection and MEDLINE). To be eligible for inclusion in the review, articles needed to be peer-reviewed; accessible in English and focused on how technology supports, or might support, collaboration (through enhanced communication) in chronic disease management. Studies were assessed for quality and a narrative synthesis conducted. Results The searches identified 289 articles of which six were included in the final analysis (three used qualitative methods, two were descriptive and one used mixed methods). Various forms of information and communication technology were described including electronic health records, online communities/learning resources and telehealth/telecare. Three themes emerged from the studies that may provide insights into how communication that facilitates collaboration in chronic disease management might be enhanced: professional conflict, collective engagement and continuous learning. Conclusions The success of technology in enhancing collaboration for chronic disease management depends upon supporting the social relationships and organization in which the technology will be placed. Decision-makers should take into account and work toward balancing the impact of technology together with the professional and cultural characteristics of health care teams.

Preventing Youth from Falling Through the Cracks Between Child/Adolescent and Adult Mental Health Services: A Systematic Review of Models of Care

Optimizing the transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) is a priority for healthcare systems. The purpose of this systematic review is to: (1) identify and compare models of care that may be used to facilitate the transition from CAMHS to AMHS; and (2) discuss trends and implications to inform future research and practice. Results identified three models of care which move beyond healthcare services and incorporate a broader range of services that better meet the dynamic needs of transition-aged youth. Joint working among providers, coupled with individualized approaches, is essential to facilitating continuity of care.

Fidelity to Assertive Community Treatment Program Standards: A Regional Survey of Adherence to Standards

In 2004, the Ontario government approved revised program standards for the operation of Assertive Community Treatment (ACT) programs in the province. This paper reports on results from The 2005 Survey of ACT Programs in Ontario. We provide a profile of ACT programs in the province and identify respondents’ perceptions of the extent to which the revised program standards have been complied with and are thought to be essential for the effective operation of an ACT program. Program Coordinators completed surveys for 56 (85%) of the 66 ACT programs in existence at the time. None of the Program Coordinators reported that their ACT program was fully compliant with all program standards and only 4% of ACT programs were identified as being fully compliant with more than 75% of the program standards. Conclusions are provided and the broader implications of lower fidelity to program standards are discussed.