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Providing the Right Support at the Right Time for People With Learning Disabilities: A Mixed-Methods Study to Identify Change Goals for a Demand, Capacity and Flow Quality Improvement Project
- James Cai, Joshua Barnett, Kirsty Haberland, Melanie Clarke, Grace Fysh, Catriona Chaplin, Ivy Lim, Michele Martiello, Ian Hall, Laura Checkley
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S3-S4
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Aims
1. To evaluate demand, capacity and flow of an integrated community learning disability service in a peri- and post-COVID-19 pandemic setting. 2. To improve flow of a community learning disability service. 3. To improve staff and service user satisfaction by engaging them and identifying common priorities.
MethodsWe collected demand and capacity data of all disciplines in a community learning disability service for 2021–2022.
We carried out focus groups with service users and their carers (N = 5) and surveyed them with a questionnaire consisting of 6 quantitative and 2 qualitative questions (N = 63), investigating the impact of waiting times on service user experience.
We surveyed staff from all disciplines (N = 20) with a questionnaire consisting of 3 qualitative questions, to identify their views on waiting times and areas to optimise.
We performed thematic analysis on all qualitative responses. We analysed quantitative data with descriptive statistics.
ResultsFrom 2021–22, the number of accepted referrals to individual disciplines increased: for example referrals to psychiatry increased by 51.6% and referrals to OT increased by 32%.
With regard to flow, the ratio of discharges to accepted referrals in the psychiatry discipline decreased from 1.5:1 to 0.6:1.
A significant proportion of service users reported waiting months (31%) or years (16%) to be seen by the learning disability team. 28% of service users reported additional problems while waiting to be seen. 31% were unaware whether they were on a waiting list or not. Quantitative data showed average waiting times for psychiatry services did not change from 2021–2022 (23.1 and 23.3 days respectively).
Thematic analysis from service users’ responses revealed an anxiety about needs not being met; a feeling of problems deteriorating while waiting; and communication issues.
Staff responses revealed desires to intervene sooner to prevent unnecessary deteriorations; and to increase team working between disciplines.
ConclusionQuantitative data analysis suggests a greatly increased demand for our service following the COVID-19 pandemic.
Our thematic analysis identifies concern of deterioration secondary to prolonged waiting times. It also highlights that communication could be improved.
As a result of this mixed-methods approach, the following change ideas were generated and are now being tested:
1. Improve communication with patients on waiting lists by testing an accessible customisable letter.
2. Organise more joint assessments and reviews of service users with multiple disciplines.
3. Short-term allocation of more urgent casework via a new integrated health and social care duty system.
The association between trajectories of change in social functioning and psychological treatment outcome in university students: a growth mixture model analysis
- Phoebe Barnett, Rob Saunders, Joshua E. J. Buckman, Syed Ali Naqvi, Satwant Singh, Joshua Stott, Jon Wheatley, Stephen Pilling
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- Journal:
- Psychological Medicine / Volume 53 / Issue 14 / October 2023
- Published online by Cambridge University Press:
- 06 March 2023, pp. 6848-6858
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Background
The transition to university and resultant social support network disruption can be detrimental to the mental health of university students. As the need for mental health support is becoming increasingly prevalent in students, identification of factors associated with poorer outcomes is a priority. Changes in social functioning have a bi-directional relationship with mental health, however it is not clear how such measures may be related to effectiveness of psychological treatments.
MethodsGrowth mixture models were estimated on a sample of 5221 students treated in routine mental health services to identify different trajectories of change in self-rated impairment in social leisure activities and close relationships during the course of treatment. Multinomial regression explored associations between trajectory classes and treatment outcomes.
ResultsFive trajectory classes were identified for social leisure activity impairment while three classes were identified for close relationship impairment. In both measures most students remained mildly impaired. Other trajectories included severe impairment with limited improvement, severe impairment with delayed improvement, and, in social leisure activities only, rapid improvement, and deterioration. Trajectories of improvement were associated with positive treatment outcomes while trajectories of worsening or stable severe impairment were associated with negative treatment outcomes.
ConclusionsChanges in social functioning impairment are associated with psychological treatment outcomes in students, suggesting that these changes may be associated with treatment effectiveness as well as recovery experiences. Future research should seek to establish whether a causal link exists to understand whether integrating social support within psychological treatment may bring additional benefit for students.
The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis
- Joshua E. J. Buckman, Rob Saunders, Zachary D. Cohen, Phoebe Barnett, Katherine Clarke, Gareth Ambler, Robert J. DeRubeis, Simon Gilbody, Steven D. Hollon, Tony Kendrick, Edward Watkins, Nicola Wiles, David Kessler, David Richards, Deborah Sharp, Sally Brabyn, Elizabeth Littlewood, Chris Salisbury, Ian R. White, Glyn Lewis, Stephen Pilling
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- Journal:
- Psychological Medicine / Volume 51 / Issue 7 / May 2021
- Published online by Cambridge University Press:
- 14 April 2021, pp. 1068-1081
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Background
This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care.
MethodsWe searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted.
ResultsTwelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions.
ConclusionsWhen adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.
Contributors
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- By W. Neil Adger, Jeroen Aerts, Armando Apan, Jessica Ayers, Jon Barnett, Juan F. Barrera, Simon P. J. Batterbury, Linda C. Botterill, Sarah Boulter, Edwin Castellanos, Declan Conway, Gustavo Cruz-Bello, W. Priyan, S. Dias, Markus G. Donat, Stephen Dovers, Thomas E. Downing, Hallie Eakin, C. J. Fotheringham, Andrew W. Garcia, Marisa C. Goulden, Daniela Guitart, John Handmer, Katharine Haynes, Sam S. L. Hettiarachchi, Saleemul Huq, Jiang Tong, David John Karoly, Jon E. Keeley, Diane Keogh, David King, Zbigniew W. Kundzewicz, Timothy M. Kusky, Karine Laaidi, Alain Le Tertre, Gregor C. Leckebusch, Matthew Mason, David M. Mills, Helda Morales, Michael J. Mortimore, Colette Mortreux, Karen O’Brien, Jean Palutikof, Mathilde Pascal, Bimal K. Paul, Munshi K. Rahman, William D. Snook, Su Buda, Alexandra D. Syphard, Melanie Thomas, Madeleine C. Thomson, Uwe Ulbrich, Pier Vellinga, George Walker, Joshua Whittaker
- Edited by Sarah Boulter, Griffith University, Queensland, Jean Palutikof, Griffith University, Queensland, David John Karoly, University of Melbourne, Daniela Guitart, Griffith University, Queensland
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- Book:
- Natural Disasters and Adaptation to Climate Change
- Published online:
- 05 October 2013
- Print publication:
- 14 October 2013, pp ix-xii
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List of contributors
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- By Jimmy N. Avari, Joshua Berman, David A. Brent, Benjamin D. Brody, Carolyn Broudy, Gerard E. Bruder, Deborah L. Cabaniss, Megan S. Chesin, Melissa P. DelBello, Davangere P. Devanand, Jordan W. Eipper, Jean Endicott, Eric A. Fertuck, Michael B. First, Benicio N. Frey, Emily Gastelum, Lucas Giner, Barbara L. Gracious, David J. Hellerstein, Aerin M. Hyun, David A. Kahn, Jürgen Kayser, S. Aiden Kelly, James H. Kocsis, Robert A. Kowatch, Gonzalo Laje, Martin J. Lan, Kyle A. B. Lapidus, Frances R. Levin, Sarah H. Lisanby, J. John Mann, Sanjay J. Mathew, Patrick J. McGrath, Francis J. McMahon, Barnett S. Meyers, Luciano Minuzzi, Diana E. Moga, Philip R. Muskin, Edward V. Nunes, Maria A. Oquendo, Ramin V. Parsey, Joan Prudic, Annie E. Rabinovitch, Drew Ramsey, Steven P. Roose, Moacyr A. Rosa, Bret R. Rutherford, Roberto Sassi, Peter A. Shapiro, Margaret G. Spinelli, Barbara H. Stanley, Meir Steiner, Jonathan W. Stewart, M. Elizabeth Sublette, Craig E. Tenke, Jiuan Su Terman, Michael Terman, Michael E. Thase, Helen Verdeli, Myrna M. Weissman
- Edited by J. John Mann, Columbia University, New York
- Edited in association with Patrick J. McGrath, Columbia University, New York, Steven P. Roose, Columbia University, New York
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- Book:
- Clinical Handbook for the Management of Mood Disorders
- Published online:
- 05 May 2013
- Print publication:
- 09 May 2013, pp vii-x
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Contributors
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Book:
- Essential Clinical Anesthesia
- Published online:
- 05 January 2012
- Print publication:
- 11 July 2011, pp xv-xxviii
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Microscopic Phenomena of Macroscopic Conseouences:Interfaces, Glasses, and Small Aggregates
- Uzi Landman, R. N. Barnett, C. L. Cleveland, W. D. Luedtke, M. W. Ribarsky, Dafna Scharf, Joshua Jortner
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- Journal:
- MRS Online Proceedings Library Archive / Volume 63 / 1985
- Published online by Cambridge University Press:
- 25 February 2011, 273
- Print publication:
- 1985
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Computer simulations open new avenues in investigations of complex material systems and phenomena. The methodology, development and applications of molecular dynamics simulations are discussed and the wealth of microscopic information revealed via simulations of interphase-interfaces, liquid metals, metallic glasses and small aggregates are demonstrated.