Development of the Huddle Observation Tool for structured case management discussions to improve situation awareness on inpatient clinical wards
Background: ‘Situation Awareness For Everyone’ (SAFE) was a 3-year project which aimed to improve situation awareness in clinical teams in order to detect potential deterioration and other potential risks to children on hospital wards. The key intervention was the ‘huddle’, a structured case management discussion which is central to facilitating situation awareness. This study aimed to develop an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle.
Edbrooke-Childs, J., Hayes, J., Sharples, E., Gondek, D., Stapley, E., Sevdalis, N., Lachman, P. & Deighton, J. (2017). Development of the Huddle Observation Tool for structured case management discussions to improve situation awareness on inpatient clinical wards. BMJ. doi: 10.1136/bmjqs-2017-00651
Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors and service providers on number of appointments
Background: Case-mix classification is a focus of international attention in considering how best to manage and fund services, by providing a basis for fairer comparison of resource utilization. Yet there is little evidence of the best ways to establish case mix for child and adolescent mental health services (CAMHS).
Martin, P., Davies, R., Macdougall, A., Ritchie, B., Vostanis, P., Whale, A., & Wolpert, M. (2017). Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors and service providers on number of missed appointments. Journal of Mental Health, 1-8.
Commentary: Why measuring clinical change at the individual level is challenging but crucial – commentary on Jensen and Corralejo (2017)
Abstract: Jensen and Corralejo highlight that most mental health intervention research focuses on the group level rather than individual level. They looked at parent‐reported outcomes for up to 24 children and found that individual‐level findings appear to tell a less positive story than the more traditional group‐level finding. They call for more reporting of outcomes at individual level.
Wolpert, M. Commentary: Why measuring clinical change at the individual level is challenging but crucial - commentary on Jensen and Corralejo (2017). (2017). Child and Adolescent Mental Health. 22(3), 167-169.
Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England (2009–2014)
Edbrooke-Childs, J., Deighton, J., & Wolpert, M. (2017). Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England (2009-2014). Journal of Adolescence, 60, 47-5
High integrity mental health services for children: focusing on the person, not the problem
Background: Around 1 in 10 children and young people worldwide have mental health difficulties that substantially affect their lives. Even in high income countries only a small minority of these people access specialist support, which has led to demands for more mental health specialists.1 We support these calls but think that focusing exclusively on the need for more healthcare professionals is not enough. We need to move away from approaches led by professionals that focus on problems towards care that is person centred and focused on progress.
Wolpert, M., Vostanis, P., Martin, K., Munk, S., Norman, R., Fonagy, P., & Feltham, A. (2017). High integrity mental health services for children: focusing on the person, not the problem. BMJ. doi:10.1136/bmj.j1500
New approaches to measurement and management for high integrity health systems
Background: Healthcare economies across the globe are in crisis. High income countries—whether their healthcare economies are market driven like the US or tax funded like the UK—are struggling with relentless demand for more services that are increasingly costly to deliver. Low and middle income countries are struggling to provide better and more equitable access to potentially lifesaving interventions while wisely allocating scarce resources across all sectors that affect human and social development. In rich and poor countries alike, policy makers, citizens, and health professionals are drawn to technology but are not learning how to use it most effectively or from mistakes made when its limits go unrecognised or unheeded.1
Mulley, A., Coulter, A., Wolpert, M., Richards, T., & Abbasi, K. (2017). New approaches to measurement and management for high integrity health systems. BMJ. doi:10.1136/bmj.j1401
Using patient‐reported outcome measures to improve service effectiveness for supervisors: a mixed‐methods evaluation of supervisors' attitudes and self‐efficacy after training to use outcome measures in child mental health
Background: Patient‐reported outcome measures (PROMs) are recommended by healthcare systems internationally, but there are a number of barriers to implementation. The aim of this research was to examine the impact of training supervisors in using PROMs on clinical practice, given the importance of leadership when changing behaviour.
Fullerton, M., Edbrooke-Childs, J., Law, D., Martin, K., Whelan, I., & Wolpert, M. (2017). Using patient-reported outcome measures to improve service effectiveness for supervisors: a mixed-methods evaluation of supervisors' attitudes and self-efficacy after training to use outcome measures in child mental health. Child and Adolescent Mental Health. doi: 10.1111/camh.12206
Goal formulation and tracking in child mental health settings: when is it more likely and is it associated with satisfaction with care?
Abstract: Goal formulation and tracking may support preference-based care. Little is known about the likelihood of goal formulation and tracking and associations with care satisfaction. Findings of the present research suggest that goal formulation and tracking may be an important part of patient satisfaction with care. Clinicians should be encouraged to consider goal formulation and tracking when it is clinically meaningful as a means of promoting collaborative practice.
Jacob, J., De Francesco, D., Deighton, J., Law, D., Wolpert, M., & Edbrooke-Childs, J. (2017). Goal formulation and tracking in child mental health settings: when is it more likely and is it associated with satisfaction with care? European Child & Adolescent Psychiatry. doi:10.1007/s00787-016-0938-y
Service-level variation, patient-level factors, and treatment outcome in those seen by child mental health services
Abstract: Service comparison is a policy priority but is not without controversy. This paper aims to investigate the amount of service-level variation in outcomes in child mental health, whether it differed when examining outcomes unadjusted vs. adjusted for expected change over time, and which patient-level characteristics were associated with the difference observed between services. Comparison of services with high proportions of young people with autism or infrequent case characteristics requiring specialist input needs particular caution as these young people may be at greater risk of poor outcomes.
Edbrooke-Childs, J., Macdougall, A., Hayes, D., Jacob, J., Wolpert, M., & Deighton, J. (2017). Service-level variation, patient-level factors, and treatment outcome in those seen by child mental health services. European Child & Adolescent Psychiatry. doi:10.1007/s00787-016-0939-x
Facilitators and Barriers to Person-centred Care in Child and Young People Mental Health Services: A Systematic Review
Abstract: Implementation of person-centred care has been widely advocated across various health settings and patient populations, including recent policy for child and family services. Nonetheless, evidence suggests that service users are rarely involved in decision-making, whilst their preferences and goals may be often unheard. The aim of the present research was to systematically review factors influencing person-centred care in mental health services for children, young people and families examining perspectives from professionals, service users and carers. This was conducted according to best practice guidelines, and seven academic databases were searched. Overall, 23 qualitative studies were included. Findings from the narrative synthesis of the facilitators and barriers are discussed in light of a recently published systematic review examining person-centred care in mental health services for adults. Facilitators and barriers were broadly similar across both settings. Training professionals in person-centred care, supporting them to use it flexibly to meet the unique needs of service users whilst also being responsive to times when it may be less appropriate and improving both the quantity and quality of information for service users and carers are key recommendations to facilitate person-centred care in mental health services with children, young people and families.
Gondek, D. Edbrooke-Childs, J., Velikonja, T., Chapman, L., Saunders, F., Hayes, D., & Wolpert, M. (2017). Facilitators and barriers to person-centred care in child and young people mental health services: A systematic review.