The disturbingly high levels of variability in EPI implementation across jurisdictions suggest a pressing need for a set of nationally agreed uniform EPI implementation standards. Additional specific strategies for rural and remote mental health services may be needed for these services to implement EPI.
The literature that is relevant to evaluation of treatment effectiveness is large, scattered and difficult to assemble for appraisal. This scoping review first develops a conceptual framework to help organize the field, and second, uses the framework to appraise early psychosis intervention (EPI) studies. Literature searches were used to identify representative study designs, which were then sorted according to evaluation approach. The groupings provided a conceptual framework upon which a map of the field could be drawn. Key words were cross-checked against definitions in dictionaries of scientific terms and the National Library of Medicine Medical Subject Headings (MeSH) browser. Using the final list of key words as search terms, the EPI evaluation literature was appraised. Experimental studies could be grouped into two classes: efficacy and effectiveness randomized controlled trials. Non-experimental studies could be subgrouped into at least four overlapping categories: clinical epidemiological; health service evaluations; quality assurance studies; and, quasi-experimental assessments of treatment effects. Applying this framework to appraise EPI studies indicated promising evidence for the effectiveness of EPI irrespective of study design type, and a clearer picture of where future evaluation efforts should be focused. Reliance on clinical trials alone will restrict the type of information that can inform clinical practice. There is convergent evidence for the benefits of specialized EPI service functions across a range of study designs. Greater investment in health services research and quality assurance approaches in evaluating EPI effectiveness should be made, which will involve scaling up of study sizes and development of an EPI programme fidelity rating template. The degree of complexity of the evaluation field suggests that greater focus on research methodology in the training of Australasian psychiatrists is urgently needed.
This article reports a test of multisystemic predictors of therapeutic engagement (TE) with adolescent sexual offenders (ASOs), and an evaluation of clinical efforts to improve TE with this client group. First, clinicians rated their TE with 105 Australian court-referred male ASOs (M = 15.53 years; SD = 1.30 years), who participated in treatment between 2001 and 2005. For this cohort, correlation analysis showed impulsivity/antisociality, negative peer relationships, and indigenous race to be associated with poorer TE. Multiple regression analysis identified impulsivity/antisociality and indigenous race as significant unique predictors. Clinical efforts subsequently focused on improving TE, particularly with higher-antisocial youth and with indigenous youth and their families. Clinicians then rated TE with a second, independent cohort of 54 court-referred male ASOs (M = 15.44 years; SD = 1.22 years), who participated in the modified treatment between 2006 and 2009. A two-way ANCOVA, controlling for impulsivity/antisociality, indicated significant improvements in TE for both indigenous and non-indigenous ASOs. Despite these general improvements, indigenous ASOs remained comparatively less engaged than their non-indigenous counterparts.
Delivery of high‐quality mental health services to clients in regional and remote areas in Australia presents significant challenges. Griffith Youth Forensic Service (GYFS) provides specialised, state‐wide assessment and systemic treatment services for young people in Queensland who have committed sexual offences. In an effort to provide equitable, ecologically valid services, GYFS clinicians recruit local para/professionals as collaborative partners in interventions. The success of GYFS interventions relies partly on the skills, knowledge and confidence of collaborative partners to work effectively. This study examines (a) the effectiveness of collaborative partnerships in enhancing knowledge, skills and confidence, and (b) the perspectives of collaborative partners regarding the collaborative model. Participant self‐reports (n = 47 collaborative partners) indicated that skills, knowledge and confidence were significantly increased over the collaboration, were maintained for 1 year, and that increased knowledge, skills and confidence were associated with perceived improvements in client outcomes.
Internationally, best practice for prison health care recommends transferring health service provision from corrections to health authorities. Although it is expected that this change will result in improved health care, there is little evidence of evaluation. This article used qualitative interviews with health service providers to gain insight into the health needs of women's prisons in Queensland, Australia, both prior to and after the transition in health care service provision. We found that service providers identified that problems persisted regardless of service provider and that improvement required increased resources and more fundamental structural changes within prison environments.
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