“You Might Lose Him Through the Cracks”: Clinicians’ Views on Discharge from Assertive Community Treatment

Bromley, Elizabeth; Mikesell, Lisa; Armstrong, Nikki Panasci; Young, Alexander S.

doi:10.1007/s10488-014-0547-3

Cited by 11 publications

(11 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies have found clinicians' perceptions of client-centeredness to conflict with their perceived need for coercion. In mental health contexts, diverse factors may encourage some degree of coercion including that clinicians often work in underresourced contexts where ideal 27 treatment is not available and work with individuals for whom risk-taking can result in serious consequences including homelessness or rehospitalization (Bromley, Mikesell, Armstrong & Young, 2014). While we also found such discordance between the need for both client-centeredness and coercion, it did not merely stem from beliefs that clinicians' knowledge is superior but appeared to equally arise from beliefs about clinicians' roles (cf.…”

Section: Role Of Epistemic Expertise In Managing Informationmentioning

confidence: 99%

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

Mikesell

Bromley

Young

et al. 2015

Health Communication

Self Cite

View full text Add to dashboard Cite

Shared decision making (SDM) interventions aim to improve client autonomy, information sharing and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued clientcentered priorities such as autonomy and empowerment when making decisions.However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: 1) the role of communication and information exchange and 2) the value and stability of clinician and client epistemic expertise.Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of SharedDecision Making (CEM-SDM).3The quality of mental health care has been argued to be largely dependent on the quality of client-clinician communication (Priebe & McCabe, 2008), which is critical for accomplishing clinical tasks and improving health outcomes (Alegría et al., 2008;Wissow et al., 2008). The model of shared decision making (SDM) reconceptualizes client-clinician communication (Patel, Bakken & Ruland, 2008) by redefining the terms by which participants come together to make treatment decisions (Drake, Deegan & Rapp, 2010). In a SDM frame, neither clinicians (paternalistic model) nor clients (informed choice model) are singularly responsible for making decisions (Makoul & Clayman, 2006). Instead, decision making is characterized by the exchange of unbiased information (Drake et al., 2010), collaboration (Charles, Gafni & Whelan, 1999) and mutual respect for differing expertise (Deegan & Drake, 2006). Given the centrality of communication in mental health care, we believe the assumptions underlying SDM warrant critical examination.For instance, despite widespread support for SDM, its principles are not uniformly perceived or advocated. Not all clients desire high levels of autonomy (Levinson, Kao, Kuby & Thisted, 2005; Say, Murtagh & Thompson, 2006), and psychiatrists have been found to both value and criticize elements of SDM including the exchange of unbiased information (Seale, Chaplin, Lelliott & Quirk, 2006). To elucidate these discrepancies, we elicited perspectives from clients and mental health clinicians about their experiences making and facilitating medication decisions and about strategies that might suppo...

show abstract

Section: Role Of Epistemic Expertise In Managing Informationmentioning

confidence: 99%

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

Mikesell

Bromley

Young

et al. 2015

Health Communication

Self Cite

View full text Add to dashboard Cite

show abstract

“…Although education has been shown to be effective in reducing stigma and improving staff capacity to manage service users, efforts to improve nurses’ and other clinicians’ attitudes and behaviours are most effective and sustainable when they also address extant beliefs, perceived or actual priorities and current practices (Bromley et al . , Gras et al . ).…”

Section: Discussionmentioning

confidence: 99%

“…Several initiatives have been implemented to improve the care and management of service users with medical co‐morbidity (Bromley et al . , Lally et al . , Li et al .…”

Section: Introductionmentioning

confidence: 99%

Improving care planning and coordination for service users with medical co‐morbidity transitioning between tertiary medical and primary care services

Cranwell

Polacsek

McCann

2016

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Accessible summaryWhat is known on the subject?• Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments.• Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services.• Little is known about mental health nurses' perspectives about how to address these problems.What this paper adds to existing knowledge?• Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive.• The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation.• Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular.What are the implications for practice?• Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity.• Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments. AbstractIntroduction: Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim: To explore mental health nurses' perspectives of the experience of service users with medical co-morbidity in tertiary medical services, and to identify how to improve care planning and coordination for service users transitioning between tertiary medical and primary care services. Method: Embedded within an experience-based

show abstract

“…ACT exits have been identified as both planned and voluntary, as well as, unplanned and involuntary exits. Planned, voluntary ACT service exits occur through achieving recovery and transferring to less intensive services, while involuntary unplanned exits from care are the result of service refusal or long-term institutionalization (i.e., jail or hospital/nursing home; Bromley et al, 2015Bromley et al, , 2017Chen & Herman, 2012;Finnerty et al, 2015;Mantzouranis et al, 2019). To date, there is limited published research of TIP and AMP!…”

Section: Young Adults Service Disengagementmentioning

confidence: 99%

Developing a community-based multidisciplinary service exit typology for young adults with serious mental health conditions.

Klodnick

Johnson

Brenits

et al. 2021

Psychiatric Rehabilitation Journal

View full text Add to dashboard Cite

Objective: Increasingly, community mental health providers are implementing multidisciplinary treatment models blending child and adult evidence-based practices to boost young adult engagement. Although promising, limited research examines how and why young adults disengage from these new models. This study examines provider documentation of treatment discharges to create a more developmentally-attuned young adult service exit typology. Method: Service records of 18-25 year-olds (n = 124) who discharged from a young adult-tailored multidisciplinary treatment team over a 5-year period were analyzed. A research team conducted a systematic content analysis of discharge forms and service notes. Planned and unplanned exits emerged as primary categories, each having distinct subcategories with noted prevalent associated experiences. Results: Participants (n = 124) were enrolled between 7 days to 3.80 years (M = 11.41 months) prior to exit. Those with "planned" exits (n = 71) were enrolled longer than those with "unplanned" exits (n = 53), means respectively 13.17 versus 9.06 months. Planned exits included: transitions either to a lower, similar or higher level of care, a return to previous provider, or insurance issues. Moving outside team geographic area contributed to planned and unplanned exits. Unplanned exits were disproportionately found among participants who were Black, had justice involvement histories, and/or experienced housing instability or homelessness. Conclusions and Implications for Practice: Young adult service exits are complex; planned exits are not always positive and unplanned exits are not always negative. Provider and research use of this new service exit typology has particular implications for identifying engagement disparities-and further tailoring models to be more attractive, culturally responsive, and impactful with young adults. Impact and ImplicationsThis study created a young adult multidisciplinary service exit typology for system, provider, and research use. The typology details planned exits (i.e., to lower, similar or higher level of care, previous provider return, insurance issue) and unplanned exits (i.e., unable to contact, service decline, abrupt move, incarceration, death). This typology has implications for identifying disparities in service engagement-and further tailoring services to be more attractive, culturally responsive, and impactful.

show abstract

“You Might Lose Him Through the Cracks”: Clinicians’ Views on Discharge from Assertive Community Treatment

Cited by 11 publications

References 41 publications

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts

Improving care planning and coordination for service users with medical co‐morbidity transitioning between tertiary medical and primary care services

Developing a community-based multidisciplinary service exit typology for young adults with serious mental health conditions.

Contact Info

Product

Resources

About