The Allegheny initiative for mental health integration for the homeless: integrating heterogeneous health services for homeless persons.
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The Allegheny Initiative for Mental Health Integration for the Homeless (AIM-HIGH) was a 3-year urban initiative in Pennsylvania that sought to enhance integration and coordination of medical and behavioral services for homeless persons through system-, provider-, and client-level interventions. On a system level, AIM-HIGH established partnerships between several key medical and behavioral health agencies. On a provider level, AIM-HIGH conducted 5 county-wide conferences regarding homeless integration, attended by 637 attendees from 72 agencies. On a client level, 5 colocated medical and behavioral health care clinics provided care to 1986 homeless patients in 4084 encounters, generating 1917 referrals for care. For a modest investment, AIM-HIGH demonstrated that integration of medical and behavioral health services for homeless persons can occur in a large urban environment. (+info)
Teaching self-administration of suctioning to children with tracheostomies.
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We examined the effectiveness of using dolls to teach young children with tracheostomies to self-administer a suctioning procedure. Four children between the ages of 5 and 8 years, who had had tracheostomies for 6 months or longer, participated. After skills were taught via doll-centered simulations, in vivo skills were evaluated. All of the training and probe sessions were conducted in the participants' classrooms or homes. Results of a multiple baseline design across subjects and skill components indicated that the performance of all children improved as a function of training. Skill maintenance was demonstrated by all participants during follow-up assessments conducted 2 to 6 weeks posttraining. Results of a questionnaire completed by caregivers and interviews with the children revealed high levels of satisfaction with the training procedures and outcomes. (+info)
Changing illness perceptions in patients with poorly controlled type 2 diabetes, a randomised controlled trial of a family-based intervention: protocol and pilot study.
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BACKGROUND: This paper presents the pilot study and protocol for a randomised controlled trial to test the effectiveness of a psychological, family-based intervention to improve outcomes in those with poorly controlled type 2 diabetes. The intervention has been designed to change the illness perceptions of patients with poorly controlled type 2 diabetes, and their family members. It is a complex psychological intervention, developed from the Self-Regulatory Model of Illness Behaviour. The important influence the family context can have in psychological interventions and diabetes management is also recognised, by the inclusion of patients' family members. METHODS/DESIGN: We aim to recruit 122 patients with persistently poorly controlled diabetes. Patients are deemed to have persistent poor control when at least two out of their last three HbA1c readings are 8.0% or over. Patients nominate a family member to participate with them, and this patient/family member dyad is randomly allocated to either the intervention or control group. Participants in the control group receive their usual care. Participants in the intervention group participate, with their family members, in three intervention sessions. Sessions one and two are delivered in the participant's home by a health psychologist. Session one takes place approximately one week after session two, with the third session, a follow-up telephone call, one week later. The intervention is based upon clarifying the illness perceptions of both the patient and the family member, examining how they influence self-management behaviours, improving the degree of similarity of patient and family member perceptions in a positive direction and developing personalized action plans to improve diabetes management. DISCUSSION: This study is the first of its kind to incorporate the evidence from illness perceptions research into developing and applying an intervention for people with poorly controlled diabetes and their families. This study also acknowledges the important role of family members in effective diabetes care. TRIAL REGISTRATION: ISRCTN62219234. (+info)
Tailored interventions to promote mammography screening: a meta-analytic review.
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OBJECTIVE: To evaluate the effectiveness of tailored interventions, designed to reach one specific person based on her unique characteristics, for promoting mammography use. METHOD: This systematic review used meta-analytic techniques to aggregate the effect size of 28 studies published from 1997 through 2005. Potential study-level moderators of outcomes (sample, intervention, and methodological characteristics) were also examined. RESULTS: A small but significant aggregate odds ratio effect size of 1.42 indicated that women exposed to tailored interventions were significantly more likely to get a mammogram (p<0.001). The type of population recruited and participants' pre-intervention level of mammography adherence did not significantly influence this effect. Tailored interventions that used the Health Belief Model and included a physician recommendation produced the strongest effects. Interventions delivered in person, by telephone, or in print were similarly effective. Finally, defining adherence as a single recent mammogram as opposed to regular or repeated mammograms yielded higher effect sizes. CONCLUSION: Tailored interventions, particularly those that employ the Health Belief Model and use a physician recommendation, are effective in promoting mammography screening. Future investigations should strive to use more standardized definitions of tailoring and assessments of mammography outcomes. (+info)
The Southcentral Foundation depression collaborative.
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OBJECTIVES: To describe a collaborative between a primary care clinic and a behavioral health clinic to treat depression among Alaska Native and American Indian patients. STUDY DESIGN: Cross-sectional study. METHODS: Protocols for screening and intervention are described. The Patient Health Questionnaire identified individuals as negative or positive for DSM-IV depression. A computerized medical record was queried for descriptive data. Distribution of depression symptoms and diagnoses, antidepressant prescription, and service utilization highlight successes and weaknesses. RESULTS: Of those screened (n = 14,648), 17.2% (n = 2,534) screened positive for depression. A little more than half (57%) of positives were prescribed antidepressant medications. Roughly 55% of patients who initially screened positive scored negative for depression after follow-up. Less than half (42%) of patients who initially screened positive had received specialty behavioral health care or a mood disorder diagnosis during the previous year. CONCLUSIONS: This program successfully identified and treated the depressive symptoms of many Alaska Native and American Indian patients who had not presented for specialty care and had not previously been diagnosed as depressed. Implementing similar programs elsewhere may help address depression as a significant health concern in the Alaska Native and American Indian population. Recommendations for future investigation are delineated to guide program improvement efforts and add to the general health disparities literature. (+info)
How and why criteria defining moderators and mediators differ between the Baron & Kenny and MacArthur approaches.
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