Improving adoption of preventive care policy and care provision in community mental health services
The impact of an implementation support intervention on preventive care practices in community mental health clinics: A non-randomised trial.
University of Newcastle
600 participants
May 1, 2019
Interventional
Conditions
Summary
The aim of this quality improvement project is to implement and examine the effectiveness of strategies to support clinical staff in the provision of the preventive care policy within community mental health services in the Hunter New England LHD. An implementation intervention will be co-developed with the service to support clinicians to provide preventive care for tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity. Evidence based strategies such as education and training, feedback reports, aids to enable care provision, and a designated support person will be tailored, specifically to overcome the impediments to preventive care provision in community mental health. It is hypothesised that clients from the intervention service will receive higher levels of preventive care compared to a control service who will receive no implementation intervention.
Eligibility
Inclusion Criteria2
- CLIENTS: Clients eligible for participation in the computer-assisted telephone interviews (CATI) at baseline and follow-up will be those who: are 18 years or older; have attended at least one appointment in the last 4-months in the community mental health service. Additional client eligibility criteria will be assessed upon phone contact and will include: English speaking; not currently inpatient, not living in aged care facilities or jail, and being physically and mentally capable of responding to the survey items.
- CLINICIANS: All clinicians within the practice support service will receive the relevant implementation support intervention strategies. This includes psychiatrists, psychologists, social workers, dieticians, nurses and occupational therapists.
Exclusion Criteria1
- Clients who are under the age of 18 or identified as too unwell or clinically inappropriate to contact, have not attended at least one appointment in the last 4-months in the community mental health service, not English speaking, currently inpatient, living in aged care facilities or jail.
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Interventions
Supporting community mental health services to provide preventive care Model of preventive care to be implemented: In line with policy within the local health district (within which the trial is being conducted), community mental health clinicians are to use practices consistent with the AAR ‘Assess, Advise, Refer’ (AAR) model for the addressing preventable risk factors. The focus of this model is the routine assessment of preventable risk factors for chronic disease (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, inadequate physical activity), provision of very brief advice around the value in addressing these risk behaviours, and connection of clients to existing specialist evidence-based services to enable ongoing behaviour change support (referral). The provision of preventive care following the ‘AAR’ model allows health risks to be addressed, but not necessarily directly by mental health service clinicians, and has demonstrated effectiveness for reducing health risk behaviours. Implementation support intervention. One community mental health service will receive practice support strategies to support the implementation of preventive care practices (AAR) into routine practice. The strategies will be tailored to overcome the impediments to preventive care provision that are specific to the community mental health service context and developed collaboratively with clinicians in the practice support service. The final mode of training, and the specifics of the final intervention components will arise during the co-development process with the community mental health service representatives. It is likely that they will include evidence-based strategies such as: • education and training (interactive activities and face to face group training) • feedback reports, • aids to enable care provision (hardcopy and electronic materials and handouts designed specifically for the study) and • a designated support person (will be recruited from within the service to assist clinicians in putting the policy into practice) Community mental health clinicians: All clinicians within the selected service will receive the implementation support strategies. The training will be delivered over a minimum of 4 weeks. The frequency of the training delivered will be specified during the co-development planning stage with the community mental health service representatives.
Locations(1)
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ACTRN12619001379101