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Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol
Background
Evidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate conducive to EBP implementation. The leadership and organizational change for implementation (LOCI) intervention includes leadership training for workgroup leaders, ongoing implementation leadership coaching, 360° assessment, and strategic planning with top and middle management regarding how they can support workgroup leaders in developing a positive EBP implementation climate.
Methods
This test of the LOCI intervention will take place in conjunction with the implementation of motivational interviewing (MI) in 60 substance use disorder treatment programs in California, USA. Participants will include agency executives, 60 program leaders, and approximately 360 treatment staff. LOCI will be tested using a multiple cohort, cluster randomized trial that randomizes workgroups (i.e., programs) within agency to either LOCI or a webinar leadership training control condition in three consecutive cohorts. The LOCI intervention is 12 months, and the webinar control intervention takes place in months 1, 5, and 8, for each cohort. Web-based surveys of staff and supervisors will be used to collect data on leadership, implementation climate, provider attitudes, and citizenship. Audio recordings of counseling sessions will be coded for MI fidelity. The unit of analysis will be the workgroup, randomized by site within agency and with care taken that co-located workgroups are assigned to the same condition to avoid contamination. Hierarchical linear modeling (HLM) will be used to analyze the data to account for the nested data structure.
Discussion
LOCI has been developed to be a feasible and effective approach for organizations to create a positive climate and fertile context for EBP implementation. The approach seeks to cultivate and sustain both effective general and implementation leadership as well as organizational strategies and support that will remain after the study has ended. Development of a positive implementation climate for MI should result in more positive service provider attitudes and behaviors related to the use of MI and, ultimately, higher fidelity in the use of MI.
Trial registration
This study is registered with Clinicaltrials.gov (
NCT03042832
), 2 February 2017, retrospectively registered.
Journal Article
The inner life of the counselor
\"To feed the interior life of the counselor is not only a sensible act for the helper, it is a true act of generosity for those they serve as well. This book directs counselors to consider their own sense of self and how they are-and are not-living a personally and professionally meaningful, mindful life. Each chapter presents a theme in a way that mental health professionals will find helpful and immediately applicable to understanding their own journey as they seek to reach out to help others in need\"-- Provided by publisher.
Book
Increasing access to health workers in remote and rural areas through improved retention : global policy recommendations
Half the world's people currently live in rural and remote areas. The problem is that most health workers live and work in cities. This imbalance is common to almost all countries and poses a major challenge to the nationwide provision of health services. Its impact, however, is most severe in low income countries. There are two reasons for this. One is that many of these countries already suffer from acute shortages of health workers - in all areas. The other is that the proportion of the population living in rural regions tends to be greater in poorer countries than in rich ones. The World Health Organization (WHO) has therefore drawn up a comprehensive set of strategies to help countries encourage health workers to live and work in remote and rural areas. These include refining the ways students are selected and educated, as well as creating better working and living conditions. The first step has been to establish what works, through a year-long process that has involved a wide range of experts from all regions of the world. The second is to share the results with those who need them, via the guidelines contained in this document. The third will be to implement them, and to monitor and evaluate progress, and - critically - to act on the findings of that monitoring and evaluation. The guidelines are a practical tool that all countries can use. As such, they complement the WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted by the Sixty-third World Health Assembly in May 2010. The Code offers a framework to manage international migration over the medium to longer term. The guidelines are a tool that can be used straight away to address one of the first triggers to internal and international migration - dissatisfaction with living and working conditions in rural areas. Together, the code of practice and
these new guidelines provide countries with instruments to improve workforce distribution and enhance health services. Doing so will address a long-standing problem, contribute to more equitable access to health care, and boost prospects for improving maternal and child health and combating diseases such as AIDS, tuberculosis and malaria.
eBook
Collaboration With People With Lived Experience of Mental Illness to Reduce Stigma and Improve Primary Care Services
Collaboration with people with lived experience of mental illness (PWLE), also referred to as service users, is a growing priority to reduce stigma and improve mental health care.
To examine feasibility and acceptability of conducting an antistigma intervention in collaboration with PWLE during mental health training of primary care practitioners (PCPs).
This pilot cluster randomized clinical trial was conducted from February 7, 2016, to August 10, 2018, with assessors, PCPs, and patients blinded to group assignment. The participants were PCPs and primary care patients diagnosed with depression, psychosis, or alcohol use disorder at primary care facilities (the cluster unit of randomization) in Nepal. Statistical analysis was performed from February 2020 to February 2021.
In the control group, PCPs were trained on the World Health Organization Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). In the Reducing Stigma Among Healthcare Providers (RESHAPE) group, the mhGAP-IG trainings for PCPs were cofacilitated by PWLE who presented recovery testimonials through photographic narratives.
Prespecified feasibility and acceptability measures were adequacy of randomization, retention rates, intervention fidelity, data missingness, and safety. Outcome measures for PCPs included the Social Distance Scale (SDS), accuracy of diagnoses of mental illness in standardized role-plays using the Enhancing Assessment of Common Therapeutic factors tool (ENACT), and accuracy of diagnosis with actual patients. The primary end point was 16 months posttraining.
Among the overall sample of 88 PCPs, 75 (85.2%) were men and 67 (76.1%) were upper caste Hindus; the mean (SD) age was 36.2 (8.8) years. Nine of the PCPs (10.2%) were physicians, whereas the remaining 79 PCPs (89.8%) were health assistants or auxiliary health workers. Thirty-four facilities were randomized to RESHAPE or the control group. All eligible PCPs participated: 43 in RESHAPE and 45 in the control group, with 76.7% (n = 33) and 73.3% (n = 33) retention at end line, respectively. Due to PCP dropout, 29 facilities (85.3%) were included in end line analysis. Of 15 PWLE trained as cofacilitators, 11 (73.3%) participated throughout the 3 months of PCP trainings. Among PCPs, mean SDS changes from pretraining to 16 months were -10.6 points (95% CI, -14.5 to -6.74 points) in RESHAPE and -2.79 points (-8.29 to 2.70 points) in the control group. Role-play-based diagnoses with ENACT were 78.1% (25 of 32) accurate in RESHAPE and 66.7% (22 of 33) in the control group. Patient diagnoses were 72.5% (29 of 40) accurate by PCPs in RESHAPE compared with 34.5% (10 of 29) by PCPs in the control group. There were no serious adverse events.
This pilot cluster randomized clinical trial found that procedures were feasible and acceptable for PCPs to be trained by PWLE. These pilot results will help inform a full trial to evaluate benefits of collaboration with PWLE during training of PCPs to reduce stigma and improve diagnostic accuracy.
ClinicalTrials.gov Identifier: NCT02793271.
Journal Article
Health and fitness professionals : practical career guide
\"If you are interested in a career in the health and fitness field (the allied health field, as it is often called), you've come to the right book. So what exactly do these people do on the job, day in and day out? What kind of skills and educational background do you need to succeed in these fields? How much can you expect to make, and what are the pros and cons of these various fields? ... [Including] interviews with professionals in the field, [the book] covers six main areas of health and fitness: ... physical therapy, occupational therapy, recreational therapy, exercise physiology, massage therapy, [and] athletic training\"--Publisher marketing.
Book
Fragile heroes. The psychological impact of the COVID-19 pandemic on health-care workers in Italy
This survey-based study aimed to explore the mental health status and psychological care needs of 933 health-care workers in Italy during the COVID-19 outbreak. Sociodemographic data, exposure to COVID-19, perception of psychological care needs, depression, anxiety, somatization, and post-traumatic symptoms were concurrently assessed. The majority of the sample (71%) suffered from somatization and 55% of distress. Female care workers experienced higher levels of anxiety (d = 0.50) and somatization symptoms (d = 0.82) and stated they needed psychological care more than men (p < .001). Younger participants (aged <40 years-old) reported higher levels of somatization, depression, anxiety, and post-traumatic symptoms (effects size range from d = 0.22 to d = 0.31). Working in a high infected area (red-zones) and directly with COVID-19 patients (front-line) affected the psychological health of participants to a smaller degree. Health-care workers who lost one of their patients reported higher levels of depression (d = 0.22), anxiety (d = 0.19), post-traumatic symptoms (d = 0.30), and psychological care needs than those who did not have the same experience (p < .01). Health-care workers who perceived the need for psychological support scored above the clinical alarming level (cut-off scores) in all the psychological scales, ranging from 76% to 88%. Psychological distress (p < .01), anxiety (p < .05), depression (p < .05), and being women (p < .01) contribute to explain the need for psychological care and accounted for 32% of the variance in this sample. These findings point out the importance to consider the psychological impact of COVID-19 on Italian health-care workers and strongly suggest establishing psychological support services for providing adequate professional care.
Journal Article
A randomized controlled trial of empathetic refutational learning with health care professionals
Background
Health care professionals are in a key position to promote vaccinations. However, consulting vaccine-hesitant patients can be difficult, especially when patients bring up anti-vaccination arguments. Whereas prior research has identified essential skills for refuting anti-vaccination arguments, little is known about how to acquire these skills. Our aim was to determine if empathetic refutational interview text scenarios help health care professionals build confidence and abilities in countering anti-vaccination arguments.
Methods
We conducted an online randomized controlled experiment with UK and Finnish health care professionals in which we randomly assigned them to an empathetic refutational interview group (
n
= 167) or a control group (
n
= 180). Participants in the empathetic refutational interview group were presented with examples of the empathetic refutational interview approach, which encompasses the identification of attitude roots, affirmations, corrections of misconceptions, and provision of facts. Control group participants received a standard facts-based approach. We examined posttest use of empathetic refutational interview techniques and pre- and posttest perceived difficulty of refuting anti-vaccination arguments.
Results
Participants in the empathetic refutational interview group used more empathetic affirmations than control group participants. The empathetic refutational interview group and the control group did not differ significantly in how often they explicitly tried to identify attitude roots, correct misconceptions, and provide vaccination facts, nor in how difficult they found anti-vaccination arguments to be to refute.
Conclusions
Brief empathetic refutational interview text scenarios can increase health care professionals’ use of affirmations when discussing vaccines with patients. Additional materials are needed to efficiently teach refutations of attitude roots.
Journal Article