Journal Article

A focused ethnography of a Child and Adolescent Mental Health Service: factors relevant to the implementation of a depression trial

Welsh, P. R., Ekers, D., Tiffin, P. A., Lewis, S., Howey, L., Kitchen, C. E. W.

2017

Overview

Background Prior to commencing a randomised controlled trial, we conducted a focused ethnography to ensure that the trial was well suited to the proposed setting. Methods A six-month observation of a Child and Adolescent Mental Health Service site in the North-East of England was undertaken to observe the site procedures, staff culture and patient care pathways. During this period, documentary data were collected and interviews were conducted with key informants to provide insight into staff perceptions of the proposed trial. The data were coded using thematic analysis and the resulting themes were verified by a second coder. Results Seventeen documents were collected, 158 h of observation and six formal staff interviews were undertaken. Four themes emerged from the data; non-clinically orientated variation in practice, diagnosis , capacity and staff economy. Non-clinically orientated variation in practice occurred when staff decisions were based upon resource availability rather than on clinical judgement. Diagnosis demonstrated differing staff confidence in making diagnoses and in the treatment of patients who had received a diagnosis. Capacity consisted of the time to attend training and the psychological capacity to consider or incorporate learning into practice. Staff economy was characterised by staff changes and shortages. There was significant interaction between the themes, with staff economy emerging as a central barrier to research. The results directly informed adaptations to the trial protocol. Conclusions An ethnographic approach has provided important insights into the individual, practical and organisational boundaries into which a trial would need to be implemented.

• Publisher: BioMed Central,Springer Nature B.V,BMC
• Subject: Adolescent / Adolescent Behavior / Adolescent Health Services - organization & administration / Adolescent Health Services - standards / Anthropology, Cultural - standards / Attitude of Health Personnel / Biomedicine / Child / Child & adolescent mental health / Child and adolescent mental health services / Child Behavior / Child Health Services - organization & administration / Child Health Services - standards / Clinical Competence / Clinical medicine / Critical Pathways - organization & administration / Data collection / Delivery of Health Care, Integrated - organization & administration / Delivery of Health Care, Integrated - standards / Depression - diagnosis / Depression - psychology / Depression - therapy / England / Ethnography / Evidence-based nursing / Focused ethnography / Health Knowledge, Attitudes, Practice / Health Sciences / Health services / Humans / Intervention / Interviews / Medicine / Medicine & Public Health / Mental depression / Mental health care / Mental Health Services - organization & administration / Mental Health Services - standards / Mixed methods / Mixed methods research / Patients / Personnel Staffing and Scheduling / Pragmatic Clinical Trials as Topic - methods / Pragmatic trials / Psychologists / Qualitative / Qualitative Methods / Qualitative research / Randomised controlled trials / Randomized Controlled Trials as Topic - methods / Randomized Controlled Trials as Topic - standards / Research Design - standards / Statistics for Life Sciences / Teams / Teenagers / Time Factors / Trials and Systematic Reviews / Workload / Workplace - psychology