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Biomedical subjects

Paula Goering

Publications and source records attributed to Paula Goering.

At least 19 recordsLinked to original sources
PubMed2006

Does systems integration affect continuity of mental health care?

Continuity of care is a concern for mental health clients in the post deinstitutionalization era of community care. A proposed solution is systems integration. This paper reviewed research on systems integration, focusing on continuity of care outcomes. A positive association between systems integration and client continuity of care was consistently demonstrated. Better results were obtained in systems characterized by stronger management arrangements, fewer service sectors, and system wide implementation of intensive case management and centralized access to services. Future research should evaluate a wider range of systems integrating mechanisms, using client-based measures that more directly represent continuity of care experiences.

Case Management↗
PubMed2006

Who uses consumer-run self-help organizations?

A multisite evaluation of community mental health services is used to answer two questions: (a) How do diagnosis, functioning, and self-assessments of consumer/survivor initiative (CSI) and assertive community treatment (ACT) participants compare?, and (b) What other supports/services are CSI and ACT participants using? The sample is from an Ontario evaluation of consumer/survivor peer initiatives in four communities (n=73). The reference group is new (n=48) and ongoing (n=134) clients of four ACT teams. Self-help organizations are serving a broader population of individuals who include a significant subgroup of persons with severe mental illness along with others with a mixed picture of higher functioning and greater instability. There is little overlap in the use of these modes of service delivery, which suggests that maintaining options within systems of care is critical to ensuring coverage and access for the broader population.

Adult↗
PubMed2006

The clinical profile and service needs of hospitalized adults with mental retardation and a psychiatric diagnosis.

OBJECTIVE: This study compared patients with both mental retardation and a psychiatric diagnosis with patients who did not have co-occurring mental retardation who were served in Ontario's tertiary mental health care system in terms of demographic characteristics, symptom profile, strengths and resources, and clinical service needs. METHODS: A secondary analysis of data from the Colorado Client Assessment Record (CCAR) that were collected between 1999 and 2003 from all tertiary psychiatric hospitals in Ontario, Canada, was completed for a random sample of 3,927 cases, representing 12,470 patients receiving psychiatric services. RESULTS: Patients with both mental retardation and a psychiatric diagnosis differed from those who did not have mental retardation in terms of demographic characteristics, diagnostic and symptom profile, resources, and recommended level of care. More specifically, patients with both mental retardation and a psychiatric diagnosis had significantly worse ratings across nearly all CCAR functional domains and were assessed as requiring more than the recommended levels of care compared with other patients. CONCLUSIONS: Patients who have both mental retardation and a psychiatric diagnosis constitute a sizeable subgroup of an already underserved psychiatric hospital population. Greater attention is required to meet the unique clinical and service needs of this challenging group.

Comorbidity↗
PubMed2006

A group intervention to promote healthy self-concepts and guide recovery in first episode schizophrenia: A pilot study.

The stress associated with managing a first episode of schizophrenia and the secondary psychological sequelae may predispose young people to the phenomenon of illness engulfment, whereby personal identity is lost and replaced with a sense of self defined entirely by the illness. The overall objective of this pilot project was to provide an initial evaluation of the impact of a novel group intervention targeting improvement of self-concept (engulfment) and overall quality of life for young adults recovering from a first episode of schizophrenia. Fifty-two young adults diagnosed with a DSM-IV schizophrenia spectrum disorder were sequentially assigned to either a 12-week group intervention that provided members with opportunities to attain healthy self-concepts or a control group that received high quality treatment as usual. The two groups were compared on pretreatment, post-treatment, and 3-month post-treatment measures of engulfment, quality of life, and psychiatric symptoms. Allowing for dropouts, 26 subjects remained in the treatment group and 14 subjects in the control group after the 3-month follow-up. Participants in the treatment group demonstrated significant improvement in engulfment, quality of life (intrapsychic subscale) and symptoms, while the comparison group did not change. These preliminary results provide support for the benefits of a group intervention designed to enhance self-concept and to minimize the engulfing effects of illness.

Adaptation, Psychological↗
PubMed2005

Consulting as a strategy for knowledge transfer.

Academic researchers who work on health policy and health services are expected to transfer knowledge to decision makers. Decision makers often do not, however, regard academics' traditional ways of doing research and disseminating their findings as relevant or useful. This article argues that consulting can be a strategy for transferring knowledge between researchers and decision makers and is effective at promoting the "enlightenment" and "interactive" models of knowledge use. Based on three case studies, it develops a model of knowledge transfer-focused consulting that consists of six stages and four types of work. Finally, the article explores how knowledge is generated in consulting and identifies several classes of factors facilitating its use by decision makers.

Data Collection↗
PubMed2004

Lifetime rates of alcoholism in adults with anxiety, depression, or co-morbid depression/anxiety: a community survey of Ontario.

BACKGROUND: Separate lines of research have demonstrated strong associations linking alcohol misuse with major depression on the one hand, and anxiety disorders on the other. In the current study we examined the possible confounding and/or additive effects of co-morbid depression/anxiety in understanding these relationships. METHODS: A total of 7195 individuals in Ontario, aged 15-64, were interviewed using the CIDI. Based on lifetime diagnoses, we compared rates of alcohol abuse/dependence in four groups consisting of normal controls, individuals with unipolar major depression but no anxiety disorders, individuals with one or more anxiety disorders without depression, and individuals with co-morbid major depression and anxiety. Age of onset of alcoholism in the four study groups was also compared. RESULTS: In both genders, there were significantly higher rates of alcoholism in all three psychiatric groups relative to controls. In females only, there was also a significantly higher rate of alcoholism in the depressed/anxious group than in the pure anxious group. The age of onset of alcoholism was the same across all four study groups. LIMITATIONS: Due to limitations related to sample size, we combined subjects with various anxiety disorders into a single anxiety group and concurrent and sequential co-morbidity were not distinguished. CONCLUSIONS: Both gender effects and depression/anxiety co-morbidity may be important considerations in the design and interpretation of studies on alcohol misuse. This may be particularly relevant when considering the strength of the association between alcoholism and anxiety disorders in women. Depression and anxiety do not appear to influence the age of onset of alcoholism. Furthermore, no single temporal pattern of onset was identified in individuals with all three disorders, suggesting no obvious cause-effect relationship among them.

Adolescent↗
PubMed2004

Needs-based planning for persons with schizophrenia residing in board-and-care homes.

Data available from a recent planning project provided an opportunity to examine impairment and service needs of individuals with schizophrenia spectrum diagnoses living in a large board-and-care program. When first implemented, this minimum-support custodial program was assumed to be adequate for discharged long-term inpatients with schizophrenia and other chronic mental illnesses. However, the needs assessments indicated considerable heterogeneity in resident level of impairment. When a validated planning template was applied to assign residents to an appropriate level of care, almost one-quarter were assigned to independent living with minimal support, one-third to community living with intensive support, and 40 percent to residential or inpatient treatment. The authors conclude that this program is not able to meet the varying needs of residents. Despite a common diagnosis, many can function in more independent settings, while others need more treatment and rehabilitation than they are currently provided.

Adult↗
PubMed2004

Nature and prevalence of mental illness in the workplace.

This discussion paper explores the state of knowledge about the prevalence of mental illness and its effect on the working population. Major trends in the literature are also commented on, and significant gaps in knowledge are identified. Annually, 12% of Canadians from 15 to 64 years suffer from a mental disorder or substance dependence. Few studies have examined the prevalence of mental disorders among Canadian workers. Results from Ontario estimate that monthly, about 8% of the working population has a diagnosable mental disorder. Preliminary findings also indicate differences in the prevalence of mental disorders among workers with regard to occupation, age, sex, physical disorders, work environment and work-related stress. Studies indicate that mental and emotional health problems are associated with staggering social and economic costs, which create a heavy burden on the workplace. About one-third of society's depression-related productivity losses can be attributed to work disruptions. The impact of mental illness on the workplace has been examined in terms of its effect on presenteeism, absenteeism and disability days. The presence of any of these has been used to indicate decreased productivity, the largest burden arising from presenteeism. In total, Canada annually loses about $4.5 billion from this decreased productivity. Mental illness is also associated with short-term and long-term disability, which in turn is often related to insurance coverage. Mental illness related disability claims have doubled and mental illness accounts for 30% of disability claims, at a cost of $15 to $33 billion annually. The needs of the working population and employers must be addressed. We must be aware of patterns of mental disorder among occupational groups and industry sectors. In addition, we must understand how the disability benefit structure impacts the prevalence as well as patterns of disability related to mental illness. Effective policies and programs must be based on solid evidence.

Absenteeism↗
PubMed2004

Residential crisis units. Are we missing out on a good idea?

Residential Crisis Units (RCU) are non-hospital-based facilities that provide mental health crisis intervention. This paper reviews the RCU literature base and finds good evidence of the ability of RCUs to function as alternatives to hospitalization for many consumers, with equivalent effectiveness and for significantly less cost. Despite this promising research, the RCU model has not been widely adopted. Using two crisis units as case examples as well as key informant interviews, this paper explores factors affecting the lack of dissemination and potential barriers to the growth of the RCU model.

Canada↗
PubMed2004

Program structure and continuity of mental health care.

Continuity has been a much discussed but under-researched objective of mental health care, in part due to measurement challenges. A small body of research has identified program features associated with continuity, based on measures of service use. A recent planning project provided an opportunity to examine the effects of these features on continuity using a new self-report continuity measure. Nine program features were measured and linear regression analyses were used to assess the relationship between these features and continuity, controlling for client characteristics. Client continuity was higher in programs that offered some night or weekend coverage and lower in programs that provided more care in the community. This latter finding was unexpected and may represent program efforts to engage individuals experiencing difficulties with service access. The association between each of the other 7 program features and continuity was not significant. Possible explanations for this finding are explored.

Community Mental Health Services↗
PubMed2003

Childhood adversities associated with major depression and/or anxiety disorders in a community sample of Ontario: issues of co-morbidity and specificity.

It has been well established that early adversity is a major risk factor for depression and for anxiety disorders in various populations and age groups. Few studies have considered the relative strength of these associations and the possible role of co-morbid depression/anxiety in understanding them. Using data from a large community sample of Ontario, Canada, we examined the relative strength of the associations between early physical abuse, sexual abuse, and/or parental strain with depression alone, anxiety alone, and co-morbid depression/anxiety. The current sample consisted of 6,597 individuals 15-64 years of age who were interviewed using the World Health Organization Composite International Diagnostic Interview (CIDI). Using a multivariate design, we compared early adversity scores across four diagnostic study groups including normal controls, individuals with major depression but no anxiety disorders, individuals with one or more anxiety disorders without major depression, and individuals with co-morbid major depression and anxiety. Individuals with past disorders were considered separately from those with current disorders. For both past and current disorders, highly significant differences in early adversity scores were found across the four study groups. A novel and robust finding, consistent across all analyses, was a marked association between early sexual abuse and co-morbid depression and anxiety but not the "pure" disorders. A strong association between early parental strain and major depression (independent of anxiety) was also found. The overall pattern of results suggest that there may be unique relationships linking particular adversities to particular manifestations of depression and anxiety disorders later in life. A particularly strong association between early sexual abuse and co-morbid depression/anxiety was found.

Adolescent↗
PubMed2003

Applying a 'stages of change' model to enhance a traditional evaluation of a research transfer course.

The aim of this study was to utilize an evaluation tool based on Prochaska's model of change in order to assess behaviour change as part of an evaluation process for a research transfer training programme (RTTP). The RTTP was a training programme offered to scientists in a psychiatry department and research institute to gain skills in research transfer. In addition to a traditional course evaluation framework evaluating overall satisfaction with the course and whether or not learning objectives were met, an additional 'stages of change' evaluation tool designed to assess change along a continuum was utilized. This instrument measured change in participants' attitudes, intentions and actions with respect to research transfer practice and consisted of a 12-question survey completed by participants prior to taking the course and 3 months post-course. In two out of the three categories, attitudes and intention to practice, there was positive change from pre- to post-course (P < 0.05). Although there was a trend of increased RT-related action, this was less robust and did not reach significance. For the RTTP transfer course, a 'stages of change' model of evaluation provided an enhanced understanding by showing changes in participants that would otherwise have been overlooked if only changes in RT behaviour were measured. Additionally, evaluating along a change continuum specifically identifies areas for improvement in future courses. The instrument developed for this study could also be used as a pre-course, participant needs assessment to tailor a course to the change needs of participants. Finally, this 'stages of change' approach provides insight into where barriers to change may exist for research transfer action.

Behavior↗
PubMed2003

Use of antidepressants among Canadian workers receiving depression-related short-term disability benefits.

OBJECTIVES: Little is known about how antidepressants are being used, but rising antidepressant expenditures and the accompanying impulse to control costs make this a critical issue to be addressed. The authors studied patterns of antidepressant use in a population of workers receiving depression-related short-term disability benefits to determine whether populations likely to benefit from antidepressants are using them and, if so, whether they are using them in a way that the benefits from their use are maximized. METHODS: The analyses were based on 1996-1998 administrative data from short-term disability and prescription drug benefit claims and occupational health department records for employees of three Canadian companies. RESULTS: Approximately 58 percent of employees who were receiving depression-related short-term disability benefits had made at least one antidepressant claim. Employees who did not use antidepressants typically reported significantly fewer symptoms at baseline on average than those who did. About 91 percent of the employees who used antidepressants filled at least one prescription for a guideline-recommended first-line agent. Approximately 79 percent of antidepressant dosages reflected those suggested by the Canadian Network for Mood and Anxiety Treatment, and three timeframe indicators suggested that most patients used antidepressants within the recommended timeframes. CONCLUSIONS: The results of this study represent an important first step in exploring the question of how antidepressants are used among workers with depression-related disability. For the most part, these workers and those whose depression was more severe were more likely to obtain antidepressants.

Adult↗
PubMed2003

Pattern of antidepressant use and duration of depression-related absence from work.

BACKGROUND: Few studies have examined the relationship between antidepressant prescription and receipt of depression-related disability benefits. AIMS: To address two questions: first, is prescription of antidepressants in accordance with published clinical guides associated with better disability outcomes, and second, what is the relationship between guideline-concordant antidepressant prescription and length of disability? METHOD: An observational study was conducted using administrative data from three major Canadian financial and insurance sector companies. Short-term disability and prescription drug claims records for 1996-1998 were linked for workers receiving depression-related short-term disability benefits during that time. RESULTS: Recommended first-line agents and recommended doses were significantly associated with return to work (chi(2)=6.64, P<0.036). In addition, among those who returned to work, early intervention was significantly associated with a shortened disability episode (beta=-24.1; 95% CI -34.4 to -13.8). CONCLUSIONS: Depression-related workplace disability is a problem for which there is no simple solution. These results provide an additional piece to the puzzle of helping workers disabled by depression to return to work.

Absenteeism↗
PubMed2003

Development of a framework for knowledge translation: understanding user context.

OBJECTIVE: To develop a framework that researchers and other knowledge disseminators who are embarking on knowledge translation can use to increase their familiarity with the intended user groups. METHODS: The framework was derived from a review and analysis of the knowledge translation literature and from the authors' own experience with a variety of user groups. RESULTS: The framework consists of five domains: the user group, the issue, the research, the knowledge translation relationship, and dissemination strategies. Within each domain, the framework includes a series of questions. The questions provide the researcher with a way of organizing what he or she already knows about the user group and the knowledge translation project, of identifying what still is unknown, and of flagging what is important to learn. CONCLUSIONS: Most researchers wishing to engage in knowledge translation are moving out of their own familiar contexts. By using this framework, researchers will learn about the new contexts in which they find themselves. The insights they gain will increase their familiarity with the user group, thus aiding in the implicit goal of the interactive model of knowledge translation: making the researcher a part of the user group context.

Evidence-Based Medicine↗
PubMed2003

Linkage and exchange at the organizational level: a model of collaboration between research and policy.

This paper describes an organization-level initiative designed to promote linkage and exchange between a research unit and the mental health policy branch of Ontario's provincial government. Using a framework that conceptualizes four tiers--inter-organizational relationship, interactive research projects, dissemination and policy formation--in the application of linkage and exchange to the research and policy development processes, we present an example in order to explore the issues that arise in each tier. We conclude that while such initiatives enhance the relevance of research in the policy development process, they also present challenges that must be recognized and managed.

Cooperative Behavior↗
PubMed2003

Left behind by reform: the case for improving primary care and mental health system services for people with moderate mental illness.

In this paper, we present a case for improving services to meet the needs of people with moderate mental illness (MMI). We begin by outlining the evolution of mental health reform and its current tendency toward excluding this population. We offer a working definition for MMI and systematically explain why individuals with moderate mental illnesses deserve increased attention and resources within both the mental health system and general medical settings. Some of the 'best practices' on a strategic programme level that can be used to serve people with MMI most effectively are discussed. Making MMI a priority involves reorienting clinical as well as programmatic approaches to address the needs of the population with these disorders. Systems-level financial, structural and manpower supply issues are crucial; challenging government to become a key player in developing a more collaborative model of physical and mental health care. Private health and mental health organisations, professional groups and individual users of services must also commit themselves to recognising the problem of MMI and respond to it more effectively.

Cost-Benefit Analysis↗