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Ashok Malla - One of the best experts on this subject based on the ideXlab platform.
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engagement in specialized Early Intervention services for psychosis as an interplay between personal agency and critical structures a qualitative study
International Journal of Nursing Studies, 2020Co-Authors: Tovah Cowan, Ashok Malla, Megan A Pope, Kevin Macdonald, Manuela Ferrari, Srividya N IyerAbstract:Abstract Background Specialized Early Intervention Programs for individuals experiencing a first episode of psychosis prioritize service engagement, generally operationalized as attendance, treatment completion, therapeutic alliance, and treatment adherence. However, there are critical theoretical and methodological gaps in understanding how service users experience and define their engagement with the service. Objectives This study aimed to explore how current and former service users define their engagement with a specialized Early Intervention Program. Design A qualitative descriptive approach was used to explore service users’ decisions to use, remain involved with, and/or leave Early Intervention services. Setting This study took place in an Early Intervention service for psychosis in Montreal, Canada. Participants Twenty-four participants who had experienced a first episode of psychosis and had been engaged in the service to varying degrees (fully engaged, partially engaged, disengaged) took part in in-depth interviews. Methods In-depth interviews were employed to collect rich insights into participants’ experiences and perceptions. The interviews were transcribed and analysed using thematic analysis, beginning with an inductive approach and completing the analysis using a theoretical approach. During the analysis, our original notions of engagement and disengagement were challenged by theorizing engagement in terms of agency and structure. Researchers engaged in reflexive practices to maintain and promote research rigor and trustworthiness. Results Participants’ narratives were thematically analyzed and organized into three themes: fluidity and temporality of engagement and disengagement; engagement as an ongoing negotiation; and critical structures and agency. Participants described engagement in a variety of ways, some of which were broader than service use and focused on self-care and commitment to recovery. These conceptions were subject to change as the individuals’ perceptions of their needs changed. As needs changed, individuals also negotiated and renegotiated their care needs with themselves and with their treatment team. These exercises of agency were constrained by key structures: the treatment team, family and friends, and societal conceptions of mental health. Conclusions Our study findings argue for an expanded definition of engagement which prioritizes individuals’ experience and acknowledges the steps towards recovery that they may make outside of the purview of the service. It also underlines the importance of a treatment structure which aligns with individuals’ needs for both support and autonomy.
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symptom and functional outcomes for a 5 year Early Intervention Program for psychoses
Schizophrenia Research, 2011Co-Authors: Ross M G Norman, Deborah Windell, Ashok Malla, Rahul Manchanda, Raj Harricharan, Sandra NorthcottAbstract:Abstract There continues to be controversy concerning the long term benefits of specialized Early Intervention Programs (SEI) for psychotic disorders. Recent reports of five year outcomes for SEI Programs indicate that benefits of Early Intervention Programs at two year follow-up have disappeared at five years. The Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario offers continuity of care for five years, with a lower intensity level of specialized Intervention after the initial two years. In this paper we examine whether the outcomes observed at two years were maintained at five year follow-up. In addition, it was possible to compare PEPP outcomes with those of the OPUS project at two and five years. Results indicate that improvement of symptoms between entry into PEPP and two year follow-up were maintained at five years. In addition, there was further improvement in global functioning between two and five year follow-up. Comparison of PEPP outcomes at two and five year follow-up to those of OPUS suggest that longer term continuity of care within SEI is associated with continuing benefits at least with respect to level of positive symptoms and functioning.
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impact of a specialized Early Intervention service for psychotic disorders on patient characteristics service use and hospital costs in a defined catchment area
The Canadian Journal of Psychiatry, 2006Co-Authors: Karen Goldberg, Ross M G Norman, Jeffrey S Hoch, Norbert Schmitz, Deborah Windell, Nicole Brown, Ashok MallaAbstract:Objective: To evaluate the impact of a new Early Intervention service for first-episode psychosis on patient characteristics, service use, and hospital costs. Method: We examined clinical records of all first admissions to hospitals of patients diagnosed with first-episode psychoses (nonaffective) over a 3-year period before and after the introduction of an Early Intervention service, the Prevention and Early Intervention Program for Psychosis (PEPP), in a defined catchment area. We examined demographic, clinical, and service use indices covering a 2-year period subsequent to the index admission for each patient. Results: Patients in the post-PEPP phase were significantly younger (P Conclusion: Introduction of a specialized Early Intervention Program may be beneficial to patients and to the health care system. To evaluate the cost-benefit ratio of Early Intervention services, longer term and more detailed data may be required. Information on funding and support and author affiliations appears at the end of the article. (Can J Psychiatry 2006;51:895-903) Clinical Implications * Introduction of a specialized Early Intervention Program may result in the reduction of involuntary hospital admissions for patients suffering from first-episode psychoses. * Introduction of an Early Intervention service may also have a positive impact on some crucial aspects of patient behaviour in subsequent admissions. * Cost savings may result from reduced hospital bed use and a reduced number of visits to the emergency service. Limitations * The data were collected in relation only to hospital care. * We did not include patients who possibly received treatment in primary health care or other parts of the mental health system in either phase. * The number of observations of the longitudinal time series data on service use may not be sufficient to reveal a significant effect of the introduction of the Early Intervention service. Key Words: Early Intervention, first episode psychoses, service use, costs Abbreviations used in this article EPPIC Early Psychosis Prevention and Intervention Centre ER emergency room IOU intensive observation unit LEO Lambeth Early Onset study PEPP Prevention and Early Intervention Program for Psychosis SD standard deviation Trajectories of outcome in schizophrenia and related disorders are determined primarily in the first 2 to 3 years, which are referred to as the critical period (1). The implications of this frequently replicated observation are twofold: Interventions sustained over this period may have the greatest impact on outcome (2,3), and any delay in the initial treatment may portend a poor outcome (4,5). In the last few years, there has been a substantial growth of specialized "Early Intervention" services based on these observations (6,7). Most Early Intervention services provide phase-specific and comprehensive treatment, including novel antipsychotic medications, some modification of assertive case management, family Intervention, and other psychosocial Interventions (8-11). …
Marylynn Brecht - One of the best experts on this subject based on the ideXlab platform.
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public health nursing care for adolescent mothers impact on infant health and selected maternal outcomes at 1 year postbirth
Journal of Adolescent Health, 2002Co-Authors: Deborah Koniakgriffin, Nancy Lois Ruth Anderson, Marylynn Brecht, Inese Verzemnieks, Janna LesserAbstract:Abstract Purpose: To compare effects of an Early Intervention Program (EIP) of intense home visitation by public health nurses (PHNs) with effects of traditional public health nursing care (TPHN) on infant health and selected maternal outcomes of adolescent mothers. Methods: EIP adolescents ( N = 102) received preparation-for-motherhood classes and individual home visits (from pregnancy through 1 year postpartum) from PHNs employed in a county health department. Participants were predominantly Latina (64%) and African-American (11%) and from impoverished backgrounds. Infant health outcomes were determined based on medical record data; interviews and standardized questionnaires evaluated other Program effects (e.g., maternal educational achievement and psychological status). Data were analyzed using Chi-square and repeated measures ANOVA. Results: Infants of EIP mothers experienced significantly fewer total days ( n = 74) and actual episodes ( n = 14) of hospitalization during the first year of life than those receiving TPHN ( n = 154, n = 24, respectively). Similarly, positive Program effects were found for immunization rates. There were no group differences in emergency room visits or repeat pregnancy rates. Alcohol, tobacco, and marijuana use significantly increased from pregnancy through 1 year postpartum in both groups but remained markedly lower than rates prior to pregnancy (lifetime rates). Conclusions: These findings demonstrate the positive effects of a PHN home visitation Program on health outcomes for children of adolescent mothers. Days of infant hospitalization were substantially reduced and immunization rates increased during the first year of life for children of EIP mothers. Greater efforts need to be directed toward preventing repeat pregnancy and return to substance use following childbirth in at-risk adolescent mothers.
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a public health nursing Early Intervention Program for adolescent mothers outcomes from pregnancy through 6 weeks postpartum
Nursing Research, 2000Co-Authors: Deborah Koniakgriffin, Nancy Lois Ruth Anderson, Inese Verzemnieks, Marylynn BrechtAbstract:BACKGROUND: Adolescent pregnancy and parenting remain a major public concern because of their impact on maternal-child health and on the social and economic well-being of the nation. Federal welfare reform legislation has created an urgent need for community-based nursing Intervention Programs to improve health and social outcomes for disadvantaged adolescent mothers and to promote their self-sufficiency. OBJECTIVE: To evaluate the effects of an Early Intervention Program (EIP) that uses a public health nursing model on health and social outcomes of adolescent mothers and their children and on the quality of mother-child interaction. METHODS: Pregnant adolescents referred to a county health department were randomly assigned to an experimental (EIP) or control (traditional public health nursing [TPHN]) group. The sample included 121 adolescents from predominantly minority and impoverished backgrounds who were followed from pregnancy through 6 weeks postpartum. Intense and comprehensive home visitation by public health nurses and preparation-for-motherhood classes were provided to adolescents in the EIP. Health outcomes were determined on the basis of medical record data. Other measures included maternal self-report on selected behaviors, nurse interviews, and the Nursing Child Assessment Teaching Scale (NCATS). RESULTS: Early findings indicate reduced premature birth and low-birth-weight (LBW) rates for young mothers receiving both forms of public health nursing care. No significant differences between groups were found for infant birth weight or type of delivery. Infants in the EIP had significantly fewer total days of birth-related hospitalization and rehospitalization than those in the TPHN group during the first 6 weeks of life (chi2(1) = 6.41; p = 0.01). Adolescents in the EIP demonstrated significantly more positive educational outcomes (e.g., lower school dropout rates) than those in the TPHN group (chi2(1) = 6.76; p < 0.009). CONCLUSIONS: The Early findings of this study demonstrate that pregnant adolescents benefit from both traditional and more intense public health nursing care in terms of prenatal and perinatal outcomes. The EIP was associated with decreased infant morbidity during the first 6 weeks of life and decreased maternal school dropout. Long-term outcomes for the EIP are being evaluated.
Srividya N Iyer - One of the best experts on this subject based on the ideXlab platform.
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engagement in specialized Early Intervention services for psychosis as an interplay between personal agency and critical structures a qualitative study
International Journal of Nursing Studies, 2020Co-Authors: Tovah Cowan, Ashok Malla, Megan A Pope, Kevin Macdonald, Manuela Ferrari, Srividya N IyerAbstract:Abstract Background Specialized Early Intervention Programs for individuals experiencing a first episode of psychosis prioritize service engagement, generally operationalized as attendance, treatment completion, therapeutic alliance, and treatment adherence. However, there are critical theoretical and methodological gaps in understanding how service users experience and define their engagement with the service. Objectives This study aimed to explore how current and former service users define their engagement with a specialized Early Intervention Program. Design A qualitative descriptive approach was used to explore service users’ decisions to use, remain involved with, and/or leave Early Intervention services. Setting This study took place in an Early Intervention service for psychosis in Montreal, Canada. Participants Twenty-four participants who had experienced a first episode of psychosis and had been engaged in the service to varying degrees (fully engaged, partially engaged, disengaged) took part in in-depth interviews. Methods In-depth interviews were employed to collect rich insights into participants’ experiences and perceptions. The interviews were transcribed and analysed using thematic analysis, beginning with an inductive approach and completing the analysis using a theoretical approach. During the analysis, our original notions of engagement and disengagement were challenged by theorizing engagement in terms of agency and structure. Researchers engaged in reflexive practices to maintain and promote research rigor and trustworthiness. Results Participants’ narratives were thematically analyzed and organized into three themes: fluidity and temporality of engagement and disengagement; engagement as an ongoing negotiation; and critical structures and agency. Participants described engagement in a variety of ways, some of which were broader than service use and focused on self-care and commitment to recovery. These conceptions were subject to change as the individuals’ perceptions of their needs changed. As needs changed, individuals also negotiated and renegotiated their care needs with themselves and with their treatment team. These exercises of agency were constrained by key structures: the treatment team, family and friends, and societal conceptions of mental health. Conclusions Our study findings argue for an expanded definition of engagement which prioritizes individuals’ experience and acknowledges the steps towards recovery that they may make outside of the purview of the service. It also underlines the importance of a treatment structure which aligns with individuals’ needs for both support and autonomy.
Rios, Karyne De Souza Augusto - One of the best experts on this subject based on the ideXlab platform.
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Efeitos de um Programa de prevenção de problemas de comportamento em crianças pré-escolares de famílias de baixa renda.
Programa de Pós-graduação em Educação Especial, 2006Co-Authors: Rios, Karyne De Souza AugustoAbstract:The objective of this research was assess the effects of an Early Intervention Program to low-income families living in a small city of São Paulo, to prevent the development of problems behavior in pre-school children, by the improvement of parental educational skills that are associated to pro-social behavior development (positive supervision and moral behavior) and the reduction of parental educational skills that are associated to problems behavior development (physical and psychological abuse, negligence, relaxed discipline, inconsistent punishment and negative supervision). Two parents group made part of the study. Each group should be constituted by six couple of parents (monoparental families or just one parent were accepted) and their respective children with ages between 6 months and 3 years old. But just four mothers in group A and one mother in group B (M5) had participated effectively. Parent interview, Parenting Sense of Competence Scale, Parenting Scale, Child Abuse Potential Inventory, Temperament Assessment Questionnaire and Client Satisfaction Questionnaire were applied with participants. Furthermore, observations of mother-child interaction were carried with one mother on group A and M5. The Intervention consisted in ten weekly sessions that have dealt the following subjects: child development, parental skills communication, positive discipline management, domestic violence, positive parental supervision and moral behavior. The strategies that have been used were: videos, dynamics, discussions, role-play, relaxing technique, angry management, solving problems, homework, and others. The data obtained by interview were categorized to aim a social demographic analysis of the participants. Comparations between total scores of each measure before Intervention, after Intervention and in Follow-up were made. The observation of mother-child interaction, that was a sequential measure were registered in a table and have been categorized in comparative graphics between the groups. The results showed that all participants were living in a high risk context to problems behavior development in children. The Temperament Assessment Questionnaire indicated that all children have demonstrated styles of temperament that are related with problems behavior development. About the Parenting Sense of Competence Scale, one mother have increased their parental satisfaction and effectiveness score, two mothers only have increased their parental satisfaction score e two other mothers have reduced their parental satisfaction and effectiveness score. There were decreased of inconsistent discipline (laxness), overreactivity and verbosity using for all participants. The observation s data indicated more frequency of positive interactions between mothers and children and the increased of positive parental behavior after the Intervention. Future studies are necessary to investigate Intervention s process and to promote relations with other professionals and with the Government to get better results and long-term consequences to families and their children.Financiadora de Estudos e ProjetosO objetivo do presente estudo foi avaliar os efeitos de um Programa de intervenção precoce direcionado às famílias de baixa renda de uma cidade do interior do estado de São Paulo, visando prevenir o surgimento de problemas de comportamento em crianças pré-escolares, por meio do aprimoramento de práticas educativas parentais associadas ao desenvolvimento de condutas pró-sociais (monitoria positiva e comportamento moral) e minimização do uso de práticas educativas parentais associadas ao desenvolvimento de problemas de comportamento (abuso físico e psicológico, negligência, disciplina relaxada, punição inconsistente e monitoria negativa). Participaram do estudo dois grupos de pais, sendo que em cada grupo, participariam seis casais de pais (sendo aceito a participação de apenas um pai, ou de famílias monoparentais) e seus respectivos filhos com idade entre 6 meses a 3 anos de idade. Entretanto, efetivamente participaram quatro mães no grupo A e apenas uma mãe no grupo B (M5). A coleta de dados foi realizada por meio de entrevistas com os pais, Escala de Senso de Competência Parental, Escala Parental, Inventario de Potencial para Abuso Infantil, Questionário de Avaliação do Temperamento e Questionário de Satisfação do Cliente. Além disso, foram realizadas observações da interação mãe-filho com uma família do grupo A e M5. A fase de intervenção consistiu em 10 sessões semanais que abordaram os seguintes temas: desenvolvimento infantil, habilidades de comunicação parental, técnicas de disciplina adequadas, violência doméstica, monitoria parental positiva, comportamento moral. Para isso foram utilizadas as seguintes estratégias: vídeos, dinâmicas, discussões, role-play, técnicas de relaxamento, manejo de raiva, solução de problemas, tarefas de casa, entre outros. Os dados obtidos por meio de entrevistas foram categorizados, visando análise sócio-demográfica dos participantes. Com relação aos dados obtidos por meio dos outros instrumentos, foram realizadas comparações entre os escores totais de cada instrumento antes da intervenção, após intervenção e no Follow-up. As observações da interação mãe-filho, que eram medidas seqüenciais, foram registradas em protocolos e categorizadas em gráficos comparativos entre os grupos. Os resultados indicaram que todos os participantes estavam inseridos em um contexto de alto risco para desenvolvimento de problemas de comportamento em crianças. O Questionário de Avaliação do Temperamento indicou que todas as crianças demonstraram estilos de temperamento favorecedores para o desenvolvimento de problemas de comportamento. Com relação a Escala de Senso de Competência Parental, uma mãe aumentou seus índices de satisfação e eficácia parental, duas somente aumentaram seu nível de satisfação parental e duas mães tiveram reduções em seus níveis de satisfação e eficácia parental. Houve decréscimo no uso de disciplina inconsistente, super-reatividade e verbalizações excessivas e inadequadas para todos os participantes. Os dados de observação indicaram maior freqüência de interações positivas entre mães e filhos e aumento de comportamentos parentais positivos após intervenção. Como lacunas a serem preenchidas em estudos posteriores, identificam-se a necessidade de mais pesquisas que procurem investigar os procedimentos de intervenção e a formulação de parcerias com outros profissionais e com o Governo gerando conseqüências mais significativas e duradouras
Karyne De Souza Augusto Rios - One of the best experts on this subject based on the ideXlab platform.
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Efeitos de um Programa de prevenção de problemas de comportamento em crianças pré-escolares de famílias de baixa renda.
Universidade Federal de São Carlos, 2006Co-Authors: Karyne De Souza Augusto RiosAbstract:O objetivo do presente estudo foi avaliar os efeitos de um Programa de intervenção precoce direcionado às famílias de baixa renda de uma cidade do interior do estado de São Paulo, visando prevenir o surgimento de problemas de comportamento em crianças pré-escolares, por meio do aprimoramento de práticas educativas parentais associadas ao desenvolvimento de condutas pró-sociais (monitoria positiva e comportamento moral) e minimização do uso de práticas educativas parentais associadas ao desenvolvimento de problemas de comportamento (abuso físico e psicológico, negligência, disciplina relaxada, punição inconsistente e monitoria negativa). Participaram do estudo dois grupos de pais, sendo que em cada grupo, participariam seis casais de pais (sendo aceito a participação de apenas um pai, ou de famílias monoparentais) e seus respectivos filhos com idade entre 6 meses a 3 anos de idade. Entretanto, efetivamente participaram quatro mães no grupo A e apenas uma mãe no grupo B (M5). A coleta de dados foi realizada por meio de entrevistas com os pais, Escala de Senso de Competência Parental, Escala Parental, Inventario de Potencial para Abuso Infantil, Questionário de Avaliação do Temperamento e Questionário de Satisfação do Cliente. Além disso, foram realizadas observações da interação mãe-filho com uma família do grupo A e M5. A fase de intervenção consistiu em 10 sessões semanais que abordaram os seguintes temas: desenvolvimento infantil, habilidades de comunicação parental, técnicas de disciplina adequadas, violência doméstica, monitoria parental positiva, comportamento moral. Para isso foram utilizadas as seguintes estratégias: vídeos, dinâmicas, discussões, role-play, técnicas de relaxamento, manejo de raiva, solução de problemas, tarefas de casa, entre outros. Os dados obtidos por meio de entrevistas foram categorizados, visando análise sócio-demográfica dos participantes. Com relação aos dados obtidos por meio dos outros instrumentos, foram realizadas comparações entre os escores totais de cada instrumento antes da intervenção, após intervenção e no Follow-up. As observações da interação mãe-filho, que eram medidas seqüenciais, foram registradas em protocolos e categorizadas em gráficos comparativos entre os grupos. Os resultados indicaram que todos os participantes estavam inseridos em um contexto de alto risco para desenvolvimento de problemas de comportamento em crianças. O Questionário de Avaliação do Temperamento indicou que todas as crianças demonstraram estilos de temperamento favorecedores para o desenvolvimento de problemas de comportamento. Com relação a Escala de Senso de Competência Parental, uma mãe aumentou seus índices de satisfação e eficácia parental, duas somente aumentaram seu nível de satisfação parental e duas mães tiveram reduções em seus níveis de satisfação e eficácia parental. Houve decréscimo no uso de disciplina inconsistente, super-reatividade e verbalizações excessivas e inadequadas para todos os participantes. Os dados de observação indicaram maior freqüência de interações positivas entre mães e filhos e aumento de comportamentos parentais positivos após intervenção. Como lacunas a serem preenchidas em estudos posteriores, identificam-se a necessidade de mais pesquisas que procurem investigar os procedimentos de intervenção e a formulação de parcerias com outros profissionais e com o Governo gerando conseqüências mais significativas e duradouras.The objective of this research was assess the effects of an Early Intervention Program to low-income families living in a small city of São Paulo, to prevent the development of problems behavior in pre-school children, by the improvement of parental educational skills that are associated to pro-social behavior development (positive supervision and moral behavior) and the reduction of parental educational skills that are associated to problems behavior development (physical and psychological abuse, negligence, relaxed discipline, inconsistent punishment and negative supervision). Two parents group made part of the study. Each group should be constituted by six couple of parents (monoparental families or just one parent were accepted) and their respective children with ages between 6 months and 3 years old. But just four mothers in group A and one mother in group B (M5) had participated effectively. Parent interview, Parenting Sense of Competence Scale, Parenting Scale, Child Abuse Potential Inventory, Temperament Assessment Questionnaire and Client Satisfaction Questionnaire were applied with participants. Furthermore, observations of mother-child interaction were carried with one mother on group A and M5. The Intervention consisted in ten weekly sessions that have dealt the following subjects: child development, parental skills communication, positive discipline management, domestic violence, positive parental supervision and moral behavior. The strategies that have been used were: videos, dynamics, discussions, role-play, relaxing technique, angry management, solving problems, homework, and others. The data obtained by interview were categorized to aim a social demographic analysis of the participants. Comparations between total scores of each measure before Intervention, after Intervention and in Follow-up were made. The observation of mother-child interaction, that was a sequential measure were registered in a table and have been categorized in comparative graphics between the groups. The results showed that all participants were living in a high risk context to problems behavior development in children. The Temperament Assessment Questionnaire indicated that all children have demonstrated styles of temperament that are related with problems behavior development. About the Parenting Sense of Competence Scale, one mother have increased their parental satisfaction and effectiveness score, two mothers only have increased their parental satisfaction score e two other mothers have reduced their parental satisfaction and effectiveness score. There were decreased of inconsistent discipline (laxness), overreactivity and verbosity using for all participants. The observations data indicated more frequency of positive interactions between mothers and children and the increased of positive parental behavior after the Intervention. Future studies are necessary to investigate Interventions process and to promote relations with other professionals and with the Government to get better results and long-term consequences to families and their children
