Eleanor Swain, Sara Boulter and Nicola Piek
This article outlines conventional dual diagnosis outcome measures and the challenges of using these measures to evaluate interventions in medium secure units. It suggests how…
Abstract
This article outlines conventional dual diagnosis outcome measures and the challenges of using these measures to evaluate interventions in medium secure units. It suggests how these challenges can be overcome by using alternative outcome measures such as measures of motivation, stages of change, beliefs, knowledge, group satisfaction, therapeutic alliance or coping strategies.
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Marc Samuel Tibber, Nicola Piek and Sara Boulter
This study is a post hoc service level investigation into the efficacy of a forensic dual diagnosis intervention. The treatment programme incorporated the principles of cognitive…
Abstract
Purpose
This study is a post hoc service level investigation into the efficacy of a forensic dual diagnosis intervention. The treatment programme incorporated the principles of cognitive behavioural therapy and Motivational Interviewing, and was comprised of three stages: psycho-education into the links between mental/physical health, substance use and offending, the cultivation of coping strategies and relapse prevention planning. The paper aims to discuss these issues.
Design/methodology/approach
Treatment outcome was tracked using pre- and post- stage 1 and 2 measures, and included self-report questionnaires that probed service users’ readiness for change, motivations for treatment and perceived effectiveness of coping strategies (n=80 and 37 patients for stages 1 and 2, respectively). In addition, service users undertook a knowledge “quiz”, which probed information retention.
Findings
The results show that whilst psycho-education (stage 1) increased service users’ knowledge of key issues, this had no parallel effects on other measures. In contrast, completion of stage 2 led to an increase in external motivation for treatment, although this did not translate into a shift in service users’ readiness for change.
Research limitations/implications
These findings are consistent with the Motivational Interviewing literature and highlight the need for a shift in internalised motivation for treatment if change is to be elicited. Further, they point towards the viability of using self-report measures to monitor treatment outcome in a secure forensic setting.
Originality/value
These findings have a number of implications for the design and on-going evaluation of forensic dual diagnosis services, an area of research that is currently under-represented in the literature.
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Jeffrey Braithwaite, Kristiana Ludlow, Kate Churruca, Wendy James, Jessica Herkes, Elise McPherson, Louise A. Ellis and Janet C. Long
Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected…
Abstract
Purpose
Much work about health reform and systems improvement in healthcare looks at shortcomings and universal problems facing health systems, but rarely are accomplishments dissected and analyzed internationally. The purpose of this paper is to address this knowledge gap by examining the lessons learned from health system reform and improvement efforts in 60 countries.
Design/methodology/approach
In total, 60 low-, middle- and high-income countries provided a case study of successful health reform, which was gathered into a compendium as a recently published book. Here, the extensive source material was re-examined through inductive content analysis to derive broad themes of systems change internationally.
Findings
Nine themes were identified: improving policy, coverage and governance; enhancing the quality of care; keeping patients safe; regulating standards and accreditation; organizing care at the macro-level; organizing care at the meso- and micro-level; developing workforces and resources; harnessing technology and IT; and making collaboratives and partnerships work.
Practical implications
These themes provide a model of what constitutes successful systems change across a wide sample of health systems, offering a store of knowledge about how reformers and improvement initiators achieve their goals.
Originality/value
Few comparative international studies of health systems include a sufficiently wide selection of low-, middle- and high-income countries in their analysis. This paper provides a more balanced approach to consider where achievements are being made across healthcare, and what we can do to replicate and spread successful examples of systems change internationally.