a causal model of access and continuity for marginalised groups on behalf of the cocoa study group...
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Prison Probation Police and courts Prison Reception Prison GatesTRANSCRIPT
Slide 1A causal model of access and continuity for marginalised
groups
[email protected]
COCOA study group
CARES Liverpool 2014
COCOA Study Group
Richard Byng 1, Cath Weyer Brown 1, Rod Sheaff 3 , Chiara Samele 2, Claire Warrington2 , Dean Harrison 4, Chris Brown 5, Christabel Owens 1, Christine Wright 1, Jill Annison 3, Sean Duggan 2, John Campbell 1
1 Peninsula Medical School, Plymouth and Exeter, England
2 Sainsbury Centre for Mental Health, London, England
3 University of Plymouth, Plymouth, England
4 Peer Researcher Consultant, England
5 University of Swansea, England
This project is funded by the National Institute for Health Research Service Delivery and Organisation Programme (NIHR SDO).
The views and opinions expressed herein are those of the author(s) and do not necessarily reflect those of the Department of Health or the NHS.
Prison
Probation
3
We conducted a literature review of policy documents for health and criminal justice examining what they said should be happening in each of the above fields; focusing particularly on where health policies talked about criminal justice and where criminal justice polices talked about health.
The study is about access and continuity of healthcare for offenders, so we were particularly interested in transition points between different parts of the criminal justice system.
The project started with some overarching questions about offenders access to, and continuity of, healthcare. We then used the policy literature review to generate further sub-questions.
This presentation focuses on ‘accessing and receiving continuity of care in and beyond the prison gates’ and so addresses the two following research sub-questions:
Problem
Objective
complex system, ill-defined concepts
access and continuity
5
Define elements of continuity and access - the outcome of interest
Identify potential mechanisms for achieving continuity –
Collation of all evidence of cause and effect
Examine by domains
200 offender pathways
28% with opiate misuse (40% all contacts), 64% mental health problems, 96% physical
Discontinuity was predominant experience except substance use
Poor access to mental health care (3/per annum)
25 times as many gain specialised substance use care….
7
Attending initially and ongoing is objective outcome of interest
Experience of access and ongoing care are subjective but important – in own right and as causes
INITIAL / RENEWED ACCESS
CONTINUITY OF ACCESS: Right person, right time, right place, right information:
Same practitioner
Abdicators
Vocally dismissive of medical/health care
Practitioners – view from offenders
Feeling cared for
Walk in
shared training
integrated assessment
integrated plan
Organisational integration
CONTINUITY OF ACCESS
Problem 2 – too banal
TRUST, COPING STYLE, BELIEFS.
CONTINUITY OF ACCESS
Identify themes
Eg Concerns about non-effectiveness of treatment lead to some participants turning down, or not desiring, mental health treatments (1014a, 1026a, 1036a, 1117a, 1158a).
Analytic process (cont)
Examine data in detail
Eg “D’you know what I mean so, I’m not (laughs) I don’t mind speaking to a psychiatrist d’you know what I mean, I mean but, at the end of the day I know, that talking ain’t gonna do nothing” (1036a)
Identify possible causal processes in each and group to write one positive contingent statement
If the way treatment is presented matches existing beliefs or overcomes previous negative beliefs offenders will believe that the treatment they will be offered might be effective and they are more likely to access healthcare
Link to other generic mid range theories: candidacy
Underlying mechanisms
A range of practitioner actions (showing cares, understands, values,) generate trust in practitioner which through branding/associations etc can be generalised to wider service or other practitioners
Words, signs, letters, conversations can generate belief in care/treatment– that its available and effective (both offenders AND practitioners from other team/sectors)
Getting seen - somehow – “any time, any place, any person” –and then either trust or belief triggers disclosure, or practitioner elicits further problems - means access can lead to treatment for one problem and can lead to more
Practitioners supported to stay calm clear when medication requests are not permissible by professional standards
Services that ‘work with’ rather than exclude because of multi-morbidity, through a range of components of integration, release constraints from practitioner to act flexibly and holistically
Matching assessment/protocols/individualised goals across a health system trigger practitioners to work collaboratively across teams
Reliable and flexible arrangements for accessing another team/service – rather than loose ‘signposting’ – ensure onward transition to care that is required
The phone’s always engaged
Wouldn’t work for me anyway
Surely there’s a better way than this
Don’t trust them anyway
We need more disease pathways
She’s here so perhaps I’ll go in
She seems to care – and didn’t get cross
Valium works for me may be she’ll give me some
Ok so lets try those techniques in mentalisation – stay calm sit back, acknowledge his distress, be firm
Guess I can see her point ….. I need to stop buying them off the street too
And she does seem to understand me….
Phew – that was tough
I can see this might even work for me
May be I’ll try referral to the counsellors who say they wont exclude due to substance use any more
He’s ok too – really values what I think
Great the counsellor has sent an update – may be we could all meet together and work up one of those new shared plans
And they don’t seem to disagree
Applying the model
Continuity and access (being seen) need to be seen as a continuum with objective criteria
Relationships, flexibility, integration mechanisms (liaison, case management, shared protocols) – can be seen as part of the experience AND contributing to objective criteria for continuity of access
A practical framework for those developing services for offenders and other excluded groups
Application to other groups – older people, children in care, as well as those with long term conditions
Thank you [email protected]
[email protected]
COCOA study group
CARES Liverpool 2014
COCOA Study Group
Richard Byng 1, Cath Weyer Brown 1, Rod Sheaff 3 , Chiara Samele 2, Claire Warrington2 , Dean Harrison 4, Chris Brown 5, Christabel Owens 1, Christine Wright 1, Jill Annison 3, Sean Duggan 2, John Campbell 1
1 Peninsula Medical School, Plymouth and Exeter, England
2 Sainsbury Centre for Mental Health, London, England
3 University of Plymouth, Plymouth, England
4 Peer Researcher Consultant, England
5 University of Swansea, England
This project is funded by the National Institute for Health Research Service Delivery and Organisation Programme (NIHR SDO).
The views and opinions expressed herein are those of the author(s) and do not necessarily reflect those of the Department of Health or the NHS.
Prison
Probation
3
We conducted a literature review of policy documents for health and criminal justice examining what they said should be happening in each of the above fields; focusing particularly on where health policies talked about criminal justice and where criminal justice polices talked about health.
The study is about access and continuity of healthcare for offenders, so we were particularly interested in transition points between different parts of the criminal justice system.
The project started with some overarching questions about offenders access to, and continuity of, healthcare. We then used the policy literature review to generate further sub-questions.
This presentation focuses on ‘accessing and receiving continuity of care in and beyond the prison gates’ and so addresses the two following research sub-questions:
Problem
Objective
complex system, ill-defined concepts
access and continuity
5
Define elements of continuity and access - the outcome of interest
Identify potential mechanisms for achieving continuity –
Collation of all evidence of cause and effect
Examine by domains
200 offender pathways
28% with opiate misuse (40% all contacts), 64% mental health problems, 96% physical
Discontinuity was predominant experience except substance use
Poor access to mental health care (3/per annum)
25 times as many gain specialised substance use care….
7
Attending initially and ongoing is objective outcome of interest
Experience of access and ongoing care are subjective but important – in own right and as causes
INITIAL / RENEWED ACCESS
CONTINUITY OF ACCESS: Right person, right time, right place, right information:
Same practitioner
Abdicators
Vocally dismissive of medical/health care
Practitioners – view from offenders
Feeling cared for
Walk in
shared training
integrated assessment
integrated plan
Organisational integration
CONTINUITY OF ACCESS
Problem 2 – too banal
TRUST, COPING STYLE, BELIEFS.
CONTINUITY OF ACCESS
Identify themes
Eg Concerns about non-effectiveness of treatment lead to some participants turning down, or not desiring, mental health treatments (1014a, 1026a, 1036a, 1117a, 1158a).
Analytic process (cont)
Examine data in detail
Eg “D’you know what I mean so, I’m not (laughs) I don’t mind speaking to a psychiatrist d’you know what I mean, I mean but, at the end of the day I know, that talking ain’t gonna do nothing” (1036a)
Identify possible causal processes in each and group to write one positive contingent statement
If the way treatment is presented matches existing beliefs or overcomes previous negative beliefs offenders will believe that the treatment they will be offered might be effective and they are more likely to access healthcare
Link to other generic mid range theories: candidacy
Underlying mechanisms
A range of practitioner actions (showing cares, understands, values,) generate trust in practitioner which through branding/associations etc can be generalised to wider service or other practitioners
Words, signs, letters, conversations can generate belief in care/treatment– that its available and effective (both offenders AND practitioners from other team/sectors)
Getting seen - somehow – “any time, any place, any person” –and then either trust or belief triggers disclosure, or practitioner elicits further problems - means access can lead to treatment for one problem and can lead to more
Practitioners supported to stay calm clear when medication requests are not permissible by professional standards
Services that ‘work with’ rather than exclude because of multi-morbidity, through a range of components of integration, release constraints from practitioner to act flexibly and holistically
Matching assessment/protocols/individualised goals across a health system trigger practitioners to work collaboratively across teams
Reliable and flexible arrangements for accessing another team/service – rather than loose ‘signposting’ – ensure onward transition to care that is required
The phone’s always engaged
Wouldn’t work for me anyway
Surely there’s a better way than this
Don’t trust them anyway
We need more disease pathways
She’s here so perhaps I’ll go in
She seems to care – and didn’t get cross
Valium works for me may be she’ll give me some
Ok so lets try those techniques in mentalisation – stay calm sit back, acknowledge his distress, be firm
Guess I can see her point ….. I need to stop buying them off the street too
And she does seem to understand me….
Phew – that was tough
I can see this might even work for me
May be I’ll try referral to the counsellors who say they wont exclude due to substance use any more
He’s ok too – really values what I think
Great the counsellor has sent an update – may be we could all meet together and work up one of those new shared plans
And they don’t seem to disagree
Applying the model
Continuity and access (being seen) need to be seen as a continuum with objective criteria
Relationships, flexibility, integration mechanisms (liaison, case management, shared protocols) – can be seen as part of the experience AND contributing to objective criteria for continuity of access
A practical framework for those developing services for offenders and other excluded groups
Application to other groups – older people, children in care, as well as those with long term conditions
Thank you [email protected]