http://nova.newcastle.edu.au/vital/access/services/Feed ${session.getAttribute("locale")} 5 http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10890 Aim: Expert opinion holds that the rate of implementation of specialist services for first presentation psychosis in Australia is much too slow. We aimed to collect evidence regarding this view from the first national survey of adult public mental health services about their self-reported efforts to implement specialist early psychosis intervention (EPI). Methods: Using a purpose-designed Census form for assessing EPI implementation, adult public mental health service directors throughout Australia were asked about EPI-relevant local service activities. Results: Sixty Census forms were returned (response rate = 61%), representing a total catchment population of 12.5 million people. A minority of services reported high levels of EPI implementation, which varied widely between area services and across state and territory jurisdictions. Rural and remote services were overrepresented in the lowest levels of reported EPI implementation. Only one service characteristic, the value of identifiable funding committed specifically to EPI, was predictive of level of reported EPI implementation. Conclusions: The disturbingly high levels of variability in EPI implementation across jurisdictions suggest a pressing need for a set of nationally agreed uniform EPI implementation standards. Additional specific strategies for rural and remote mental health services may be needed for these services to implement EPI. 2012-06-12T23:43:49.472Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:10461 The literature that is relevant to evaluation of treatment effectiveness is large, scattered and difficult to assemble for appraisal. This scoping review first develops a conceptual framework to help organize the field, and second, uses the framework to appraise early psychosis intervention (EPI) studies. Literature searches were used to identify representative study designs, which were then sorted according to evaluation approach. The groupings provided a conceptual framework upon which a map of the field could be drawn. Key words were cross-checked against definitions in dictionaries of scientific terms and the National Library of Medicine Medical Subject Headings (MeSH) browser. Using the final list of key words as search terms, the EPI evaluation literature was appraised. Experimental studies could be grouped into two classes: efficacy and effectiveness randomized controlled trials. Non-experimental studies could be subgrouped into at least four overlapping categories: clinical epidemiological; health service evaluations; quality assurance studies; and, quasi-experimental assessments of treatment effects. Applying this framework to appraise EPI studies indicated promising evidence for the effectiveness of EPI irrespective of study design type, and a clearer picture of where future evaluation efforts should be focused. Reliance on clinical trials alone will restrict the type of information that can inform clinical practice. There is convergent evidence for the benefits of specialized EPI service functions across a range of study designs. Greater investment in health services research and quality assurance approaches in evaluating EPI effectiveness should be made, which will involve scaling up of study sizes and development of an EPI programme fidelity rating template. The degree of complexity of the evaluation field suggests that greater focus on research methodology in the training of Australasian psychiatrists is urgently needed. 2012-03-20T22:30:13.701Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:2249 Introduction: An effective means of reducing disability from psychotic disorders is the provision of early detection and intervention targeted at the prodromal phase. Research has led to the reliable identification of individuals at risk of developing a psychotic disorder (Yung et al, 1998) and assisted in the development of preventative interventions in clinical settings (French & Morrison, 2004). However while intervention programs have been trialled for early psychosis (EP), therehas been a lack of research directed towards EP service delivery for rural and remote communities (RARC). The Detection, Evaluation and Psychological Therapy for Health (DEPTH) project is a multisite RCT of cognitive behavioural therapy for youths at risk for psychosis and has been adapted for rural service delivery. DEPTH also incorporates motivational interviewing to address the high incidence of cannabis problems for at-risk youths. Objectives: The paper will present preliminary data for at-risk youths from an urban and a rural setting. It will describe essential differences for service delivery in rural areas and will detail the adaptations of the EDIE manual to address the comorbidity of cannabis problems. Method: Routine clinical data will provide demographic and clinical information on EP rural youths. The DEPTH multisite RCT for at risk youths will demonstrate (i) an early intervention model for RARC, and (ii) methodology for targeting cannabis problems for at risk youths. Results EP in RARC is characterised by a substantial proportion of aboriginal youths in some areas, high levels of drug/alcohol problems, vast distances to access services. Preliminary data from DEPTH will be presented. Discussion: The DEPTH project illustrates the adaptation of a manualised early intervention for youths at risk of developing psychosis to incorporate treatment for cannabis problems. The paper provides the opportunity to further explore the specific needs of rural youths in providing early intervention services. 2010-04-27T06:56:57.816Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:2955 BACKGROUND: An effective means of reducing disability from psychotic disorders is the provision of early detection and intervention targeted at the prodromal phase. Current research and clinical programs for early psychosis (EP) have failed to encapsulate the specific needs of rural and remote communities (RARC) such as limited availability of mental health providers and long distances to travel for care (Fox et al, 1995). This study investigated access to care and service delivery for rural youths experiencing EP. METHODS: Routine clinical mental health service data were analysed for 10–25 year old patients across three rural regions of New South Wales. A large data set (N=1562) for the Central West (CW) rural region was compared to smaller data sets for the Far West (FW) remote and the North Coast (NC) coastal regions. Demographic, clinical and service features were analysed against characteristics specific to RARC. Clinical measures included the HoNOSCA, HoNOS and SDQ. RESULTS: EP patients in the CW represented 10.4% of patients accessing mental health services, but utilised services twice as often as non EP patients and absorbed 37.6% of inpatient service encounters. While the median distance to access service for CW EP patients was 88km, an absence of inpatient services for FW resulted in FW EP patients travelling as far as 895km for hospitalisation. CONCLUSIONS: The results emphasise the importance of developing specific EP services to address the diversity across RARC. The lack of appropriate and timely treatment for rural youths is likely to increase the impairment associated with EP. 2010-04-27T06:46:19.530Z ]]> http://nova.newcastle.edu.au/vital/access/manager/Repository/uon:5228 Objective: The aim of this study was to investigate access to care and service delivery for first-episode psychosis (FEP) in rural, coastal and remote regions. Method: Routine clinical outcome data were analysed for patients aged 10-25 years who presented to mental health services in either a rural, coastal or remote region of New South Wales over a 3-year period. Results: The results showed rural region FEP patients travelled significantly further to access services than non-FEP patients. Remote region FEP patients were older and more likely to be male and Aboriginal than non-FEP patients. Alcohol and drug problems were significantly more likely for FEP than non-FEP patients across all regions. Utilization of mental health services was more frequent for FEP than non-FEP children and adolescents. Conclusion: The study highlights the importance of identification of FEP, particularly in the 10-18-year age group, where cognitive problems are likely to adversely affect schooling as well as be detrimental to social relationships. Service provision for FEP youth in rural areas requires innovation and coordination of limited resources,including better provision of training and ongoing clinical supervision. 2010-04-27T04:40:41.697Z ]]>