Centre for Youth Mental Health - Theses
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ItemEarly psychosis workforce: development of core competencies for mental health professionals working in the early psychosis field( 2016)Background: Evidence for early intervention in psychosis has steadily grown over the last 20 years leading to increasing investment in early psychosis service development and a rapidly expanding workforce. Although training of staff has been identified as critical to early psychosis model fidelity and the effective delivery of early psychosis services, to date there has been limited peer-reviewed research in this area. The development and use of competency standards has been identified as useful in supporting health professionals’ education and training, and in health workforce development. Currently the most common approach to competency standards development in healthcare is expert consensus. The overall aim of this thesis was to identify the core competencies required of mental health professionals working in the early psychosis field, which could function as an evidence-based tool to support the early psychosis workforce, strengthen early psychosis model fidelity and in turn assist early psychosis service implementation. The Delphi method was used to establish expert consensus on the core competencies Method: A two-stage Delphi method was used to establish expert consensus on the core competencies. In the first stage, a systematic literature search was conducted to generate competency items. A Delphi Reference Group consisting of 5 clinicians and researchers further reviewed these competency statements for overlap and redundancy. In the second stage, an expert panel consisting of expert early psychosis clinicians from around the world was formed. Panel members then rated each of the competency items on how essential they are to the clinical practice of all early psychosis clinicians. A comparison group of experts in adult severe mental illness was also formed. Data from the comparison group was not included in the primary study. Post-hoc comparisons were made to determine whether there were any differences or similarities in response patterns between the two different panels. Results: In total, 1023 pieces of literature, including textbooks, journal articles and grey literature were reviewed, from which 4667 competency statements were extracted for potential inclusion in the study. After review by the Delphi Reference Group, a final 542 competency statements were identified for inclusion in the questionnaire. 63 early psychosis experts participated in three questionnaire rating rounds. The overall retention rate was 93.6% across all three rating rounds. Of the 542 competency items, 242 competency statements were rated as ‘Essential’ or ‘Important’ by 90% or more of the expert panel and are thus identified as the required core competencies of an early psychosis clinician. Twenty-nine of these competency statements were endorsed by 62 or more of the 63 early psychosis experts. Due to the very high level of consensus achieved, these highest-rated competency statements may be considered the foundational competencies for early psychosis practice. A comparison group of 15 experts in adult severe mental illness participated in one rating round. There were few notable differences between the two expert groups. However the differences identified indicate that there may be important philosophical differences between mainstream mental health services and an early intervention approach to early psychosis care. Conclusion: The study generated a set of core competencies required of clinicians working in the early psychosis field. The core competencies provide a common language for early psychosis clinicians across professional disciplines and regardless of country of practice. The findings thus provide a useful resource to support early psychosis workforce development and early psychosis service reform.
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ItemTreatment decision making for young people diagnosed with major depressive disorders( 2011)Adolescence is a crucial period of risk for depression, with one in every five people experiencing a depressive episode before the time they are 18 years old. Engaging young people in effective treatment during this time is essential to prevent potential long-term negative impact. Guidelines advocate for young people to be involved in treatment decision making, both in terms of receiving information about treatment options, and also making choices about their own care. These recommendations are in line with a model of decision making called ‘shared decision making’ (SDM), one of several models of medical decision making. Yet little is known about processes related to treatment decision making in this age group or young people’s preferred model of treatment decision making. What little literature that exists suggests young people would value involvement in treatment decision making and that such involvement may enhance engagement. In order to address this gap in our understanding of treatment decision making in young people, semi-structured, qualitative interviews were conducted with clients (n=10), caregivers (n=5) and clinicians (n=22) about their experiences and beliefs about treatment decision making for young people diagnosed with major depressive disorder (MDD). Thematic analysis was used to identify key themes in the data. Clients and caregivers reported a range of experiences regarding how involved they were in treatment decision making, yet, consistent with the small body of literature identified, they all wanted involvement of some sort. Clinicians also wanted clients, and caregivers as appropriate, to be involved. All participants (clients, caregivers and clinicians) reported a lack of information exchange (e.g. information about potential risks and benefits of different treatment options) and wanted resources to fill this gap. Overall, the findings from these interviews indicated a preference for involvement in treatment decision making that was in line with a SDM model. In response, an evidence-based decision aid that facilitates SDM was developed for young people diagnosed with MDD who are faced with the decision about which treatment option is best for them. The decision aid was developed according to international standards, and included field-testing with clients (n=5) and clinicians (n=3), who all found the tool acceptable and useful. The current study provides the basis from which an understanding of treatment decision making for young people diagnosed with MDD can be further built, and from which additional resources can be developed and tested in order to contribute to the emerging field of youth SDM. Approaches that support young people to make evidence-based and preference-based treatment decisions have the potential to increase guideline-concordant care, satisfaction, adherence and clinical outcomes.
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ItemNavigating the digital disconnect: understanding the use of information communication technologies by the youth health workforce to help improve young people's mental health and wellbeing( 2011)Despite local and national efforts to address the challenge, the mental ill-health of young people in Australia remains a leading public health concern. Over a quarter of all young Australians aged 16 to 24 experience a mental disorder in any one year (Australian Bureau of Statistics, 2010b). Suicide rates remain high, with suicide now the foremost cause of death in the 15 to 24 year old age group (Australian Bureau of Statistics, 2010a). Aside from its significant social impacts, mental ill-health has enormous economic implications. Economic modelling estimates that in 2009 the direct costs of untreated mental disorders in Australian young people totalled $10.6 billion (Access Economics, 2009). Unless addressed, the effects of mental ill-health can persist over an individual’s lifetime (Costello et al., 2006) and lead to further occupational, economic and interpersonal difficulties. Presently, only 29% of young Australians with a mental disorder seek help when they need it (Burns et al., 2010a, Slade et al., 2009). Timely and evidence-based treatments are only encountered by a small proportion of those young people who do receive care (Andrews et al., 2000, Libby et al., 2007). This has a substantial effect on the overall wellbeing of our community. (For full abstract see document)