RESUMEN
WHAT IS KNOWN ON THE SUBJECT?: Children and adolescents' mental health problems, such as autism spectrum disorder, anxiety disorder and attention-deficit hyperactivity disorder, are a global public health concern, and nurses require advanced expertise and skills to properly care for this population. There is a gap between the required competencies and the actual skills and knowledge of CAMHN practitioners. Previous studies suggest that educational interventions for nurses are necessary to enhance the quality of care for children and adolescents with mental health problems. However, the corresponding evaluation indicators have not been verified, making it difficult to determine the most effective methods. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The present study developed the two-factor (direct care for children and their family members and approach to the care environment) Clinical Competency Assessment Scale in Child and Adolescent Mental Health Nursing (CCAS-CAMHN). We demonstrated that the assessment scale was reliable and valid, based on its adequate internal consistency and temporal stability, the acceptable range of its model-fit indexes, and its good concurrent and divergent validity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The newly developed scale is useful for assessing nurses' competency and could help them identify their difficulties in CAMHN. The scale could contribute to the development of effective educational interventions to enhance the quality of care for children and adolescents with mental health problems. ABSTRACT: INTRODUCTION: Caring for children and adolescents with mental health problems, such as autism spectrum disorder, anxiety disorder and attention-deficit hyperactivity disorder, requires expertise and skills. A quantitative clinical competency measurement tool in child and adolescent mental health nursing (CAMHN) is needed to evaluate the indicators of advanced expertise. AIM: The aim of this study was to develop a clinical competency assessment scale in CAMHN and evaluate its psychometric properties. METHOD: Scale items were derived from previous studies and adjusted based on cognitive interviews with five CAMHN experts. In total, 505 nurses in CAMHN from 29 hospitals in Japan participated in the self-administered survey. The scale's construct validity, criterion-related validity, internal consistency and test-retest reliability were assessed. RESULTS: A two-factor (direct care for children and their family members and approach to the care environment) scale was constructed. A secondary structural model showed that a two-factor model fits best. The total score was significantly and positively correlated with excellence in nursing practice, amount of clinical experience and mental status. The overall scale exhibited good validity and reliability. DISCUSSION: The scale is reliable and valid for assessing CAMHN clinical competency. IMPLICATIONS FOR PRACTICE: The scale is useful for assessing nurses' competency and evaluating educational interventions' effectiveness for nurses.
Asunto(s)
Competencia Clínica , Enfermería Psiquiátrica , Psicometría , Humanos , Competencia Clínica/normas , Enfermería Psiquiátrica/normas , Enfermería Psiquiátrica/educación , Adolescente , Niño , Femenino , Masculino , Psicometría/normas , Psicometría/instrumentación , Adulto , Enfermería Pediátrica/normas , Reproducibilidad de los Resultados , Persona de Mediana EdadRESUMEN
AIM: The Japanese Ministry of Health, Labor and Welfare sponsored the current examination of a new community mental health service, the Japan Outreach Model Project (JOMP), for persons with mental illnesses and who find it difficult to continue with ongoing treatment. Shorter readmission rates and hospital stays were found. In this study, the amount and type of care that were delivered by the JOMP were examined in order to inform the process of establishing the public insurance system. METHODS: The data were collected from 32 JOMP outreach teams from 21 prefectures in Japan that agreed to participate; 415 patients were included in the analysis. The clients' characteristics, social functions, problematic behavior score, and the amount and type of care that were delivered were examined. RESULTS: Higher amounts of care were delivered in the first month, compared to the remaining months, and the care was relatively stable from months 2-5. This suggests that consistently high care was needed for the JOMP clients who found it difficult to maintain contact with mental health services. Those clients with an increased overall global assessment functioning score at 6 months (n = 151) had received significantly more care than those whose functioning had decreased or remained stable (n = 150). The types of increased care that were provided to the higher functioning group were: "assistance with daily living tasks," "medical support for psychiatric symptoms," "empowering the client," "communication and coordination," "support for physical health," and "vocational and educational support." CONCLUSION: The type and amount of care can positively influence good functional outcomes for those in the community who find it difficult to maintain contact with mental health services.
Asunto(s)
Relaciones Comunidad-Institución , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Disparidades en Atención de Salud , Humanos , Japón , Tiempo de Internación/estadística & datos numéricos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Readmisión del Paciente/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: Japan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP. METHOD: This longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time. RESULTS: The rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to "prevent exacerbation of somatic symptoms" and "care for families". CONCLUSION: These results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.