The implementation of routine outcome measures in a Tier 3 Psychological Therapies Service: The process of enhancing data quality and reflections of implementation challenges

Background: The Newham Psychological Therapies Service (PTS) has been using the CORE System of evaluation to demonstrate effectiveness since 2004. More recently there has been the national and local drive to improve outcomes as outlined by a number of Department of Health policies and the Improving Access to Psychological Therapies (IAPT) initiative. Aims: This paper describes how, as a secondary care complex mental health service, we have engaged with the process of outcome measurement through complementing the usage of the CORE System with additional measures forming the service pilot minimum dataset. The process of implementation is outlined along with reflections on the challenges which the service faced in introducing outcome measurement. Findings: Engagement with outcome measurement by a service requires attention to be paid to the organisational and professional aspects and personal resonances for clinicians if it is to become established as a meaningful enterprise within secondary care services. Despite success at this task, challenges remain to the further development of this area of work.     

Does knowing translate to doing? Practitioners’ experiences of Circle of Security-Parenting (COS-P) training and implementation

This study sought to understand how practitioners perceive and experience the Circle of Security-Parenting (COS-P) training, and further, how they integrate and implement it into practice, and how these experiences influence their use and understanding of the program and its underlying model. A thematic analysis of semistructured interviews at two time points (shortly after training and 3–6 months after training) was used to explore 12 practitioners’ experiences of COS-P training and subsequent implementation. Three main themes were identified; clinical salience, personal salience, and partial use of the program. The findings reflected participants’ common perception that the model is relevant and generalizable to a wide variety of contexts. It also highlighted potential barriers to implementation, particularly practitioners’ experiences using only components of the COS-P program in isolation. The results suggest practitioners’ assumptions about client complexities, vulnerabilities, and/or incapacities, can prompt practitioners to withhold the use of COS-P (in part or whole), thereby potentially neglecting key components required for client change. The only participants who implemented the COS-P training in full had additional training in Circle of Security.     

Acute pain disrupts prospective memory cue detection processes

Prospective memory refers to the planning, retention, retrieval, and execution of intentions for future behaviours and it is integral to the enterprise of daily living. Although prospective memory relies upon retrospective memory and executive processes often disrupted by pain, limited research has explored the influence of acute or chronic pain on the ability to complete prospective memory tasks. In the present study we investigated the influence of acute pain on prospective memory tasks that varied in their demands on executive processes (i.e., non-focal versus focal prospective memory cues). Complex-span working memory tasks were also administered to examine whether individual differences in working memory capacity moderated any negative impact of pain on prospective memory. Acute pain significantly impaired prospective memory performance in conditions that encouraged non-focal strategic processing of prospective memory cues, but not in conditions that encouraged more spontaneous focal processing. Individual differences in working memory capacity did not moderate the effect of acute pain on non-focal prospective memory. These findings provide new insights into prospective memory dysfunction created by painful experiences.     

Patients' intentions in primary care: Measurement and preliminary investigation

Abstract

A questionnaire to assess patients' intentions in primary care was completed by 206 patients. Patients also rated the amount of help with their presenting problem which they thought could be provided by each of 11 secondary services. A principal components analysis of the intentions revealed 4 components: “Explanation and understanding,” “Support,” “Medical treatment” and “Information-seeking.” Individual patients' intentions were quantified on each of these dimensions. Requests for “Explanation and understanding” did not correlate with expectation of help from any of the 11 sources. In contrast, each of the remaining 3 types of request correlated with expectation of help from a number of sources. These results show, first, a way of measuring patients' intentions on multiple independent dimensions. Secondly, they indicate that patients look solely to the general practitioner for general information and reassurance about their problems. For emotional support they look to additional, mainly psychiatric, sources. This calls into question the view that general practitioners are seen by patients as more appropriate providers of emotional support than specialist services.     

Does confrontation with potential goal failure promote self-regulation? Examining the role of distress in the pursuit of weight goals

Implementation intentions planning in advance the situation in which one will act, have been proposed to be an effective self-regulatory technique for changing health behaviour. Encouraging people to receive text message reminders of their implementation intentions should enhance their strength and, thus, it was predicted that this combined approach would be particularly effective in increasing exercise. Participants (N = 155) were randomly allocated to one of five conditions (implementation intentions and SMS, implementation intention, SMS or one of two control groups) then completed self-report measures of exercise behaviour and motivation. Four weeks later, they responded to similar items. Results suggested that the combined intervention increased exercise frequency significantly more than the other strategies including the implementation intention group. It is proposed, therefore, that implementation intention effects can be enhanced via plan reminders.     

Direct,mediated and moderated impacts of personality variables on smoking initiation in adolescents

Role of ‘Big Five’ personality traits as predictors of smoking and moderators of the intention-smoking relationship was tested. Five hundred and fifty-three adolescents (aged 11–12) completed measures of self-reported past smoking, gender, intentions to smoke, perceived behavioural control, family smoking, friends smoking at times 1 and 2 (6 months apart). At time 3, 2 years later, the same adolescents completed measures of the Big Five and self-reported smoking (a subset of 300 also provided an objective smoking measure). At time 4, two years after time 3, a sub-sample of 122 adolescents provided a self-report measure of recent smoking. Simple correlations indicated significant direct effects of conscientiousness (self-reported smoking, times 3 and 4), extraversion (time 4 smoking) and neuroticism (all smoking measures) on smoking. Logistic regression showed intention, and the interaction between conscientiousness and intention to significantly predict both self-reported and objectively assessed smoking (both at time 3) after controlling for other variables. Multiple regression showed intentions, family smoking and the interaction between conscientiousness and intention to significantly predict self-reported smoking at time 4 after controlling for other variables. The findings indicate that the impact of personality variables on smoking is through mediated (through cognitions) and moderated (conscientiousness by intention interaction) pathways.     

Social cognition models and health behaviour: A structured review

Abstract

A number of social cognition models have been developed to account for socio-demographic variations in health behaviour. This paper distinguishes between: (a) motivational, (b) behavioural enaction, and (c) multi-stage models of health behaviour. The models are evaluated in terms of advancement of existing knowledge and - where appropriate - predictive utility. Common themes that appear within- and between- these categories are discussed, with consideration of ways in which theory may be advanced by future research. Each approach has associated strengths and weaknesses, suggesting that a “consensus” approach to the study of health behaviour may prove fruitful. Identification of the key constructs across different model types would allow coherent integration and promote further understanding of the psycho-social determinants of health behaviour.