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Table of Contents
Contents:
  1. Evaluation Report: The Youth Primary Mental Health Service
  2. Support Services
  3. Background
  4. Innovations in the design of mental health services for young people: an Australian perspective
  5. Evaluation Toolkit - Centre for Innovation in Campus Mental Health

Evaluation Report: The Youth Primary Mental Health Service

Other needs are met through referral to linked agencies, which are often represented in the local consortium, such as specialist mental health and housing services. This stepped care model ensures that care is safe and linked to the actual stage of illness, and offers a preemptive approach to therapeutic intervention. It is hoped that they will ultimately be expanded to cover not only all headspace communities, but also the full diagnostic spectrum in young people with any severe mental illness.

A comprehensive sample of 22, young people assessed by headspace nationally revealed that headspace appears to be successfully addressing the issues of access and engagement, 29 a conclusion further evidenced by the heavy demand for eheadspace services from across the nation. However, headspace is still a work in progress. Important gaps remain, notably the fact that more than half of the Australian community is not yet covered, as the current level of funding does not yet allow full national coverage.

Furthermore, access rates for young men, some ethnic populations, and young adults, while improved, are still too low, and the program does not yet adequately cover those with serious mental illness. More specialized care for the more complex subset of young people who can access care via the headspace portal is also an urgent funding priority. The long-term aim of these reforms is to develop a nationwide youth mental health stream of care that fully integrates care for young people with other service systems; notably education, employment, housing, and justice, in order to provide a seamless coverage of mental health care from puberty to mature adulthood at around 25 years of age, with soft transitions with child and adult mental health care and links with other mainstream services as appropriate.

This system acknowledges biopsychosocial development and recognizes the complexity and challenges faced by young people as they become independent adults, as well as the burden of disease imposed on this age group by poor mental health. In fact, with its multidisciplinary approach, it also deliberately seeks to blur the distinctions between traditionally separate tiers of primary and specialist care, including some aspects of acute care, in recognition of the complexity of the presentation of much of the mental ill-health apparent in young people, allowing a flexible and appropriate response for each individual, depending on their own unique needs.

Support Services

An independent evaluation has just been completed, and this will no doubt inform the further evolution of the headspace model. However, the indications are that the model is justified, not only purely on the grounds of the significant improvement it offers in terms of access to care, which has been acknowledged by policymakers both nationally and internationally, but also indications of early benefit for the majority of patients. These various services have been adapted to their local contexts and offer somewhat different models of care to headspace, but all have in common the key principles of youth-focused, multidisciplinary comprehensive care in a stigma-free, community-based center.

The process of initiating and sustaining these reforms in youth mental health shares some characteristics with the earlier wave of reform in early psychosis. Here, innovative and entrepreneurial thinking have provided proof of their value in mental health care, with the successful evidence-informed upscaling of early intervention in psychosis, now available in specialized services across hundreds of locations and numerous national health systems. However, psychiatry and the mental health field more generally remains conservative, and entrepreneurial thinking, even when committed to the principles of evidence-informed health care, is often viewed with suspicion.

This is to a large extent due to our historical legacy. Psychiatry and the mental health field more generally have been characterized by immunity to reform from the 19th century through to the late 20th century. The asylum era and psychoanalysis were 19th century ideas that threw a heavy shadow over reform. The current status quo, which is narrow and under pressure, reacts badly to change, and this is even more so since deinstitutionalization, which general consensus considers as largely botched, short-changing patients and society as a whole.

We do have a way forward at the macro level, but we need to overcome a number of genuine obstacles.


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The current reality is that despite its much greater projected impact on human suffering and productivity over the next 20 years, mental health continues to be seriously underfunded in comparison with cancer, cardiovascular disease, diabetes, and other noncommunicable diseases. As health expenditure continues to rise worldwide, we must increasingly consider our spending priorities and channel future health funding into those areas that will benefit people and society the most.

This will require a reorganization of our health care system that makes value — defined as the best outcomes for clients for the lowest cost — the overarching goal.

Background

This means affirmative action and preferential investment in mental health care. Mental health care needs to shift its focus from our historical, and largely palliative, approach to care to a more preemptive and preventive focus to enable the greatest potential public health gains. How can this be achieved? The first step is to respect and nurture innovation and the entrepreneurial spirit. Innovation is a vital ingredient if we are to dispel the current largely palliative mindset in mental health care.

Innovation encompasses new thinking, new treatments, and new service models, all of which we desperately need. It is driven by a genuine need for change and requires creativity, reasonable evidence, independent champions, and substantial public involvement to enable new resources and systems of care to be developed and implemented. The establishment of headspace is an example of this process: it was inspired by the need for change, designed and championed by a group of clinician scientists and translational researchers, demanded by the public, and progressively funded by the Australian Government.

The scaling up literature, 40 , 41 again a body of knowledge that cuts across many fields of endeavor, bears witness to the key elements that are required for success in achieving transformational reform. There are often serious threats and resistance to such reform. Issues of power and control may overwhelm or even derail the original objectives of the reforms. Innovation in health care is hard won and too often fragile. Mental health needs innovation more than any other area at a number of levels; the youth mental health reforms represent green shoots that must be carefully nurtured.

Innovations in the design of mental health services for young people: an Australian perspective

The best opportunity for obtaining real benefits in mental health care lies in system reform based on the principles of early intervention and a priority focus on the developmental period of greatest need and capacity to benefit from investment, emerging adulthood. This by no means argues against investments in earlier or later life stage care, which are also essential.

The arguments for this type of transformational reform are resonating strongly with the community and with policymakers, and it is hoped that the 21st century clinical infrastructure and cultures of care, such as headspace, that result from these efforts will be able to reduce the lifelong impact of mental ill-health on our health, happiness, and prosperity over the next two decades and on into the future.

He played a leading role in the design and establishment of headspace, the National Youth Mental Health Foundation, and is currently the Director of the headspace Board. The author reports no other conflicts of interest in this work. Global burden of disease in young people aged 10—24 years: a systematic analysis. Canberra, Australia: Department of Health and Ageing; Arch Gen Psychiatry.

Evaluation Toolkit - Centre for Innovation in Campus Mental Health

Arnett JJ. Emerging Adulthood. Geneva, Switzerland: World Economic Forum; Service responses for youth onset mental disorders. Follow SickKids. Follow SickKids Foundation. Learning Institute Newsletter Click to see our newsletter. Careers Media Volunteers Our services Donate now!


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For example, most kids with mental disorders are not recognized as having a mental health challenge. If they are recognized they are not often referred to a mental health provider. To address these barriers, models of care must: involve systems and not just individual clinics; include client engagement; and ensure commitment to evidence-based treatments.

Stepped-based care. In this model of care the intensity and type of treatment is determined by need, by complexity and previous response to treatment. As need or complexity increases, or if the child has not responded to a generic approach, more resource-intensive and personalized interventions are employed. For example, many children with emotional and behavioural problems can respond to a brief positive parenting program. Enviar Fazer login Entrar.

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