| Zusammenfassung: | <p><strong>Service Improvement Project</p></strong>
<p><strong>Trauma-Informed Care in a Pain Management Setting: Clinician and Patient Perspectives</p></strong>
<p>Objective: This mixed-methods study aimed to (1) establish the levels of distress and adverse childhood events (ACEs) evident in referrals to a UK pain management service; and (2) explore experiences of trauma-informed care provision and receipt.</p>
<p>Methods and Measures: 958 patients (N=656 females, N=296 males, N=6 non-binary) were included in an audit. Sixteen interviews with patients (N=8) and clinicians (N=8) were conducted. Descriptive statistics were derived from audit data and reflexive thematic analysis used to identify themes.</p>
<p>Results: (1) Approximately a quarter of patients met the threshold for severe depression and anxiety and 91% of those who opted to report ACEs had experienced at least one ACE and 38% five or more ACEs. (2) Four patient themes were identified: Environmental (re)triggering; Uncertainty in systems; Acting with knowledge of pain and Working in partnership with clinicians. Four clinician themes were identified: Weighing (re)traumatisation; Tackling top-down systemic barriers; A trauma-informed team ethos and Levelling the power dynamic.</p>
<p>Conclusion: Findings suggest that trauma-informed care is a feasible and worthwhile approach in the service. Clinical recommendations for supporting trauma-informed care delivery in the service are discussed.</p></br>
<p><strong>Theory-Driven Research Project</p></strong>
<p><strong>Understanding how People with Facial Palsy Evaluate Social Situations</p></strong>
<p>Objectives: The current study aimed to explore whether people with facial palsy experienced more social appearance anxiety, social anxiety, fear of negative evaluation and engaged in more appearance-fixing behaviour than controls without facial palsy. The secondary aim was to investigate whether fear of negative evaluation and appearance-fixing behaviour were predictive of social appearance anxiety in people with facial palsy.</p>
<p>Method: People with facial palsy (n=78) and people without facial palsy (n=86) completed online questionnaires with measures of social anxiety, social appearance anxiety, fear of negative evaluation and appearance-fixing behaviour.</p>
<p>Results: The facial palsy group experienced significantly greater social appearance anxiety, social anxiety and fear of negative evaluation than the control group, controlling for depression. The facial palsy group also engaged in significantly more appearance-fixing behaviour than the control group. Further, controlling for depression, fear of negative evaluation from others and appearance-fixing were both found to be significant positive predictors of social appearance anxiety in the facial palsy group.</p>
<p>Discussion: Findings are consistent with Clark and Well’s (1995) cognitive behavioural model of social anxiety. Findings indicate a need for screening and provision for psychological support for social anxiety in people with facial palsy and that cognitions relating to fear of negative evaluation and appearance-fixing behaviour are potentially useful targets for intervention.</p></br>
<p><strong>Systematic Review of the Literature</p></strong>
<p><strong>Personal Recovery in Mental Health Difficulties in People with Experience of Homelessness: A Qualitative Systematic Review</p></strong>
<p>Objectives: The present review aimed to investigate qualitative accounts of mental health personal recovery in people with experience of homelessness and adapt the widely adopted CHIME model of personal recovery (Connectedness; Hope and optimism; Identity; Meaning and Empowerment) to better represent the experiences of this population.</p>
<p>Methods: A systematic review identified qualitative studies investigating first-person accounts of mental health personal recovery in people with experience of homelessness. Nine databases were searched: CINAHL, SCOPUS, Embase, Medline, PsychINFO, Pubmed, Web of Science, ASSIA and Social Services Abstracts. Risk of bias was assessed using the CASP Qualitative Studies Checklist. Included studies underwent “best fit” framework synthesis, comprising deductive analysis using the CHIME first- and second-order themes as well as inductive analysis to capture aspects not covered by the a priori framework.</p>
<p>Results: The review expanded the CHIME model and identified the following recovery processes in this population: Security and stability; Encouragement and hope; Constructing identity; Understanding and meaning; Relationships and connectedness; Empowerment and Dual Recovery: SECURED. Importantly, security and stability were identified as a necessary pre-requisite for the other recovery processes. Challenges within each recovery process were also identified.</p>
<p>Conclusions: SECURED offers a transdiagnostic framework to support understanding of mental health personal recovery in the context of homelessness. Findings support the “Housing First” model of service provision. However, findings highlight that housing alone is not enough for mental health recovery and the other processes must also be supported.</p>
|
|---|