A Qualitative Investigation into Barriers and Enablers for the Development of a Clinical Pathway for Individuals Living with FASD and Mental Disorder/Addictions
Publication: Canadian Journal of Community Mental Health
16 March 2020
Abstract
It is common for individuals with fetal alcohol spectrum disorders (FASD) to require support for mental health and addictions but there are challenges associated with receiving appropriate care in Canada. This qualitative investigation of the barriers and enablers to the development of a clinical pathway in mental health and addictions included focus groups of individuals with FASD, caregivers, family members, and clinicians. Data was thematically coded and the following themes are described: the absence of support outside of crisis, the struggle of navigating separated services, the common experience of service providers who lack understanding of FASD, and the benefits of FASD-informed care.
Résumé
Il est fréquent que les personnes atteintes d’un trouble du spectre de l’alcoolisation fœtale aient besoin de soutien en matière de santé mentale et de toxicomanie, mais il existe des défis associés à la prestation de soins appropriés au Canada. Cette enquête qualitative sur les obstacles et les catalyseurs à l’élaboration d’un cheminement clinique en santé mentale et en toxicomanie comprenait des groupes de discussion composés de personnes ayant un trouble du spectre de l’alcoolisation fœtale, des soignants, des membres de la famille et des cliniciens. Les données qui ont été codées thématiquement et les thèmes suivants sont décrits : l’absence de soutien en dehors de la crise, la difficulté de naviguer dans des services séparés, l’expérience commune des fournisseurs de services qui ne comprennent pas l’ensemble des troubles causés par l’alcoolisation fœtale et les avantages des soins éclairés.
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References
Alati R., Al Mamun A., Williams G. M., O’Callaghan M., Najman J. M., and Bor W. 2006 In utero alcohol exposure and prediction of alcohol disorders in early adulthood: A birth cohort study Archives of General Psychiatry 63 9 1009 -1016
Al-Busaidi Z. Q. 2008 Qualitative research and its uses in health care Sultan Qaboos University Medical Journal 8 1 11 -19
Allen D., Gillen E., and Rixson L. 2009 Systematic review of the effectiveness of integrated care pathways: What works, for whom, in which circumstances? International Journal of Evidence-Based Healthcare 7 2 61 -74
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-V (5th ed.). Washington, DC: American Psychiatric Association.
Anderson T., Mela M., and Stewart M. 2018 The implementation of the 2012 mental health strategy for Canada through the lens of FASD Canadian Journal of Community Mental Health
Badry, D. E., & Bradshaw, C. M. (2011). Assessment and diagnosis of FASD among adults: A national and international systematic review. Public Health Agency of Canada.
Baker R., Camosso-Stefinovic J., Gillies C., Shaw E. J., Cheater F., Flottorp S., and Robertson N. 2010 Tailored interventions to overcome identified barriers to change: Effects on professional practice and health care outcomes The Cochrane Library
Bell E., Andrew G., Di Pietro N., Chudley A. E., Reynolds J. N., and Racine E. 2015 It’s a shame! Stigma against fetal alcohol spectrum disorder: Examining the ethical implications for public health practices and policies Public Health Ethics 9 1 65 -77
Birks, M., & Mills, J. (2015). Grounded theory: A practical guide: Sage.
Brown J., Herrick S., and Long-McGie J. 2014 Fetal alcohol spectrum disorders and offender reentry: A review for criminal justice and mental health professionals Behavioral Health 1 1 1 -19
Butow P., Price M. A., Shaw J. M., Turner J., Clayton J. M., Grimison P., and Kirsten L. 2015 Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines Psycho-Oncology 24 9 987 -1001
Campbell H., Bradshaw N., and Porteous M. 1998 Integrated care pathways BMJ 316 133 -144
Canadian Fetal Alcohol Spectrum Disorder Research Network. (2016). Learning together. Retrieved from https://canfasd.ca/learning-together/
Centre for Addiction and Mental Health. (2016). Integrated care pathways. Retrieved from http://www.camh.ca/en/hospital/care_program_and_services/ICPs/Pages/default.aspx
Chasnoff I. J., Telford E., Wells A. M., and King L. 2015 Mental health disorders among children within child welfare who have prenatal substance exposure: Rural vs. urban populations Child Welfare 94 4 53
Chasnoff I. J., Wells A. M., and King L. 2015 Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure Pediatrics 135 2 264 -270
Cisco, 2017. WebEx. Retrieved from https://www.webex.ca/en/
Corrigan P. 2004 How stigma interferes with mental health care American Psychologist 59 7 614
D’Entremont B. 2009 Clinical pathways: The Ottawa Hospital experience The Canadian Nurse 105 5 8 -9
Fast D. K. and Conry J. 2009 Fetal alcohol spectrum disorders and the criminal justice system Developmental Disabilities Research Reviews 15 3 250 -257
French S. D., Green S. E., O’Connor D. A., McKenzie J. E., Francis J. J., Michie S., and Grimshaw J. M. 2012 Developing theory-informed behaviour change interventions to implement evidence into practice: A systematic approach using the Theoretical Domains Framework Implementation Science 7 1 38
Fluid Surveys. (2017). Online websurveys. Retrieved from http://fluidsurveys.com/
Gibson O., Lisy K., Davy C., Aromataris E., Kite E., Lockwood C., and Brown A. 2015 Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: A systematic review Implementation Science 10 1 71
Goodman, D., Pivarnyik, S., & Lwin, K. (2014). Appendix 2: Inventory of Canadian FASD services & resources: Regional analysis. Toronto: Child Welfare Institute, Children’s Aid Society of Toronto.
Government of Saskatchewan. (2017). Using Patient Pathways. Retrieved from http://www.sasksurgery.ca/provider/patientpathways.html
Himmelreich, M., Lutke, C., & Travis, E. (2017). The lay of the land: Final results of a health survey of 500+ adults with diagnosed FASD. Paper presented at the 7th International Conference on Fetal alcohol spectrum disorders.
Kitzinger J. 1994 The methodology of focus groups: The importance of interaction between research participants Sociology of Health & Illness 16 1 103 -121
Liamputtong, P. (2011). Focus group methodology: Principle and practice: Sage Publications.
Lockhart P. J. 2001 Fetal alcohol spectrum disorders for mental health professionals – a brief review September 2001 14 5 463 -469
Martin P. Y. and Turner B. A. 1986 Grounded theory and organizational research The Journal of Applied Behavioral Science 22 2 141 -157
McCluskey A., Vratsistas-Curto A., and Schurr K. 2013 Barriers and enablers to implementing multiple stroke guideline recommendations: A qualitative study BMC Health Services Research 13 1 323
Moltu C., Stefansen J., Nøtnes J. C., Skjølberg Å., and Veseth M. 2017 What are “good outcomes” in public mental health settings? A qualitative exploration of clients’ and therapists’ experiences International Journal of Mental Health Systems 11 1 12
Morgan D. L. 1996 Focus groups Annual Review of Sociology 22 1 129 -152
Nielsen A. S. and Nielsen B. 2015 Implementation of a clinical pathway may improve alcohol treatment outcome Addiction Science & Clinical Practice 10 1 1
O’Connor M. J. and Paley B. 2009 Psychiatric conditions associated with prenatal alcohol exposure Developmental Disabilities Research Reviews 15 3 225 -234
Paley B. and O’Connor M. J. 2009 Intervention for individuals with fetal alcohol spectrum disorders: Treatment approaches and case management Developmental Disabilities Research Reviews 15 3 258 -267
Panella M., Marchisio S., and Di Stanislao F. 2003 Reducing clinical variations with clinical pathways: Do pathways work? International Journal for Quality in Health Care 15 6 509 -521
Paradis E., O’Brien B., Nimmon L., Bandiera G., and Martimianakis M. A. 2016 Design: Selection of data collection methods Journal of Graduate Medical Education 8 2 263 -264
Pei J., Denys K., Hughes J., and Rasmussen C. 2011 Mental health issues in fetal alcohol spectrum disorder Journal of Mental Health 20 5 473 -483
Popova, S., Lange, S., Burd, L., & Rehm, J. (2015). The burden and economic impact of fetal alcohol spectrum disorder in Canada: Toronto, ON, Canada: Centre for Addiction and Mental Health.
Popova S., Lange S., Shield K., Mihic A., Chudley A. E., Mukherjee R. A., and Rehm J. 2016 Comorbidity of fetal alcohol spectrum disorder: A systematic review and meta-analysis The Lancet 387 10022 978 -987
Rankin N. M., Butow P. N., Thein T., Robinson T., Shaw J. M., Price M. A., and Grimison P. 2015 Everybody wants it done but nobody wants to do it: An exploration of the barrier and enablers of critical components towards creating a clinical pathway for anxiety and depression in cancer BMC Health Services Research 15 1 1
Rotter T., Kinsman L., James E., Machotta A., Gothe H., Willis J., and Kugler J. 2010 Clinical pathways: Effects on professional practice, patient outcomes, length of stay and hospital costs Cochrane Database Syst Rev 3 3
Rotter T., Kinsman L., James E., Machotta A., Willis J., Snow P., and Kugler J. 2011 The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs: Cochrane systematic review and meta-analysis Evaluation & the Health Professions 0163278711407313
Rotter T., Kinsman L., Machotta A., Zhao F. L., van der Weijden T., Ronellenfitsch U., and Scott S. D. 2013 Clinical pathways for primary care: Effects on professional practice, patient outcomes, and costs The Cochrane Library
Shaw J. M., Price M. A., Clayton J. M., Grimison P., Shaw T., Rankin N., and Butow P. N. 2016 Developing a clinical pathway for the identification and management of anxiety and depression in adult cancer patients: aAn online Delphi consensus process Supportive Care in Cancer 24 1 33 -41
Smith T. J. and Hillner B. E. 2001 Ensuring quality cancer care by the use of clinical practice guidelines and critical pathways Journal of Clinical Oncology 19 11 2886 -2897
Stewart, D. W., Shamdasani, P. N., & Rook, D. W. (1990). Focus groups: Theory and practice. Applied social research methods series. Focus groups: theory and practice applied social research methods series.
Streissguth, A., Barr, H., Kogan, J., & Bookstein, F. (1996). Understanding the occurrence of secondary disabilities in clients with fetal alcohol syndrome (FAS) and fetal alcohol effects (FAE). Final report to the Centers for Disease Control and Prevention (CDC), 96–06.
Streissguth A. P., Bookstein F. L., Barr H. M., Sampson P. D., O’Malley K., and Young J. K. 2004 Risk factors for adverse life outcomes in fetal alcohol syndrome and fetal alcohol effects Journal of Developmental & Behavioral Pediatrics 25 4 228 -238
Sunderland A. and Findlay L. C. 2013 Perceived need for mental health care in Canada: Results from the 2012 Canadian Community Health Survey–Mental Health Health Reports 24 9 3
Tough S. C., Clarke M., and Hicks M. 2003 Knowledge and attitudes of Canadian psychiatrists regarding fetal alcohol spectrum disorders The Canadian Child and Adolescent Psychiatry Review 12 3 64
Travers C., Martin-Khan M., and Lie D. 2009 Barriers and enablers of health promotion, prevention and early intervention in primary care: Evidence to inform the Australian national dementia strategy Australasian Journal on Ageing 28 2 51 -57
Tremblay M., Pei J., Plesuk D., Muchortow A., Mihai P., and Jordao R. 2017 Development of a Clinical Practice Model for Serving Clients with Fetal Alcohol Spectrum Disorder International Journal for the Advancement of Counselling 39 1 82 -97
Vanhaecht K., Bollmann M., Bower K., Gallagher C., Gardini A., Guezo J., and Sermeus W. 2006 Prevalence and use of clinical pathways in 23 countries—an international survey by the European Pathway Association Journal of Integrated Pathways 10 1 28 -34
Vanhaecht K., Ovretveit J., Elliott M. J., Sermeus W., Ellershaw J., and Panella M. 2012 Have we drawn the wrong conclusions about the value of care pathways? Is a Cochrane review appropriate? Evaluation & the Health Professions 35 1 28 -42
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Published In
Canadian Journal of Community Mental Health
Volume 38 • Number 3 • November 2019
Pages: 43 - 60
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Version of record online: 16 March 2020
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Tara Anderson, Mansfield Mela, Thomas Rotter, and Nancy Poole. 2019. A Qualitative Investigation into Barriers and Enablers for the Development of a Clinical Pathway for Individuals Living with FASD and Mental Disorder/Addictions. Canadian Journal of Community Mental Health.
38(3): 43-60. https://doi.org/10.7870/cjcmh-2019-009
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