Country : United Kingdom
Assignment Task
 


Critique
The purpose of this assignment is to critique of a primary research paper: Transitions of Care from Child and Adolescent Mental Health (CAHMS) Service to Adult Mental Health Services (AMHS) (TRACK Study): A study of protocols in Greater London. The Bennet (2001) critiquing tool will be the main framework used to critique this study. The paper under critique is a quantitative study and is part one of a three -stage research study ‘ Transition from CAHMS to Adult Mental Health Services (TRACK): A Study of Service Organisation, Policies and Carer Perspectives’ Report for the National Institute for Health Research Service Delivery and Organisation programme, (2010). This paper was chosen for its relevance to the core document “Together for Mental Health: A strategy for Mental Health and Wellbeing in Wales”, (Welsh Government, 2012). The study was commissioned by the “National Institute of Health Research (NIHR) Service Delivery and Organisation (SDO) programme’ and funded by the Department of Health UK (Singh et al 2008). It is also relevant to the author’s Practice learning opportunity within a mental health setting.
Search Strategy
The literature search used electronic databases in FIND IT namely: CINAHL, Medline, PsychINFO, Science Direct and Social care institute for excellence (SCIE). The databases accessed were chosen for relevance to the study. The search required key words to produce specific material. The key words used were, ‘adult services’, ‘young people’, ‘transition’ and ‘mental health’. The search produced over 4000, articles in FIND IT. The author reduced the volume of articles by adding UK based research articles only, within an eight- year period from 2008-2017 of which are peer reviewed (Whittaker, 2010). Peer reviewed articles have been subject to expert analysis and can be referred to as high quality material (Whittaker, 2010). As the core document did not refer to a specific research paper, the “snowball method” was initiated. Rubin and Babbie (2013) refer to snowballing as a method of garnering information difficult to find whereby one source will lead to another source. The core document infers that transition between services needs improvement by adopting a better management process of transition for young people, (Welsh Government 2012).
Background
The study is about gathering information on protocols of transition between Child and Adolescent Mental Health services (CAHMS) and Adult Mental Health services (AMHS) with the aim of establishing if the protocols help or hinder the transition process. For many young people the transition from children’s mental health services into adult mental health is poorly managed with the transition often occurring at a time when young people are going through developmental changes. (Singh 2005, echoed by Dunn 2017). Many are discharged from children services as they no longer meet the criteria but are too young for adult services, leaving young people exposed to external environmental risks, Not in Education, Employment or Training (NEET) (Brodie et al, 2011).The leading author of the study Professor Singh, of Social and Community Psychiatry, holds high academic attainment and is the consultant Psychiatrist in early intervention services at Warwick University. Singh trained as a surgeon, is the lead on the Mental Health Network and lead researcher of several national research programmes. He was commissioned to prepare a report from the TRACK Study by the National Institute for Health Research Service Delivery and Organisation Programme (2010). Moli Paul is a consultant Psychiatrist at Coventry and Warwick Universities with research interest in the area of transition between CAHMS and AMHS (Paul, 2015). Tamsin Ford and Tami Kramer are both members of the Royal College of Psychiatrists. Verification of credentials is essential, as it validates credibility of the researchers knowledge and skills to undertake the study presented (Ryan et al 2007).
Literature Review
Literature reviews aid the formulation of research questions highlighting gaps in past research studies and goes beyond earlier research (Rubin and Babbie 2013, Bell, 2010). Singh et al (2008), Moli, (2015), Dunn, (2017) found little evidence of any research about protocols of transition from the literature review, giving a clear direction for the focus of the study and the research question. Ryan et al (2007) mention the importance of congruence between the data from the literature review and the research question as it indicates that the aim of the research is valid with a clear objective. The researchers involved in this study carried out a literature review, via access of many databases such as: CINAHL, PsychINFO, EMBASE, in addition to publications and reports. An oversight of this paper would be in the structural layout, as it does not have a clear heading for the ‘literature review’. The literature review is included under the heading pertaining to how the tool used to obtain data, was constructed. However the researchers have carried out a thorough review of previous studies, reports and publication bulletins. Singh ((2005) carried out a book review of the ‘Interface between child and adult mental health services’ written by Reder, P et al (2000). This review highlighted key themes: Poor transition protocols, better staff training, joint working between CAHMS and AMHS, age related boundaries. Whittaker (2010) argues against the use of books for literature reviews, as they have not been robustly examined for validity as peer- reviewed journal articles have; however they can provide an overview of key themes. Although the literature review cited can be criticised for being dated, the review of the literature highlights clearly the need for further research as the more up to date review of literature is still proving to be relevant today with evidence of key themes. In addition some sources cited are not UK based and arguably considered not culturally applicable such as Davies, (2005). Arguably, differences appear between the research papers cited by Singh (2008) and Dunn (2017). Singh (2008) used a quantitative design to review protocols of transition and Dunn (2017) used a qualitative design to review views of young peoples experiences of transition. However both studies indicate that transition is still an issue in mental health services.
Study Aim
The aim of any study should be clearly defined (Ryan et al 2007). The aim of this study was not easy to identify under its own heading, as is common in research papers. The aim of the study was found under the background and methodology heading. The title of the study is clear about the aim of studying transition protocols in the area of London within the mental health services. Further evidence of congruence is found under the background heading where the researcher classifies two types of transition, developmental transition and situational transition, the defined term used for the study was situational transition pertaining to transition of care from one service to another.
Study Design
Research design should clearly state the method used to collect data, how it is collected and the appropriate tools used (Ryan et al (2007. There are limitations for the reader in the following areas, no clear explanation for the choice of method used, type of research design or data collection. Whittaker (2010) cites two types of data, Qualitative and Quantitative and both have specific outcomes. Qualitative data explores social phenomena and Qualitative data focuses on measurable outcomes that can be analysed and used statistically. The research data collected is quantitative this is evident in the gleaning of information being sought such as numbers of individuals suitable for transfer into AMHS, how many services use protocols and transition boundaries. The method of gathering data was a multi site, postal survey questionnaire, typically used in qualitative research to gather information as a sample of a large population, for descriptive or exploratory reasons and can be cheaper than an interview and generalizable to a large population. This therefore seems an appropriate method for gathering of numerical data for the researchers study aim (Rubin and Babbie, 2013). Rubin and Babbie (2013) cite a disadvantage to the use of postal surveys having a negative effect on response rates especially where data collection methods have not been considered. Participants may fail to respond if there is no envelope or stamp, impacting on representativeness of results. To combat non -response rates, the researcher sent out reminder postal requests and follow-up calls. Johnson (2015) and Dillman (2007) suggest faster response rates with web surveys and criticise the use of reminder letters in delaying surveys.
Study Sample
The study sample consisted of 65 CAHMS teams in Greater London. Whittaker (2010) echoed by Lim and Ting (2012), espouse that sampling is a process of selecting subjects for study chosen from a target population. The sample chosen garnered from service managers; National CAHMS support service and psychiatrists, as the researchers did not have a list of CAHMS teams at the start of the study. It seems that the sample method was snowballing (non probability sampling) a procedure used when target groups are difficult to find, selected subjects are requested to give information about other possible subjects of a population, (Rubin and Babbie 2013, Blaxter et al 2002). Recruitment was dependant on the information gained from other teams that were sent the study tool. Although the researchers recognise the limitations of this method of recruitment, it is open to criticism, as the researcher could not know if all the CAHMS teams were included in the study, as well as being too generalised to the rest of UK. Singh et al (2008) echoes experiences in Wales, supported by the “Together for Mental Health in (Wales) strategy (2012), where there are gaps in provision for 16-19 year olds, (Welsh Government 2012). It is also difficult to define what area of London is included in the study, as Greater London is not clearly explained there are two boroughs of London, inner and City of London, (ONS 2017).
Data Collection
Whittaker (2010) suggests piloting the questionnaire to avoid questions being misinterpreted allowing room for rewording of questions. The study does not mention piloting of the questionnaire survey raising concern of reliability. Although not mentioned in the paper, the Track report (2010) mentions a pilot questionnaire, designed collaboratively with CAHMS consultants. Whittaker (2010), Runbin and Babbie (2013) urge researchers to send follow up letters to enhance response rates. The study data collection was obtained from survey questionnaires posted to team managers of identified CAHMS, with a further two postal reminders and follow up telephone calls. Although the postal service was used to obtain data from participants; Rubin and Babbie (2013) opine that most people find surveys too much hassle; the researcher could have used self -mailing questionnaires. The data collection method can be criticised for not being clear, on the returning of the data.
Ethical Considerations
Ethics committees have to give approval before research can proceed, (Ryan et al 2007). Ethics are not discussed within the study, however a report of the study (2010) established approval by, Wandsworth Medical Ethics and Research Committee (MREC). Protection from harm, confidentiality and anonymity are essential aspects of any study (Ryan et al 2007). The study under review used a postal questionnaire survey assumed to protect anonymity of sensitive information also enabling participants open responses (Rubin and Babbie, 2013). However, anonymity is not protected in this study as the report (2010) clearly identifies the respondents through the questionnaire form, whereby Name, Title and team ID are requested, which is likely to bring into question participant honesty. According to Ryan et al (2007) autonomy assumes the freedom to partake, free from harassment, with clear understanding of the study. However, it could be inferred that there was a possibility of respondents feeling harassed and compelled to participate due to the follow up calls and reminder letters being sent out.
Data Analysis
Data analysis is an exploration exercise to evaluate information gathered focusing in on key themes, similarities and differences, coding, cleaning data and presenting it, Whittaker (2010). Ryan (2007) opines that Quantitative research can be complex due to the terms used in statistical presentation of data. Statistics should be clearly presented enabling the reviewer to identify if the results answer the question, (Ryan 2007). Data was entered into a Statistical Package for Social Sciences (SPSS) a software program on a computer that produces statistical data from the raw data gathered. Ryan (2007) mentions that research design that is descriptive should present descriptive statistics. Descriptive statistics help to show data in an easy format for the viewer (Rubin and Babbie 2013). This was evident in the table set out within the research paper. The study set out a clear descriptive approach of gathering data from the National service framework document as follows; type of service, catchment area and transition boundaries, Team structure, size, referral rates to AMHS. The results of the data seem valid as the descriptive statistics show differences in protocols presented through standard deviation, means (averages) ranges and percentages. Although statistical data is presented it is difficult for the reviewer to understand.
Study Results
Statistical data is typical of quantitative research and is best presented clearly using graphs, tables or charts; it should allow the viewer to easily understand the results (Ryan et 2007). The results of the study under review are presented in Table format using percentages. When carrying out data analysis in readiness to present the results the response sample size is relevant regarding generalizability, to avoid response bias the results must be above fifty percent (Ryan et al (2007). The percentage of participants of the study is recorded at 65%, according to Ryan et al (2007) is sufficient enough for generalizability of the population.
Discussion
The researchers discuss the results fairly through content analysis of the protocols underpinned in the National Service Framework (NSF) the results highlight poor clinical practice when it comes to preparing for transition. The researchers aim was to find factors that hinder transition from CAMHS to AMHS of which they achieved. The discussion is balanced regarding protocols under the NSF pertaining to CAHMS therefore answering the research question evident in the results, yet the omission by the researchers about the aim not being about gaps in services indicates limitations for the researchers, arguably they could have gleaned information about protocols from AMHS and used a qualitative approach to establish a more balanced study, of which the researchers admit.
 

    

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  • Posted on : February 15th, 2020
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