Multidisciplinary Community Mental Health Team - Research Paper Example

1. Review and Critique of Quantitative Research Paper Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care John Carpenter, Justine Schneider, Toby Brandon and David Wooff Summary of Paper: This research was conducted as a longitudinal (over two years) study of staff working in various models of integrated Community Mental Health Care Teams (CMHTs), in four districts in the North of England. Initially, 31 social workers and 82 health professionals comprised the sample subjects, who completed nine questionnaires anonymously, to provide the data. Several variables were used; these included 'profession', 'district', 'strategy', 'approach', ' job satisfaction' and 'stress'. The purpose was to investigate relationships between organization of community mental health services and professional and team identification, team functioning and the psychological well-being and job satisfaction of staff in the teams. The researchers hypothesized that well-established, integrated teams would function better than the discrete team model, based on attitudes, shared values, clearer objectives and role definitions etc., which would result in higher levels of job satisfaction and less stress. The conclusions reached were described as 'tentative' (Carpenter et al, 2001), owing to the small sample size, with results showing that different patterns of service organization were associated with perceptions of team functioning and role conflict. More 'targeted' (ie. focused on particular patients) services performed better on those measures, while their hypothesis, regarding service organization and job satisfaction, was overturned, as little difference was identified. Finally, because social workers had less positive perceptions, it was suggested that support and supervision be put in place to ensure their contribution when setting up integrated services. In order to review and critique the research paper, each section as it occurs will be discussed, with final critical comments to close. Title and Researchers: The title does not fully explain the specific purpose of the research, as no 2. variables are included and may possibly inform better with the addition of these, such as ..."Mental Health Care Using Organizational Models in Four NH S Districts" The researchers are eminently qualified and experienced in various fields; research, social sciences, sociology, psychology and statistics, with many past and ongoing projects to support their credibility. That funding was provided by the Department of Health, and that the British Journal of Social Work reviewed and accepted the research, adds further credence to the value of the work. Summary: This clearly sets out what was to be investigated and defines the results and findings. The language is easily understood, and though no straightforward 'why' is present, there is no bias shown and results are honestly reported. It provides a good synopsis for the paper and what the work entailed. Introduction: In this section, the scene is set, with much background information on previous research and findings. It might even be considered an informal literature review. Some confusion arises on learning that "CMHTs were found to be comparatively effective," although "variation was evident" (Carpenter et al, p. 1083, 2001), while on the other hand, "there is as yet no evidence concerning whether team functioning can be promoted by greater integration of health and social care services." The statement seems to suggest that the research will find such evidence, given the aims which follow, but it is couched in a roundabout manner, and raises the question as to why this is necessary if the CMHTs were effective Aims: At last, the hypothesis and central point of the investigation is laid out in detail. The language is sometimes repetitive, but is unambiguous and helpful in spelling out just what is involved and what they hoped to discover, again no clear statement of what could be done with such findings. The researchers wanted to see how attitudes, values, team functioning, practice, role clarity and conflict, team objectives, professional origins, and so forth, would be affected by how services were organized and delivered. All the positive aspects were assumed to ideally result in better job satisfaction, more participation and less stress. A further aim was to explore differences 3. between social workers and health professionals, with two time points used to account for change over time. Method: By extracting results from a linked study of all the Mental Health Trusts in England (Schneider et al, 1999), integration was defined, using "criteria chosen to reflect the organizational compatibility between health and social services" (Carpenter et al, p. 1084, 2001). While this provided valuable background information as to variables (eg. targeted trusts, inclusive trusts), it would have been better included in the Introduction, alongside the other references to earlier studies. The volume of information could happily be condensed, as it appears to outweigh the more relevant issues of practical actions. However, Figure 1 is excellent, and with a simple explanation, would have been sufficient here. Measures: These are again, clearly explained, though the sample subjects would have been more appropriately sited in this section, and not with the Results. Significant numbers of participants dropped, from 113 to 77, with a loss of nine social workers at Time 2, raising doubts as to the validity of the findings. The fact that few psychiatrists took part also calls into question how the final analysis reflected the true picture. The use of nine questionnaires, while undoubtedly collecting comprehensive data, seemed over-burdening for participants. Some questionnaire examples would have been useful, but given publishing constraints, their absence is understandable. The inclusion of gender and racial make up of the sample seemed an irrelevant afterthought, almost as if boxes were ticked, so this must be included, and was it necessary, given that the research sought to explore professional differences in experiences and perceptions Data Collection and Analysis: Plain numbers, as well as percentages might have clarified Time 2, as would the reasons for social workers' withdrawal from the research. There appears to have been every conceivable statistical method applied in order to reach conclusions, and where data could not be judged reliable, this fact was shared honestly. Given the variables and sample size, the complications can be accepted. However, the tables and headed paragraphs including personal 4. views were an asset in aiding interpretation of all elements covered in the study. In particular, Tables 3 and 4 present results very clearly and are most helpful. With reference to Table 6 and 'job satisfaction', the researchers were honest in declaring the need for larger samples before drawing conclusions. Discussion: Results are once more clearly and honestly presented, highlighting the weaknesses and limitations, again, size of sample, absence of some health professionals, and only one district in each cell. Evidence of ethical practice appears in this section, given that some information was not reported "for reasons of confidentiality". (Carpenter et al, p. 1097, 2001). Regarding professional differences, interestingly, the researchers found social workers not to have lower job satisfaction and role clarity, as opposed to th findings of Onyett et al (1997) and Peck and Norman (1999). Good comparisons are made throughout the Discussion, with other other studies, which helped to put matters into perspective, but inserting data from other Trusts appeared too little, too late in the overall scheme. Conclusion: There appeared to be few definitive outcomes identified - e.g. "differing patterns of service organization may be associated with staff perceptions of team functioning.." and "Service organizations had no evident impact...stress or job satisfaction" and "conclusions are tentative because of the small sample sizes." (Carpenter et al, p. 1100, 2001). The only recommendation, which is not specifically described as such, calls for support and supervision so that social workers contribution is ensured in setting up CMHTs. The final conclusion is one which may be extended to any team situation in order to achieve common goals; that in "well-established services", people who have job satisfaction will see themselves as part of a well-functioning team, and are "no more stressed than the general population." Reduction of role conflict and enhancing role clarity makes for "positive outcomes." (Carpenter et al, p. 1100, 2001) Critical Comment: Overall, the paper provides good backgound information, excellent bibliography and plenty of clearly presented detail. While the purpose and integrity of the research 5. are not in doubt, it raises some questions, and produces the impression of 'a sledgehammer to crack a nut'. Given that a linked survey had already produced much relevant data, with a larger sample available on which to test the hypotheses, one wonders why the researchers did not make use of this, and thereby reach sturdier conclusions and more concrete recommendations. There appears to be too many variables applied to too few areas and subjects to make this a properly quantitative study. The qualitative data gathered from questionnaire nine, though adding to the authenticity and interest, makes the study a bit of both, but may be accepted as a positive aid to interpreting numerical analysis, making the figures more real and the presentation more human. Because of the decrease in numbers at Time 2, and the lack of all health professional participation, the overall small size, it is difficult to consider the findings as entirely valid or useful, or the whole exercise as worthwhile. Much similar research, findings and NH recommendations and directives were already in place, almost making this study feel redundant, especially in light of the only suggestion being around social workers perceived needs in setting up of teams. In conclusion, the research appears not to inform anyone of anything they did not already know, but the thoroughness of the approach, the the methodology provide a good model for any future, larger studies, applicable to many areas and disciplines, where change needs to be properly managed and teams formed with best practice in mind. Reference List Critically Reviewing the Literature - Evaluation Criteria (nd) Academic Services, Millbrook House Retrieved 21 August 2006 from http://www.2.plymouth.ac.uk/millbrook/rsosurces/sealit/critical.htm Exploratory Factor Analysis , Stepwise Regression (nd) Statistics Toolbox Retrieved 21 August 2006 from http://www.ioa.pdx.edu/newsom/semclass/ho_efa.doc Open University Handbook - D820 Study Guide TMA3 (2003) Section 5:4, published by OU 2003 Trinder, Liz, (1996) Social Work Research: the state of the art (or science). Child & Family Social Work 1 (4) 233-242 (1996). Retrieved 20 August from http://www.rip.org.uk/changeprojects/documents/digdeeper/LizTrinder.pdf Read More