Browsing by Author "Bonfils, Kelsey"

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    Agenda Setting in Psychiatric Consultations: An Exploratory Study
    (2013) Frankel, Richard M.; Salyers, Michelle P.; Bonfils, Kelsey; Oles, Sylwia; Matthias, Marianne S.
    Objective: Patient- or consumer-centeredness has been recognized as a critical component of quality in primary health care, but is only beginning to be recognized and studied in mental health. Among the first opportunities to be consumer-centered is collaboratively producing an agenda of topics to be covered during a clinic visit. Early agenda setting sets the stage for what is to come and can affect the course, direction, and quality of care. The purpose of this work is to study agenda setting practices among 8 prescribers (5 psychiatrists and 3 nurse practitioners) at the beginning of their encounters with 124 consumers diagnosed with schizophrenia spectrum disorders (56%), bipolar disorder (23%), major depression (15%), and other disorders (6%). Method: We modified an extant agenda-setting rubric by adding behaviors identified by a multidisciplinary team who iteratively reviewed transcripts of the visit openings. Once overall consensus was achieved, two research assistants coded all of the transcripts. Twenty-five transcripts were scored by both raters to establish interrater reliability. Results: We identified 10 essential elements of agenda setting. Almost 10% of visits had no agenda set, and only 1 of 3 encounters had partial or complete elicitation of a single concern. Few additional concerns (4%) were solicited, and no encounter contained more than 6 essential elements. Conclusions and implications for practice: Collaborative agenda setting represents a unique opportunity to translate the concept of consumer-centeredness into mental health care. Initial results suggest the rating system is reliable, but the essential elements are not being used in practice.
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    Metacognitive function and fragmentation in schizophrenia: Relationship to cognition, self-experience and developing treatments
    (Elsevier, 2020-03) Lysaker, Paul H.; Minor, Kyle S.; Lysaker, John T.; Hasson-Ohayon, Ilanit; Bonfils, Kelsey; Hochheiser, Jesse; Vohs, Jenifer L.; Psychiatry, School of Medicine
    Bleuler suggested that fragmentation of thought, emotion and volition were the unifying feature of the disorders he termed schizophrenia. In this paper we review research seeking to measure some of the aspects of fragmentation related to the experience of the self and others described by Bleuler. We focus on work which uses the concept of metacognition to characterize and quantify alterations or decrements in the processes by which fragments or pieces of information are integrated into a coherent sense of self and others. We describe the rationale and support for one method for quantifying metacognition and its potential to study the fragmentation of a person's sense of themselves, others and the relative place of themselves and others in the larger human community. We summarize research using that method which suggests that deficits in metacognition commonly occur in schizophrenia and are related to basic neurobiological indices of brain functioning. We also present findings indicating that the capacity for metacognition in schizophrenia is positively related to a broad range of aspects of psychological and social functioning when measured concurrently and prospectively. Finally, we discuss the evolution and study of one therapy that targets metacognitive capacity, Metacognitive Reflection and Insight Therapy (MERIT) and its potential to treat fragmentation and promote recovery.
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    Rasch analysis of the illness management and recovery scale-clinician version
    (2014) McGuire, Alan B.; Kean, Jean; Bonfils, Kelsey; Presnell, Jade; Salyers, Michelle P.
    Rationale, aims and objectives The illness management and recovery scale-clinician version (IMRS-C) is a measure of outcomes thought to be important indicators of progress for consumers participating in illness management and recovery (IMR). Prior research has examined the psychometric properties of the IMRS-C; extant research supports certain aspects of the scale's reliability (test–retest) and validity (sensitivity to interventions). Analyses based on Rasch provide certain advantages and have not been applied to the IMRS-C. Method This study used an archival IMRS database including responses regarding 697 participants with severe mental illness from a variety of community-based settings. Rasch analyses were utilized to determine item functioning and utility of the IMRS-C. Results Results of Rasch analyses using the IMRS-C as one unidimensional scale were problematic. Analyses grouping items into three separate scales measuring recovery, management and biological vulnerability were more promising, but the third scale had other limitations. Conclusions Results suggest that the items included in the IMRS-C can form two screeners, one for recovery and one for management; items regarding biological vulnerability were inadequate. The assessment could be supplemented by more refined measures of coping/self-management and recovery constructs.