Browsing by Author "Firmin, Ruth"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    Burnout and Self-Reported Quality of Care in Community Mental Health
    (2014) Salyers, Michelle P.; Fukui, Sadaaki; Rollins, Angela L.; Firmin, Ruth; Gearhart, Timothy; Noll, James P.; Williams, Stacy; Davis, C.J.
  • Thumbnail Image
    Item
    Burnout and self-reported quality of care in community mental health
    (Springer, 2015-01) Salyers, Michelle P.; Fukui, Sadaaki; Rollins, Angela L.; Firmin, Ruth; Gearhart, Timothy; Noll, James P.; Williams, Stacy; Davis, C.J.; Department of Psychology, School of Science
    Staff burnout is widely believed to be problematic in mental healthcare, but few studies have linked burnout directly with quality of care. The purpose of this study was to examine the relationship between burnout and a newly developed scale for quality of care in a sample of community mental health workers (N=113). The Self-Reported Quality of Care scale had three distinct factors (Client-Centered Care, General Work Conscientiousness, and Low Errors), with good internal consistency. Burnout, particularly personal accomplishment, and to a lesser extent depersonalization, were predictive of overall self-rated Quality of Care, over and above background variables.
  • Thumbnail Image
    Item
    Clinicians' Perceptions of How Burnout Affects Their Work
    (2015-02) Salyers, Michelle P.; Flanagan, Mindy E.; Firmin, Ruth; Rollins, Angela L.; Department of Psychology, IU School of Science
    Objective: The aim of this mixed-methods study was to identify ways that professional burnout may affect clinical work and consumer outcomes. Methods: Clinicians (N=120) participating in a burnout intervention trial completed a survey before the intervention, rating their level of burnout and answering open-ended questions about how burnout may affect their work. Responses were analyzed with team-based content analysis. Results: Clinicians reported specific ways that burnout affects work, including empathy, communication, therapeutic alliance, and consumer engagement. Clinicians acknowledged negative impacts on outcomes, although few consumer outcomes were specified. Clinicians with higher levels of depersonalization were more likely to report that burnout affects how staff work with consumers (r=.21, p<.05); however, emotionally exhausted clinicians were less likely to report an impact on consumer outcomes (r=–.24, p=.01). Conclusions: Reducing professional burnout may have secondary gains in improving quality of services and consumer outcomes; findings point to specific aspects of care and outcome domains that could be targeted.
  • Thumbnail Image
    Item
    Consumer and Relationship Factors Associated with Shared Decision-Making in Mental Health Consultations
    (2014-12) Matthias, Marianne S.; Fukui, Sadaaki; Kukla, Marina; Eliacin, Johanne; Bonfils, Kelsey A.; Firmin, Ruth; Oles, Sylwia; Adams, Erin L.; Collins, Linda A.; Salyers, Michelle P.; Department of Psychology, IU School of Science
    Objective: This study explored the association between shared decision making and consumers’ illness management skills and consumer-provider relationships. Methods: Medication management appointments for 79 consumers were audio recorded. Independent coders rated overall shared decision making, minimum level of shared decision making, and consumer-provider agreement for 63 clients whose visit included a treatment decision. Mental health diagnoses, medication adherence, patient activation, illness management, working alliance, and length of consumer-provider relationships were also assessed. Correlation analyses were used to determine relationships among measures. Results: Overall shared decision making was not associated with any variables. Minimum levels of shared decision making were associated with higher scores on the bond subscale of the Working Alliance Inventory, indicating a higher degree of liking and trust, and with better medication adherence. Agreement was associated with shorter consumer-provider relationships. Conclusions: Consumer-provider relationships and shared decision making might have a more nuanced association than originally thought.
  • Thumbnail Image
    Item
    F247. Internalized Stigma Has a Stronger Relationship with Intrinsic Motivation Compared to Amotivation in Early Phase and Prolonged Schizophrenia
    (Oxford University Press, 2018-04) Firmin, Ruth; Luther, Lauren; Lysaker, Paul; Vohs, Jennifer; Psychiatry, School of Medicine
    Background Motivation deficits predict decreased functioning in schizophrenia. Recent work suggests deficits reflect challenges in separate domains: intrinsic motivation (one’s internal drive to engage in a behavior out of enjoyment or interest) and amotivation (one’s broader decrease in motivated behavior linked to avolition and anhedonia). Internalized stigma is another determinant of functioning for people with schizophrenia that may impact motivation. However, little is known about these relationships, including which aspects of motivation it may impact nor when these links emerge. Identifying the link between these constructs may help to identify whether internalized stigma may be a novel treatment target to facilitate improvements in motivation. Methods Forty adults with early phase schizophrenia and 66 adults with prolonged schizophrenia completed measures of internalized stigma, intrinsic motivation, and amotivation. Pearson’s correlations were examined followed by Fischer’s r-to-z transformations to compare differences in the magnitude of associations between internalized stigma and intrinsic motivation and internalized stigma and amotivation among the first episode and prolonged samples. Next, we conducted stepwise regressions to examine whether internalized stigma was associated with intrinsic motivation above and beyond associations with amotivation in each sample. Results In the early phase sample, the association between internalized stigma was greater with intrinsic motivation (r=-0.48, p=.00) compared to amotivation (r=0.27, p=0.10). Associations with internalized stigma in the prolonged sample were also greater with intrinsic motivation (r=-0.30, p=0.02) versus amotivation (r=0.19, p=0.12). The magnitude of the associations between internalized stigma and intrinsic motivation (z=1.03, p=0.15) and between internalized stigma and amotivation (z=0.41, p = 0.34) did not significantly differ when comparing phase of illness. Regression analyses indicated that, controlling for amotivation, internalized stigma predicted intrinsic motivation in both the prolonged sample (R2=0.09, F(1,64) =6.18, p=0.02) and the early phase schizophrenia sample (R2=0.23, F(1,37)=10.98, p=.00). Discussion Results suggest internalized stigma has a stronger relationship with intrinsic motivation separate from, and above and beyond, its association with amotivation. Findings support models of intrinsic and amotivation being distinct domains. Links between internalized stigma and motivation appear to emerge and persist from the early stages of schizophrenia, suggesting that targeting stigma in early intervention services may help to improve intrinsic motivation in people with schizophrenia.
  • Thumbnail Image
    Item
    What we are like when we are at our best: Appreciative stories of staff in a community mental health center
    (Taylor & Francis, 2015) Salyers, Michelle P.; Firmin, Ruth; Gearhart, Timothy; Avery, Elizabeth; Frankel, Richard M.; Department of Psychology, School of Science
    Appreciative Inquiry is an organizational change methodology that discovers what works well in an organization and then pursues strategies to enhance those factors. The initial discovery process itself provides data ripe for qualitative analysis. Narratives were collected from 27 community mental health staff about times when they were at their best. An emergent, consensus-based analysis was used to understand the stories and exemplary work -- with competent, caring staff and elements needed to support them. Findings are discussed in light of self-determination theory that people are at their best with a sense of mastery, connection, and autonomy.