Using ‘candidacy’ as a framework for understanding access to mainstream psychological treatment for people with intellectual disabilities and common mental health problems within the English Improving Access to Psychological Therapies service

Chinn, Deborah; Abraham, Elisabeth

doi:10.1111/jir.12274

Cited by 27 publications

(42 citation statements)

References 40 publications

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“…In other studies of access using candidacy theory, service users could feel devalued by negative interactions with providers [23] and frustrated by delays in diagnoses [26] or ineligibility for programs [21]. However the fear of being denied future care for serious illness illustrates the heightened significance of provider adjudications to women with substance misuse and in contact with the criminal justice system.…”

Section: Discussionmentioning

confidence: 99%

“…Family and other advocates can greatly assist access to care [21]. However, women leaving prison often lack social connectedness and support in the community [43].…”

Section: Discussionmentioning

confidence: 99%

“…It emphasizes that healthcare access is contingent and subject to constant negotiation. Candidacy has been applied to healthcare access in diverse situations including people with intellectual disability [21], mental health problems [22], multiple sclerosis [23], young people seeking sexual health care [24], women who were sex workers needing primary care [25] and children with asthma [26]. It has not yet been applied to people in contact with the criminal justice system and people with histories of substance misuse in the research literature.…”

Section: Introductionmentioning

confidence: 99%

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Medical homelessness and candidacy: women transiting between prison and community health care

Abbott

Magin

Davison

et al. 2017

Int J Equity Health

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BackgroundWomen in contact with the prison system have high health needs. Short periods in prison and serial incarcerations are common. Examination of their experiences of health care both in prison and in the community may assist in better supporting their wellbeing and, ultimately, decrease their risk of returning to prison.MethodsWe interviewed women in prisons in Sydney, Australia, using pre-release and post-release interviews. We undertook thematic analysis of the combined interviews, considering them as continuing narratives of their healthcare experiences. We further reviewed the findings using the theoretical lens of candidacy to generate additional insights on healthcare access.ResultsSixty-nine interviews were conducted with 40 women pre-release and 29 of these post-release. Most had histories of substance misuse. Women saw prison as an opportunity to address neglected health problems, but long waiting lists impeded healthcare delivery. Both in prison and in the community, the dual stigmas of substance misuse and being a prisoner could lead to provider judgements that their claims to care were not legitimate. They feared they would be blocked from care even if seriously ill. Family support, self-efficacy, assertiveness, overcoming substance misuse, compliance with health system rules and transitional care programs increased their personal capacity to access health care.ConclusionsFor women in transition between prison and community, healthcare access could be experienced as ‘medical homelessness’ in which women felt caught in a perpetual state of waiting and exclusion during cycles of prison- and community-based care. Their healthcare experiences were characterized by ineffectual attempts to access care, transient relationships with healthcare providers, disrupted medical management and a fear that stigma would prevent candidacy to health care even in the event of serious illness. Consideration of the vulnerabilities and likely points of exclusion for women in contact with the criminal justice system will assist in increasing healthcare access for this marginalised population.

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Section: Discussionmentioning

confidence: 99%

“…Family and other advocates can greatly assist access to care [21]. However, women leaving prison often lack social connectedness and support in the community [43].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Medical homelessness and candidacy: women transiting between prison and community health care

Abbott

Magin

Davison

et al. 2017

Int J Equity Health

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“…Of these, six dealt with a range of primary care services, 50,55,58,62,66,67 six dealt with with general practice, [51][52][53]57,60,70 five dealt with cancer screening, 59,63,68,69,72 two dealt with dental services, 56,64 two dealt with mental health services, 54,61 one dealt with diabetic retinopathy screening 65 and one dealt with sexual health. 71 The majority of included studies used a cross-sectional (e.g.…”

Section: Accessing Servicesmentioning

confidence: 99%

“…Only two studies used a cohort or case-control design 63,69 and two were classed as mixed methods. 54,71…”

Section: Accessing Servicesmentioning

confidence: 99%

Access to primary and community health-care services for people 16 years and over with intellectual disabilities: a mapping and targeted systematic review

Cantrell

Croot

Johnson

et al. 2020

Health Serv Deliv Res

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Background In 2015, approximately 2.16% of adults were recorded as having intellectual disabilities. UK government policy is that adults with intellectual disabilities should access mainstream health services. However, people with intellectual disabilities experience challenges when accessing primary and community health services that can lead to inequalities and shorter life expectancy. Objectives To map and review the evidence on access to primary and community health-care services for adults with intellectual disabilities and their carers. To identify influencing factors for gaining access to primary and community health-care services. To determine which actions, interventions or models of service provision improve entry access to these services for people with intellectual disabilities and their carers. Finally, to identify the gaps in evidence and provide implications for health care and recommendations for research. Data sources MEDLINE, The Cochrane Library, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Education Resources Information Center (ERIC) were searched from 2002 to 2018. Review methods The mapping review methodology included an extensive literature search, article selection and data extraction of relevant abstracts. Findings from the mapping review informed the scope of the targeted systematic review. Methodology for the targeted systematic review included an extensive literature search informed by the mapping review, article selection, data extraction, quality appraisal and narrative synthesis. Results The mapping review included 413 studies with data extraction completed on abstracts. The targeted systematic review synthesised the evidence from 80 studies reported in 82 publications. During the review process, the team identified three key points at which people with intellectual disabilities potentially interacted with primary and community health-care services: identifying needs, accessing services and interaction during a consultation. In addition, there were a number of papers about interventions or innovations to improve access. Evidence from the studies was synthesised within the four clusters. Influencing factors were identified: staff knowledge/skills, joint working with learning disability services, service delivery model, uptake, appointment making, carer/support role, relationship with staff, time, accessible information and communication. The influencing factors were cross-cutting through the literature, with certain factors having more importance in certain clusters. Limitations The main limitation was the weak evidence base. The studies generally had small samples, had study designs that were open to potential biases and measured only short-term outcomes. Conclusions Health checks were found to help identify health needs and improve the care of long-term conditions. Important factors for accessing health services for adults with intellectual disabilities were consistency of care and support, staff training, communication skills and time to communicate, and provision of accessible information. Health professionals need to ensure that there is joint working between different services, clear communication and accurate record-keeping. Future research questions centre on the need to develop and value creative study designs capable of addressing the complex issues identified in the findings of the review for this complex population. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 5. See the NIHR Journals Library website for further project information.

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Barriers and facilitators to providing CBT for people living with dementia: Perceptions of psychological therapists

Baker

Brede

Cooper

et al. 2021

Clin Psychology and Psychoth

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Many people living with dementia or mild cognitive impairment (MCI) experience anxiety and depression. Cognitive behavioural therapy (CBT) is a recommended treatment for adults, commonly provided through primary care psychological therapies services. This study explored the facilitators and barriers to providing CBT interventions for people living with dementia or MCI, as perceived by therapists working in such services. Structured interviews were conducted with 14 clinicians recruited through primary care psychological therapies services about their experiences of working with people living with dementia or MCI and their ideas about factors that enhance or hinder offering and delivering CBT to this population. Interview recordings were transcribed and analysed using thematic analysis. Credibility checks were incorporated throughout. Three themes were identified: ‘attitudes towards dementia’, ‘competing demands’, and ‘pressure without support’. Perceived facilitators and barriers occurred across individual, service, and system levels. Facilitators were positive engagement and outcomes for people living with dementia or MCI, positive attitudes of clinicians, and flexibility within some services. In contrast, perceived barriers were stigma towards dementia and mental health in older adults, high pressure on staff to perform with a lack of support to do so, exclusion based on diagnosis, and inflexibility within some services. Clinicians were confident that people living with dementia or MCI could benefit from CBT, with some adaptations to delivery. There are implications for staff support and training, and for commissioning practices relating to the tension between minimal resources, equitable access, and person‐centred care.

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Using ‘candidacy’ as a framework for understanding access to mainstream psychological treatment for people with intellectual disabilities and common mental health problems within the English Improving Access to Psychological Therapies service

Cited by 27 publications

References 40 publications

Medical homelessness and candidacy: women transiting between prison and community health care

Medical homelessness and candidacy: women transiting between prison and community health care

Access to primary and community health-care services for people 16 years and over with intellectual disabilities: a mapping and targeted systematic review

Barriers and facilitators to providing CBT for people living with dementia: Perceptions of psychological therapists

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