Methods Provided Consultations Question & Answer Guide (With Explanation)

This type of question evaluates analytical and critical thinking skills.

What This Question Is About

This question relates to methods provided consultations and requires a structured academic response.

How to Approach This Question

Use appropriate theories and support your answer with clear reasoning.

Key Explanation

This topic involves methods provided consultations. A strong answer should include explanation, application, and examples.

Original Question

Methods LMM provided consultations to several Canadian aboriginal reserves and to urban Indian centers and facilities in the province of Saskatchewan. LMM implemented talking circles within and around 10 primary care health clinics, usually in the waiting room after hours. Posters and flyers were widely circulated to announce talking circles at the primary care clinic to explore solutions to problems of drugs, alcohol, and mental health in the community. No one was excluded. A total of 1211 people attended at least 1 meeting. Participants completed the MYMOP2 initial rating form on the first day of participation and the follow-up form on their fourth time of participation. A total of 415 participants submitted both an initial rating and at least 1 follow-up form. There were 234 people available for telephone interview at the completion of their eighth week of participation. This project had institutional review board approval as part of a larger research project on spirituality and health. No identifying data were provided on the MYMOP2 forms. Respondents picked their own code names so that their first and second MYMOP2 forms could be correlated. The study lasted for 3 years and finished when LMM left Saskatchewan, so the study size was determined by factors external to the participants. The MYMOP2 is a patient-centered, problem-specific outcome measure. Evidence suggests that it is a useful and sensitive measure of change in perceived symptoms and quality of life.16-18 In the current study, participants used the MYMOP2 to choose the 1 or 2 symptoms of most concern to them, along with 1 activity of daily living that was restricted or prevented by these symptoms. The respondent scored these items according to their severity in the previous week using a 7-point Likert scale ranging from 0 (as good as it can be) to 6 (as bad as it can be). They also rated their general feelings of well-being. Measures were taken before the first treatment (baseline) and at follow-up 3 months later. Additional details collected included gender, age, occupation, and marital status. The MYMOP2 has been used in clinical audits in the United Kingdom (UK) to improve patient care,19 to show that acupuncture benefited people with chronic illness,18 and to assess overall outcomes in a complementary care clinic.20 In all these contexts, the MYMOP2 provided an opportunity to assess overall improvement in symptom severity, the degree to which symptoms restrict participation in desired activities, and overall quality of life in cases in which the symptoms themselves may be radically different. The use of symptom-specific scales in these cases would result in insufficient numbers of participants for comparison purposes and also prevent across-illness comparisons. Paterson and Britten,18 Rees,19 and Harris et al20 have argued that the MYMOP2 is more useful than other tools for the “real-world” situation in which clinicians apply the same treatment methods (group therapy, talking circle, acupuncture) to a variety of different patients and conditions, all with the same goal of reducing their suffering and improving their quality of life. LMM typically participated in the first talking circle and encouraged participants to continue to meet on their own. LMM or an associate appeared regularly to distribute MYMOP2 follow-up forms and to provide support to the continuation of the talking circles. The talking circles consisted of a kind of “leaderless leadership” in which the person who had originally convened the talking circle welcomed new members (whom anyone could invite), led the opening prayer, and oriented members to the task or question for which the talking circle had been convened. No fees were charged and no professionals were intentionally involved in leadership roles. The opening invitation usually related to exploring how alcohol, drugs, and mental health issues affected participants and their families in their home communities. No attempt was made to personalize the invitation to those people who came. The MYMOP2 was introduced as a tool to assess how participation might have an impact on participants’ own health and sense of well-being. The rationale for this lay in their participation in problem solving for the community in a uniquely Native American (First Nations) manner. Support groups and 12-step groups were also available in the communities involved in this study. We wondered whether having the opportunity to meet in this culturally appropriate manner with others would reduce the primary complaints that people had (as reported on the MYMOP2). Even with the best resources, mental health services cannot meet the need for mental health care in the community.21 We wondered whether culturally syntonic practices could help fill that gap. This could be important in health care systems such as the UK’s in which primary care has considerable power to fashion the development of services locally, through both service provision and commissioning. In the UK, primary care trusts are able to provide locally any form of service they choose, including mental health care.21 Statistical Analyses Descriptive statistics were compiled in the standard method provided by Statistical Product and Service Solutions (SPSS) version 17 (IBM, Armonk, NY). Paired t tests were used to compare pre- and postbaseline and end data on the MYMOP2 scale for the 2 most prominent symptoms, their effect on activities of daily life, and the person’s overall well-being. Participants who provided only one MYMOP2 were not included in the analysis. Sources of Bias The results of this study are biased toward people who came at least four times. We do not know the reasons why people came fewer than four times. We picked four attendances as a minimum number expected to produce change in participants. Psychotherapy outcome studies tend to require a minimum of six visits. We cannot provide an intent-to-treat analysis because all circles had open enrollment, and no one was referred specifically to the circle. All who came were welcome. Follow-up data was collected only on the fourth time that a person attended the circle, and a person could attend without providing any data. Results The mean age of the participants was 40.5 years. Of the participants, 65.5% were women (mean [standard deviation (SD)] age, 42.1 [15.9] years), and 66% of those were married. For men, 35.1% were married. Of the respondents, 21.6% reported taking prescription medication for their main symptom; the majority of which included analgesic and anti-inflammatory drugs for musculoskeletal complaints, headaches, and migraines. Other medications commonly reported by participants included antidepressants, antihistamines, anti-anxiety agents, sleep-promoting agents, and narcotic pain medications. Of participants taking medication, 72% had experienced their main symptom for more than a year. All participants were asked if cutting down or avoiding medication was important to them; 29.8% reported this was “very important,” whereas 29.8% indicated it was “not important.” Table 1. The number of patients reporting the most common symptoms upon arrival at the talking circle (N = 415) Symptom Men (n = 143) Women (n = 272) Musculoskeletal 37 90 “Family problems” 22 75 Headaches 21 63 “Stress” 25 56 “Children” 15 39 “Marriage” 19 31 “Depression” 13 30 Worry/fear/anxiety 12 13 Financial/money 47 15 “Work” 33 14 Other 42 118 Total 286 544 Histograms were used to confirm that the results followed an approximate normal distribution, which they did. The paired-samples t-test procedure of SPSS, version 18 (IBM) was used to test the hypothesis that statistically significant improvement occurred in symptoms, activities of daily living, and overall well-being during the time that participants attended the talking circles. The reporting of specific medications taken was spotty and not judged reliable, so it was not analyzed. Although the majority of patients served were aboriginal, nonaboriginal people also attended the talking circle. As we did not ask about ethnicity, no analysis was possible on that variable. Table 2 presents the results of paired t-test analyses. Both the participant’s primary symptom and his or her secondary symptom showed a statistically significant decrease in severity from the beginning of participation in the talking circle to the end of the fourth visit. The extent to which symptoms interfered with daily life was also statistically significant, decreasing from baseline through the fourth visit. Ratings of overall well-being also statistically significantly improved (lower ratings equal better well-being). Effect sizes ranged from 0.75 to 1.19, indicating that participating in the talking circle had a robust effect. Table 2. Comparison of baseline and end data Result Symptom 1 Symptom 2 Effect on activities of daily life Overall well-being Difference from baseline to end −1.9 −1.2 −1.9 −0.9 SD 1.6 1.6 1.8 0.9 95% CI of the differences of the mean −2.179 to −1.621 −1.479 to −0.921 −2.2288 to −1.5712 −1.0644 to −0.7356 Significance p < 0.001 p < 0.001 p < 0.001 p < 0.001 Effect size 1.19 0.75 1.06 1.00 Open in a new tab CI = confidence interval; SD = standard deviation. The statistical power to detect an effect was 100%. can you summarize the above study

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