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Harrison R, Iqbal MP, Chitkara U, Adams C, Chauhan A, Mitchell R, Manias E, Alston M, Hadley AM. Approaches for enhancing patient-reported experience measurement with ethnically diverse communities: a rapid evidence synthesis. Int J Equity Health 2024; 23:26. [PMID: 38342909 PMCID: PMC10860321 DOI: 10.1186/s12939-024-02107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 01/13/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Patient-reported experience measures (PREMs) are used to drive and evaluate unit and organisational-level healthcare improvement, but also at a population level, these measures can be key indicators of healthcare quality. Current evidence indicates that ethnically diverse communities frequently experience poorer care quality and outcomes, with PREMs data required from this population to direct service improvement efforts. This review synthesises evidence of the methods and approaches used to promote participation in PREMs among ethnically diverse populations. METHODS A rapid evidence appraisal (REA) methodology was utilised to identify the disparate literature on this topic. A search strategy was developed and applied to three major electronic databases in July 2022 (Medline; PsycINFO and CINAHL), in addition to websites of health agencies in Organisation for Economic Co-operation and Development countries via grey literature searches. A narrative evidence synthesis was undertaken to address the review question. RESULTS The review resulted in 97 included studies, comprised 86 articles from electronic database searches and 11 articles from the grey literature. Data extraction and synthesis identified five strategies used in PREM instruments and processes to enhance participation among ethnically diverse communities. Strategies applied sought to better inform communities about PREMs, to create accessible PREMs instruments, to support PREMs completion and to include culturally relevant topics. Several methods were used, predominantly drawing upon bicultural workers, translation, and community outreach to access and support communities at one or more stages of design or administration of PREMs. Limited evidence was available of the effectiveness of the identified methods and strategies. PREMs topics of trust, cultural responsiveness, care navigation and coordination were identified as pertinent to and frequently explored with this population. CONCLUSIONS The findings provide a basis for a maturity model that may guide change to increase participation of ethnically diverse communities in PREMs. In the short-medium term, health systems and services must be able to recognise and respond to cultural and linguistic diversity in the population when applying existing PREMs. In the longer-term, by working in collaboration with ethnically diverse communities, systems and services may co-create adapted or novel PREMs that tackle the factors that currently inhibit uptake and completion among ethnically diverse communities.
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Affiliation(s)
- Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Maha Pervaz Iqbal
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Upma Chitkara
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Corey Adams
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences- Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Rebecca Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, VIC, 3800, Australia
| | - Megan Alston
- Elevating the Human Experience Program, NSW Ministry of Health, Sydney, NSW, 2065, Australia
| | - Anne Marie Hadley
- Elevating the Human Experience Program, NSW Ministry of Health, Sydney, NSW, 2065, Australia
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Spaas C, Said-Metwaly S, Skovdal M, Primdahl NL, Jervelund SS, Hilden PK, Andersen AJ, Opaas M, Soye E, Watters C, Verelst A, Derluyn I, Colpin H, Haene LD. School-based Psychosocial Interventions' Effectiveness in Strengthening Refugee and Migrant Adolescents' Mental Health, Resilience, and Social Relations: A Four-country Cluster Randomized Study. PSYCHOSOCIAL INTERVENTION 2023; 32:177-189. [PMID: 37691715 PMCID: PMC10484026 DOI: 10.5093/pi2023a12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/30/2023] [Indexed: 09/12/2023]
Abstract
School-based psychosocial interventions are increasingly put forward as a way to support young refugees' and migrants' well-being and mental health in resettlement. However, the evidence on these interventions' effectiveness remains scarce and scholars denounce particular gaps in the evidence to date, pointing to a lack of large-scale, controlled studies and studies including social outcome measures. This cluster randomized study aims to strengthen the evidence base on school-based psychosocial interventions for refugee and migrant youth by assessing the effect of two interventions, Classroom Drama and Welcome to School, on youth's mental health, resilience, and social relations in Belgium, Denmark, Norway, and the United Kingdom. Multilevel analyses were conducted separately for the two interventions (Classroom Drama, n = 307, ages 11-19; Welcome to School, n = 251, ages 11-23), using separate no-treatment control groups. Our analyses indicated a significant main, positive effect of Classroom Drama on perceived family support, and an effect on perceived support from friends that was moderated by country: in the United Kingdom, the intervention group reported an increase in perceived friend support, whereas the control group reported a decrease. Furthermore, baseline resilience moderated the effect of the Classroom Drama intervention on behavioral difficulties and well-being. No effects of Welcome to School on any of the outcome variables were found. Overall, this study provides novel, nuanced evidence on school-based psychosocial interventions for refugee and migrant adolescents.
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Affiliation(s)
- Caroline Spaas
- KU Leuven UniversityBelgiumKU Leuven University, Belgium;
| | - Sameh Said-Metwaly
- KU Leuven UniversityBelgiumKU Leuven University, Belgium;
- Damanhour UniversityEgyptDamanhour University, Egypt;
| | - Morten Skovdal
- University of CopenhagenDenmarkUniversity of Copenhagen, Denmark;
| | | | | | - Per Kristian Hilden
- Norwegian Centre for Violence and Traumatic Stress StudiesOsloNorwayNorwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway;
| | - Arnfinn J. Andersen
- Norwegian Centre for Violence and Traumatic Stress StudiesOsloNorwayNorwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway;
| | - Marianne Opaas
- Norwegian Centre for Violence and Traumatic Stress StudiesOsloNorwayNorwegian Centre for Violence and Traumatic Stress Studies, NKVTS, Oslo, Norway;
| | - Emma Soye
- University of SussexSchool of Education and Social WorkUKSchool of Education and Social Work, University of Sussex, UK;
| | - Charles Watters
- University of SussexSchool of Education and Social WorkUKSchool of Education and Social Work, University of Sussex, UK;
| | - An Verelst
- Ghent UniversityBelgiumGhent University, Belgium
| | - Ilse Derluyn
- Ghent UniversityBelgiumGhent University, Belgium
| | - Hilde Colpin
- KU Leuven UniversityBelgiumKU Leuven University, Belgium;
| | - Lucia De Haene
- KU Leuven UniversityBelgiumKU Leuven University, Belgium;
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3
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Herati H, Meyer SB. Mental health interventions for immigrant-refugee children and youth living in Canada: a scoping review and way forward. J Ment Health 2023; 32:276-289. [PMID: 32915669 DOI: 10.1080/09638237.2020.1818710] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Traumatic life events experienced by immigrant-refugee children and youth may deteriorate their mental health and well-being. It is a public health priority to develop appropriate mental health interventions for this population. AIMS To understand the psychosocial needs of immigrant-refugee children and youth resettled in Canada in the context of their school and community and to identify the characteristics of school-/community-based mental health programs for this group. METHOD Arksey and O'Malley's methodology for scoping reviews was used to select the studies based on criteria, extract data in a table, and synthesize main findings. RESULTS Fifteen peer-reviewed articles and five grey literature were identified. Key findings show that collaboration between schools, communities, and families play a crucial role in developing and implementing comprehensive mental health interventions for immigrant-refugee children/youth. Involving cultural brokers/interpreters and racially diverse school teachers/staff, is important to establish a trustful relationship between school authorities and marginalized population. CONCLUSIONS Further research is needed to examine the impact of collaborative mental healthcare among multiracial and newcomer families in Canada. Furthermore, there is a need to study the impact of adopting creative expression programs at schools/communities to improve emotional/behavioural problems and enhance school performance of these groups.
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Affiliation(s)
- Hoda Herati
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Samantha B Meyer
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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4
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Diaz Maldonado A, Simon A, Barry C, Hassler C, Lenjalley A, Giacobi C, Moro MR, Lachal J. Adolescent attendance at transcultural psychotherapy: a retrospective cohort study. Eur Child Adolesc Psychiatry 2022; 31:1-8. [PMID: 33751239 DOI: 10.1007/s00787-021-01760-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
Migrant adolescents in therapy for psychological problems are at risk of poor attendance or even of dropping out. Transcultural psychotherapy has been developed in France to take cultural diversity into account in psychological treatment and to deal with the specific difficulties encountered in the psychotherapeutic treatment of this population. This study aims to assess adolescents' attendance rates to this form of psychotherapy and to explore the association of these rates with demographic, cultural, and clinical variables. We conducted a retrospective clinical cohort study of 148 adolescents aged from 11 to 20 years treated between 2008 and 2018 at two transcultural psychotherapy centers in Paris. Statistical analyses tested demographic, cultural, and clinical hypotheses. The main result was the high attendance rate at transcultural psychotherapy sessions among adolescents (77.8%). Attendance rates were not associated with age, gender, family size, generation of migration, or cultural area of origin, but were significantly linked to support in therapy, specifically, the presence at the first transcultural psychotherapy session of the first-line therapist, an interpreter, or both. Transcultural psychotherapy appears to be an effective method for addressing the complex symptoms experienced by migrant adolescents. Better attendance at sessions is statistically significantly associated with factors favoring a therapeutic alliance, specifically, the presence of the first-line therapist or an interpreter in TPT sessions and the existence of support from a social worker. The holistic approach of transcultural psychotherapy to adolescent care may explain the high attendance rates observed.
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Affiliation(s)
- Andrea Diaz Maldonado
- AP-HP, Cochin Hospital, Maison de Solenn, 75014, Paris, France
- Université de Paris, PCPP, 92100, Boulogne-Billancourt, France
| | - Amalini Simon
- AP-HP, Cochin Hospital, Maison de Solenn, 75014, Paris, France
- Université de Paris, PCPP, 92100, Boulogne-Billancourt, France
- Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, CESP, INSERM, Université Paris-Saclay, 94807, Villejuif, France
- Assistance publique-Hôpitaux de Paris (AP-HP), Université de Paris 13, Hôpital Avicenne, service de psychopathologie, 3413, 93009, Bobigny cedex, EA, France
| | - Caroline Barry
- Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, CESP, INSERM, Université Paris-Saclay, 94807, Villejuif, France
| | - Christine Hassler
- Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, CESP, INSERM, Université Paris-Saclay, 94807, Villejuif, France
| | - Adrien Lenjalley
- Centre Hospitalier de Niort, Unité Pour Adolescent, 79000, Niort, France
| | - Carole Giacobi
- Groupe Hospitalier Littoral Atlantique, Service de pédopsychiatrie, 17019, La Rochelle, France
| | - Marie Rose Moro
- AP-HP, Cochin Hospital, Maison de Solenn, 75014, Paris, France
- Université de Paris, PCPP, 92100, Boulogne-Billancourt, France
- Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, CESP, INSERM, Université Paris-Saclay, 94807, Villejuif, France
| | - Jonathan Lachal
- Fac. de Médecine - Univ. Paris-Sud, Fac. de Médecine - UVSQ, CESP, INSERM, Université Paris-Saclay, 94807, Villejuif, France.
- CHU de Clermont-Ferrand, Service de Psychiatrie de L'Enfant Et de L'Adolescent, 63000, Clermont-Ferrand, France.
- Université Clermont Auvergne, 63000, Clermont-Ferrand, France.
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5
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Spaas C, Verbiest S, de Smet S, Kevers R, Missotten L, De Haene L. Working With the Encounter: A Descriptive Account and Case Analysis of School-Based Collaborative Mental Health Care for Refugee Children in Leuven, Belgium. Front Psychol 2022; 13:806473. [PMID: 35356344 PMCID: PMC8959124 DOI: 10.3389/fpsyg.2022.806473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Scholars increasingly point toward schools as meaningful contexts in which to provide psychosocial care for refugee children. Collaborative mental health care in school forms a particular practice of school-based mental health care provision. Developed in Canada and inspired by systemic intervention approaches, collaborative mental health care in schools involves the formation of an interdisciplinary care network, in which mental health care providers and school partners collaborate with each other and the refugee family in a joint assessment of child development and mental health, as well as joint intervention planning and provision. It aims to move away from an individual perspective on refugee children's development, toward an engagement with refugee families' perspectives on their migration histories, cultural background and social condition in shaping assessment and intervention, as such fostering refugee empowerment, equality, and participation in the host society. Relating to the first stage of van Yperen's four-stage model for establishing evidence-based youth care, this article aims to engage in an initial exploration of the effectiveness of a developing school-based collaborative mental health care practice in Leuven, Belgium. First, we propose a detailed description, co-developed through reflection on case documents, written process reflections, intervision, an initial identification of intervention themes, and articulating interconnections with scholarly literature on transcultural and systemic refugee trauma care. Second, we engage in an in-depth exploration of processes and working mechanisms, obtained through co-constructed clinical case analysis of case work collected through our practice in schools in Leuven, Belgium. Our descriptive analysis indicates the role of central processes that may operate as working mechanisms in school-based collaborative mental health care and points to how collaborative mental health care may mobilize the school and the family-school interaction as a vehicle of restoring safety and stability in the aftermath of cumulative traumatization. Our analysis furthermore forms an important starting point for reflections on future research opportunities, and central clinical dynamics touching upon power disparities and low-threshold access to mental health care for refugee families.
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Affiliation(s)
- Caroline Spaas
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Siel Verbiest
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Sofie de Smet
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Studies in Performing Arts and Media, Faculty of Arts and Philosophy, University of Ghent, Ghent, Belgium
| | - Ruth Kevers
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Lies Missotten
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Lucia De Haene
- Parenting and Special Education Research Unit, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
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6
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Carballeira Carrera L, Lévesque-Daniel S, Moro MR, Mansouri M, Lachal J. Becoming a transcultural psychotherapist: Qualitative study of the experience of professionals in training in a transcultural psychotherapy group. Transcult Psychiatry 2022; 59:143-153. [PMID: 32878593 DOI: 10.1177/1363461520950065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Transcultural psychotherapy is an original therapeutic technique designed to respond to difficulties encountered in psychiatric treatment for migrants. Today, this psychotherapy is formalized and it is in use at numerous sites in France and internationally. An increasing number of professionals are seeking training in this method. We sought to explore the experiences of these trainees, at their entry in the group and during their training. This qualitative study used focus groups to interview trainees participating in a transcultural psychotherapy training group. The thematic analysis generated two domains of experience: the emotional and personal experience within the transcultural group, including the private feelings of the trainee-participants, their initial difficulties, and the changes in these feelings; and their perception of this specific type of care, that is, their perspectives on transcultural psychotherapy and its most original aspects. Based on the narratives of trainees in this program, we conclude that becoming a transcultural psychotherapist involves a process not only of cultural decentering but also of professional decentering. This decentering cannot be learned theoretically: it must be experienced, for a long enough time to become imbued with it and to allow oneself to modify one's practices. After sufficient time in the group, the trainees succeed in extricating themselves, little by little, from their ethnocentric vision of psychotherapy, and come to tolerate and then integrate new ways of doing and thinking.
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Affiliation(s)
| | - Sarah Lévesque-Daniel
- Cochin Hospital, Maison de Solenn, Paris, France.,Université de Montréal, Montreal, Canada
| | - Marie Rose Moro
- Cochin Hospital, Maison de Solenn, Paris, France.,Université Paris Descartes, Paris, France.,INSERM, Université Paris-Saclay, Paris, France
| | - Malika Mansouri
- Université Paris Descartes, Paris, France.,Safe Childhood Association, Sauvegarde 93, Paris, France
| | - Jonathan Lachal
- Cochin Hospital, Maison de Solenn, Paris, France.,Université Paris Descartes, Paris, France.,INSERM, Université Paris-Saclay, Paris, France
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7
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Viksveen P, Bjønness SE, Cardenas NE, Game JR, Berg SH, Salamonsen A, Storm M, Aase K. User involvement in adolescents' mental healthcare: a systematic review. Eur Child Adolesc Psychiatry 2022; 31:1765-1788. [PMID: 34089383 PMCID: PMC9666298 DOI: 10.1007/s00787-021-01818-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/31/2021] [Indexed: 12/29/2022]
Abstract
More than one out of ten adolescents suffer from mental illness at any given time. Still, there is limited knowledge about their involvement in mental healthcare. Adolescents have the right to be involved in decisions affecting their healthcare, but limited research focuses on their engagement and decision-making. Therefore, this systematic review aims to explore the existing experiences with, the effectiveness of, and safety issues associated with user involvement for adolescents' mental healthcare at the individual and organizational level. A systematic literature review on user involvement in adolescents' mental healthcare was carried out. A protocol pre-determined the eligibility criteria and search strategies, and established guidelines were used for data extraction, critical appraisal, and reporting of results. Quantitative studies were analysed individually due to heterogeneity of the studies, while qualitative studies were analysed using thematic synthesis. A total of 31 studies were included in the review. The experiences with user involvement were reported in 24 studies with three themes at the individual level: unilateral clinician control versus collaborative relationship, capacity and support for active involvement, the right to be involved; and two themes at the organizational level: involvement outcomes relevant to adolescents' needs, conditions for optimal involvement. The effectiveness of user involvement was reported in seven studies documenting fragmented evidence related to different support structures to facilitate adolescents' involvement. The safety associated with user involvement was not reported in any studies, yet a few examples related to potential risks associated with involvement of adolescents in decision-making and as consultants were mentioned.
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Affiliation(s)
- Petter Viksveen
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Stig Erlend Bjønness
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Nicole Elizabeth Cardenas
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Julia Rose Game
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Siv Hilde Berg
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Anita Salamonsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - North (RKBU North), Faculty of Health Sciences, UiT The Arctic University of Norway, Langnes, P.O. Box 6050, Tromsø, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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Mental health service use among migrant and Swedish-born children and youth: a register-based cohort study of 472,129 individuals in Stockholm. Soc Psychiatry Psychiatr Epidemiol 2022; 57:161-171. [PMID: 34319406 PMCID: PMC8761127 DOI: 10.1007/s00127-021-02145-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/09/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE Migrant children underutilize mental health services (MHS), but differences according to age, reason for migration, type of problem, and time have not been thoroughly analyzed. We aimed to explore utilization of MHS among migrant children and youth and to study if the hypothesized lower utilization could be explained by fewer neurodevelopmental assessments. METHODS A cohort of the population aged 0-24 years in Stockholm, comprising 472,129 individuals were followed for maximum 10 years, between January 1, 2006 and December 31, 2015. We categorized individuals as accompanied refugee migrants, unaccompanied refugee migrants and non-refugee migrants, or Swedish-born. We used survival and logistic analyses to estimate rates of utilization of MHS. RESULTS Migrant children and youth utilized less MHS than the majority population, with hazard ratios ranging from 0.62 (95% CI: 0.57; 0.67) to 0.72 (95% CI: 0.69; 0.76). Refugee and non-refugee children utilized less mental health care than their Swedish peers, apart from the youngest refugees (0-10 years) who had similar utilization as Swedish-born. The lower rates were partly explained by all migrant youths' lower risk of being diagnosed with a neurodevelopmental condition. Time in Sweden had a major impact, such that unaccompanied refugee minors had a higher utilization in their first 2 years in Sweden (OR: 3.39, 95% CI: 2.96; 3.85). CONCLUSION Migrant youth use less MHS compared with native-born peers, and this is partly explained by fewer neurodevelopmental diagnoses. Strengthening the awareness about unmet needs, and the referring capacity by professionals in contact with migrant children could help reduce barriers to care.
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MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:339-361. [PMID: 33206200 DOI: 10.1007/s00127-020-01976-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/24/2020] [Indexed: 01/28/2023]
Abstract
Worldwide, growing concern with young people's mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11-30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes-initiating contact with mental health services; characteristics of services' response; and youths' and carers' appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths' pathways to them. It underlines the need for grounding reform in youths' and carers' perspectives and needs.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, Canada. .,Douglas Research Centre, Montreal, Canada. .,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada. .,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada.
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
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10
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Nadeau L, Johnson-Lafleur J, Jaimes A, Bolduc E. L’engagement dans les soins en collaboration en santé mentale jeunesse pour les familles migrantes : des lieux cliniques ancrés dans leurs contextes institutionnel et sociopolitique. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1075386ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectifs Cet article vise à combler certaines lacunes dans la littérature concernant les conditions propices à des soins en collaboration de qualité en santé mentale jeunesse (SMJ) pour les jeunes migrants et leurs familles, dans les services de première ligne. Il examine les facteurs susceptibles de favoriser l’engagement des familles migrantes dans les services, en tenant compte des dimensions liées à la rencontre clinique, aux enjeux systémiques et aux questions institutionnelles/sociopolitiques.
Méthode Utilisant un devis multiphase en méthodes mixtes, l’article présente séquentiellement les résultats qualitatifs et quantitatifs spécifiques aux familles migrantes, d’un vaste programme de recherche sur les soins en collaboration en SMJ dans des quartiers culturellement et socioéconomiquement diversifiés. Ces résultats proviennent de données collectées à Montréal au cours de la dernière décennie par le biais de questionnaires, d’entrevues semi-structurées, de groupes de discussion, d’observation participante et de documentation. Les participants à la recherche étaient des enfants, des adolescents et des parents de familles migrantes, des cliniciens et des gestionnaires.
Résultats Les résultats suggèrent que le macrosystème sociopolitique et institutionnel structure l’espace de la clinique et influence le processus de soins. En particulier, les réformes successives du système de santé posent des défis de taille aux institutions et aux équipes en SMJ quant à leur capacité à créer un environnement favorable à la continuité des soins et au partenariat interinstitutionnel et à la collaboration interprofessionnelle, des facteurs associés à l’engagement des familles dans les soins. Cet engagement est également tributaire des représentations que les familles migrantes se font de la santé mentale et des services. Ces représentations sont façonnées par leur expérience des soins, mais aussi par ce que leur environnement socioculturel et les discours publics leur permettent d’imaginer de ces services. Cela invite à considérer une intégration de dimensions culturelles et sociopolitiques dans le concept d’engagement. Enfin, les résultats suggèrent également que les écoles jouent un rôle important pour favoriser l’engagement dans les soins de santé mentale.
Conclusion La qualité des soins de santé mentale pour les enfants et adolescents migrants dépend de l’engagement des familles dans les services, et aussi de l’engagement réciproque des cliniciens et des institutions. Les contextes politiques où des tensions entre les groupes majoritaires et minoritaires sont présentes peuvent également faire obstacle aux soins. Étant donné que les familles migrantes s’engagent moins dans les services par rapport aux familles non migrantes, ces considérations appellent à un examen important des moyens pour faciliter l’engagement des familles migrantes dans les soins en collaboration en SMJ. L’article propose certaines avenues pour favoriser cet engagement.
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Affiliation(s)
- Lucie Nadeau
- MD, M. Sc., Professeure agrégée, Université McGill, Institut universitaire SHERPA ; pédopsychiatre, CUSM
| | - Janique Johnson-Lafleur
- Ph. D.(c), M. Sc., Université McGill ; coordonnatrice de recherche, Institut universitaire SHERPA
| | - Annie Jaimes
- Ph. D., chercheure postdoctorale, Université York ; chercheure-praticienne, Institut universitaire SHERPA
| | - Emmanuelle Bolduc
- MBA, M. Sc., Coordonnatrice de programme CoVivre, Institut universitaire SHERPA
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11
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Lachal J, Moro MR, Carretier E, Simon A, Barry C, Falissard B, Rouquette A. Assessment of transcultural psychotherapy to treat resistant major depressive disorder in children and adolescents from migrant families: Protocol for a randomized controlled trial using mixed method and Bayesian approaches. Int J Methods Psychiatr Res 2020; 29:1-10. [PMID: 32918513 PMCID: PMC7723212 DOI: 10.1002/mpr.1847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cultural variations complicate psychiatric care, especially for migrant children. Transcultural psychotherapy (TCP) is an original psychotherapeutic technique developed to address complex situations of resistant mental disorders in the context of migration. This research will aim to assess the efficacy, the acceptability, and describe the therapeutic processes of TCP for the treatment of depression in first or second generation of migration children and adolescents. METHOD Mixed method study using a multicenter, Bayesian randomized clinical trial with blinded evaluation of the primary outcome. Two parallel groups of 40 children or adolescents from 6 to 20 years old and their family will be included. In the experimental group, patients will attend six sessions of transcultural therapy in addition to usual care. RESULTS The improved Clinical Global Impression scale scores at 6 months will be compared across groups. Qualitative analysis of families and therapists' interviews will allow to specify the therapeutic processes and acceptability of the therapy. CONCLUSION The findings will encourage the development and routinization of TCP for second-line use and its adaption as a first-line technique in this population.
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Affiliation(s)
- Jonathan Lachal
- AP-HP, Maison de Solenn, Hôpital Cochin, Paris, France.,Université de Paris, PCPP, Boulogne-Billancourt, France.,CESP, Fac. de Médecine - Université Paris-Sud, Fac. de Médecine - UVSQ, INSERM, DevPsy, Université Paris-Saclay, Villejuif, France
| | - Marie Rose Moro
- AP-HP, Maison de Solenn, Hôpital Cochin, Paris, France.,Université de Paris, PCPP, Boulogne-Billancourt, France.,CESP, Fac. de Médecine - Université Paris-Sud, Fac. de Médecine - UVSQ, INSERM, DevPsy, Université Paris-Saclay, Villejuif, France
| | - Emilie Carretier
- AP-HP, Maison de Solenn, Hôpital Cochin, Paris, France.,Université de Paris, PCPP, Boulogne-Billancourt, France.,CESP, Fac. de Médecine - Université Paris-Sud, Fac. de Médecine - UVSQ, INSERM, DevPsy, Université Paris-Saclay, Villejuif, France
| | - Amalini Simon
- AP-HP, Maison de Solenn, Hôpital Cochin, Paris, France.,CESP, Fac. de Médecine - Université Paris-Sud, Fac. de Médecine - UVSQ, INSERM, DevPsy, Université Paris-Saclay, Villejuif, France
| | - Caroline Barry
- CESP, Fac. de Médecine - Université Paris-Sud, Fac. de Médecine - UVSQ, INSERM, DevPsy, Université Paris-Saclay, Villejuif, France
| | - Bruno Falissard
- CESP, Fac. de Médecine - Université Paris-Sud, Fac. de Médecine - UVSQ, INSERM, DevPsy, Université Paris-Saclay, Villejuif, France
| | - Alexandra Rouquette
- CESP, Fac. de Médecine - Université Paris-Sud, Fac. de Médecine - UVSQ, INSERM, DevPsy, Université Paris-Saclay, Villejuif, France.,Public Health and Epidemiology Department, AP-HP, Bicêtre Hospital, Le Kremlin-Bicêtre, France
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12
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Grau L, Carretier E, Moro MR, Revah-Levy A, Sibeoni J, Lachal J. A qualitative exploration of what works for migrant adolescents in transcultural psychotherapy: perceptions of adolescents, their parents, and their therapists. BMC Psychiatry 2020; 20:564. [PMID: 33243219 PMCID: PMC7690022 DOI: 10.1186/s12888-020-02970-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Migrant adolescents are at a higher risk than their native-born counterparts of psychiatric disorders, and their care is a public health issue. In France, transcultural psychotherapy is a treatment provided by a group of therapists designed to meet the specific needs of these patients when usual care appears ineffective. The objective of this study was to explore the therapeutic elements at work in transcultural psychotherapy. METHODS We conducted a qualitative study crossing the perspectives of adolescents receiving transcultural psychotherapy, their parents, their first-line therapist (FLT), and the transcultural therapists. The families were chosen by purposive sampling. Data were collected during semi-structured individual (for FLTs) and group (families and transcultural therapists) interviews that explored the therapeutic elements involved and effective in transcultural psychotherapy. We used interpretative phenomenological analysis (IPA) to examine the data. In all, 44 participants were questioned: three adolescents (2 girls and 1 boy, all aged 18 to 21 years) and their parents (3 mothers and 1 father), three FLTs (2 child psychiatrists and 1 psychologist), and the 34 therapists participating in the three transcultural psychotherapy groups. RESULTS The analysis uncovered three themes: (1) the perceived effectiveness of the group's functioning; (2) the recounting of the individual, family, and cultural history to allow for complexity and nuance; and (3) the personal investment by therapists, made possible by the group. CONCLUSIONS Our results show some therapeutic elements at work in transcultural psychotherapy that enable it to meet the particular needs of some migrant adolescents that are unmet in standard therapy. Continuing to study transcultural psychotherapy and assess its effectiveness is essential for promoting and optimizing psychiatric care for migrant adolescents.
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Affiliation(s)
- Léa Grau
- UFR des Lettres, des Sciences de l'Homme et des Sociétés Unité Transversale de Recherche Psychogenèse et Psychopathologie, UTRPP EA4403, Univ. Paris 13, F-93430, Villetaneuse, France
| | - Emilie Carretier
- UFR des Lettres, des Sciences de l'Homme et des Sociétés Unité Transversale de Recherche Psychogenèse et Psychopathologie, UTRPP EA4403, Univ. Paris 13, F-93430, Villetaneuse, France
- AP-HP, Hôpital Cochin, Maison de Solenn, 97 Boulevard de Port Royal, 75014, Paris, France
| | - Marie-Rose Moro
- AP-HP, Hôpital Cochin, Maison de Solenn, 97 Boulevard de Port Royal, 75014, Paris, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, F-94807, Villejuif, France
- Université de Paris, PCPP, F-92100, Boulogne-Billancourt, France
| | - Anne Revah-Levy
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, F95100, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Jordan Sibeoni
- Service Universitaire de Psychiatrie de l'Adolescent, Centre Hospitalier d'Argenteuil, F95100, Argenteuil, France
- ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
| | - Jonathan Lachal
- AP-HP, Hôpital Cochin, Maison de Solenn, 97 Boulevard de Port Royal, 75014, Paris, France.
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, F-94807, Villejuif, France.
- Université de Paris, PCPP, F-92100, Boulogne-Billancourt, France.
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13
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Lachal J, Simon A, Hassler C, Barry C, Camara H, Massari N, Franchitti R, Mao SF, Roy Edward T, Carballeira Carrera L, Rouchon JF, Moro MR. Epidemiological description of 529 families referred for French transcultural psychotherapy: A decade of experience. PLoS One 2020; 15:e0236990. [PMID: 32750077 PMCID: PMC7402487 DOI: 10.1371/journal.pone.0236990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 07/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Transcultural psychotherapy (TPT) is an original therapeutic method developed in various forms in France and several other countries in Europe as well as North America to address issues of migrant mental health care when psychosocial, economic, or cultural barriers hinder its accessibility and effectiveness. This study aims to describe the patients referred for TPT in Paris and its suburbs over the past decade, to examine intercultural differences and associations with social, demographic, and clinical variables, and to assess TPT in terms of patient adherence, attendance, and duration of care. METHOD Retrospective study of 529 patients referred for TPT care, classified in three categories-no treatment, initiated treatment, engaged and continuing treatment. Collection and analysis of social, demographic, cultural, and clinical data, as well as of country of origin, duration of treatment, number of sessions attended (adherence), and number of sessions scheduled. RESULTS In all, 301 patients from 45 countries participated in an 11-month course of care lasting an average of 8 sessions. Most were children, accompanied by their families. The main psychiatric symptoms at the beginning of treatment were depressive, and the main cultural problem identified was the existence of a traditional theory explaining the illness in the family's culture. Patients kept 80% of their appointments for sessions, and attendance was not associated with socio-cultural or clinical variables. CONCLUSION The high level of treatment adherence and attendance over time suggest that TPT is an effective method for addressing complex symptoms experienced by migrant families. Results highlighted the potential richness and originality of studies based on retrospective medical data.
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Affiliation(s)
- Jonathan Lachal
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Amalini Simon
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Christine Hassler
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Caroline Barry
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Hawa Camara
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
| | - Nelly Massari
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
| | - Roberta Franchitti
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- Sapienza Università di Roma, Rome, Italy
| | - Sann-Fou Mao
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- Département Etudes Psychanalytiques, UFR IHSS, Université de Paris, Paris, France
| | - Tony Roy Edward
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- Institut de Psychologie, Université de Paris, Boulogne-Billancourt, France
| | | | - Jeanne-Flore Rouchon
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
- Assistance Publique–Hôpitaux de Paris (AP–HP), Hôpital Avicenne, Service de Psychopathologie, Université de Paris, France
| | - Marie Rose Moro
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- Université de Paris, PCPP, Boulogne-Billancourt, France
- Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, Villejuif, France
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14
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Women Veterans' Perspectives on How to Make Veterans Affairs Healthcare Settings More Welcoming to Women. Womens Health Issues 2020; 30:299-305. [DOI: 10.1016/j.whi.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/17/2020] [Indexed: 02/06/2023]
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15
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Nooteboom LA, Mulder EA, Kuiper CHZ, Colins OF, Vermeiren RRJM. Towards Integrated Youth Care: A Systematic Review of Facilitators and Barriers for Professionals. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:88-105. [PMID: 32424453 PMCID: PMC7803720 DOI: 10.1007/s10488-020-01049-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To overcome fragmentation in support for children and their families with multiple and enduring problems across life domains, professionals increasingly try to organize integrated care. However, it is unclear what facilitators and barriers professionals experience when providing this integrated care. Our systematic review, including 55 studies from a broad variety of settings in Youth Care, showed that integrated care on a professional level is a multi-component entity consisting of several facilitators and barriers. Findings were clustered in seven general themes: ‘Child’s environment’, ‘Preconditions’, ‘Care process’, ‘Expertise’, ‘Interprofessional collaboration’, ‘Information exchange’, and ‘Professional identity’. The identified facilitators and barriers were generally consistent across studies, indicating broad applicability across settings and professional disciplines. This review clearly shows that when Youth Care professionals address a broad spectrum of problems, a variety of facilitators and barriers should be considered. Registration PROSPERO, registration number CRD42018084527.
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Affiliation(s)
- Laura A Nooteboom
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Post Box 15, 2300 AA, Leiden, The Netherlands.
| | - Eva A Mulder
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Post Box 15, 2300 AA, Leiden, The Netherlands.,Academic Workplace Youth at Risk, Pluryn, Nijmegen, The Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre - Location VUMC, Amsterdam, The Netherlands
| | - Chris H Z Kuiper
- Leiden University of Applied Sciences, Leiden, The Netherlands.,Horizon Youth Care and Special Education, Rotterdam, The Netherlands
| | - Olivier F Colins
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Post Box 15, 2300 AA, Leiden, The Netherlands.,Department of Special Needs Education, Faculty of Psychology & Educational Sciences, Ghent University, Ghent, Belgium
| | - Robert R J M Vermeiren
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Centre, Post Box 15, 2300 AA, Leiden, The Netherlands.,Youz, Parnassia Group, The Hague, The Netherlands
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16
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Riza E, Kalkman S, Coritsidis A, Koubardas S, Vassiliu S, Lazarou D, Karnaki P, Zota D, Kantzanou M, Psaltopoulou T, Linos A. Community-Based Healthcare for Migrants and Refugees: A Scoping Literature Review of Best Practices. Healthcare (Basel) 2020; 8:E115. [PMID: 32354069 PMCID: PMC7349376 DOI: 10.3390/healthcare8020115] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Strengthening community-based healthcare is a valuable strategy to reduce health inequalities and improve the integration of migrants and refugees into local communities in the European Union. However, little is known about how to effectively develop and run community-based healthcare models for migrants and refugees. Aiming at identifying the most-promising best practices, we performed a scoping review of the international academic literature into effective community-based healthcare models and interventions for migrants and refugees as part of the Mig-HealthCare project. METHODS A systematic search in PubMed, EMBASE, and Scopus databases was conducted in March 2018 following the PRISMA methodology. Data extraction from eligible publications included information on general study characteristics, a brief description of the intervention/model, and reported outcomes in terms of effectiveness and challenges. Subsequently, we critically assessed the available evidence per type of healthcare service according to specific criteria to establish a shortlist of the most promising best practices. RESULTS In total, 118 academic publications were critically reviewed and categorized in the thematic areas of mental health (n = 53), general health services (n = 36), noncommunicable diseases (n = 13), primary healthcare (n = 9), and women's maternal and child health (n = 7). CONCLUSION A set of 15 of the most-promising best practices and tools in community-based healthcare for migrants and refugees were identified that include several intervention approaches per thematic category. The elements of good communication, the linguistic barriers and the cultural differences, played crucial roles in the effective application of the interventions. The close collaboration of the various stakeholders, the local communities, the migrant/refugee communities, and the partnerships is a key element in the successful implementation of primary healthcare provision.
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Affiliation(s)
- Elena Riza
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Shona Kalkman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3584 CG Utrecht, The Netherlands
| | - Alexandra Coritsidis
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8434, USA
| | - Sotirios Koubardas
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Sofia Vassiliu
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Despoina Lazarou
- Institute of Human Sciences, Wadham College, University of Oxford, Oxford OX1 3PN, UK
| | - Panagiota Karnaki
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Dina Zota
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Athena Linos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- Prolepsis Institute for Preventive Medicine and Environmental and Occupational Health, 151 21 Marousi, Greece
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17
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Bjønness S, Viksveen P, Johannessen JO, Storm M. User participation and shared decision-making in adolescent mental healthcare: a qualitative study of healthcare professionals' perspectives. Child Adolesc Psychiatry Ment Health 2020; 14:2. [PMID: 31988656 PMCID: PMC6969458 DOI: 10.1186/s13034-020-0310-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/07/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Most mental health problems occur in adolescence. There is increasing recognition of user participation and shared decision-making in adolescents' mental healthcare. However, research in this field of clinical practice is still sparse. The objective of this study was to explore healthcare professionals' perspectives on user participation, and opportunities for shared decision-making in Child and Adolescent Mental Health Service (CAMHS) inpatient units. METHODS Healthcare professionals at CAMHS inpatient units participated in three focus group interviews. Fifteen participants with experience with user participation and shared decision-making were recruited from five hospitals in Norway. RESULTS Five themes emerged: (1) involvement before admission; (2) sufficient time to feel safe; (3) individualized therapy; (4) access to meetings where decisions are made; and (5) changing professionals' attitudes and practices. CONCLUSION User participation and shared decision-making require changes in workplace culture, and routines that allow for individualized mental health services that are adapted to adolescents' needs. This calls for a flexible approach that challenges clinical pathways and short-stay hospital policies. The results of this study may inform further work on strengthening user participation and the implementation of shared decision-making.Trial registration Norwegian Regional Committees for Medical and Health Research Ethics, reference number 2017/1195.
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Affiliation(s)
- Stig Bjønness
- Centre for Resilience in Healthcare (SHARE), Department for Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Petter Viksveen
- Centre for Resilience in Healthcare (SHARE), Department for Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Jan Olav Johannessen
- Department of Psychiatry, Stavanger University Hospital, Stavanger, Norway
- Department for Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Marianne Storm
- Department for Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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18
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Ballesteros-Urpí A, Torralbas-Ortega J, Muro P, Pardo-Hernandez H. Measure of clinical improvement in children and adolescents with psychiatric disorders: an evaluation of multiple perspectives with HoNOSCA. Medwave 2020; 20:e7762. [PMID: 31999674 DOI: 10.5867/medwave.2020.01.7762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/14/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Routine outcome assessment is helpful to inform decision-making, resource allocation, and health policy design. Routine outcome assessment in the hospital setting for children and adolescents with psychiatric disorders remains limited. The clinical instrument HoNOSCA (Health of the Nation Outcome Scales for Children and Adolescents), which has recently become available in Spanish and Catalan, allows outcome assessment in this population from the perspective of patients, their parents or legal guardians, and clinicians. HoNOSCA measures 13 areas of health and psychosocial functioning. Objectives The aim of this study was to assess mental health outcomes in psychiatric day hospital pediatric patients from three perspectives (patient, par-ent/legal guardian, clinician), using the Spanish and Catalan versions of HoNOSCA. Methods We recruited patients up to 18 years old with any psychiatric disorder at the day unit of the Salut Mental Parc Taulí Hospital Universitari (Sabadell, Catalonia, Spain). We obtained admission and discharge HoNOSCA scores for the patients, their parents or legal guardians, and their clinicians. Results We recruited 99 patients over the study period (January 2015 to December 2017), 11 of which were lost to follow-up. Among the remaining 88, we found significant improvement in HoNOSCA scores from admission to discharge. Agreement between the HoNOSCA scores for the three different groups of evaluators (patients, parents/legal guardians, and clinicians) was weak at admission but better at discharge. In general, evaluations from patients and their parents or legal guardians had lower HoNOSCA scores (indicating a better mental health status) at admis-sion compared to those from clinicians. At discharge, however, the scores were more homogenous across the three groups of stakeholders. Conclusions Use of HoNOSCA allows for routine evaluation of mental health outcomes in the psychiatric day hospital setting from the perspective of pa-tients, their parents or legal guardians, and clinicians.
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Affiliation(s)
- Anna Ballesteros-Urpí
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain; Department of Education, Universitat de Barcelona, Barcelona, Spain. Address: . Carrer Villarroel 170, 08036, Barcelona, Spain. ORCID: 0000-0002-7712-2423
| | - Jordi Torralbas-Ortega
- Mental Health Center, Parc Taulí Hospital Universitari, Institut dInvestigació i Innovació Parc Taulí I3PT, Barcelona, Spain
| | - Pilar Muro
- Facultat d'Educació Social i Treball Social, Fundació Pere Tarrés, Universitat Ramon Llull, Barcelona, Spain
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. ORCID: 0000-0003-3714-0309
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19
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Youssef A, Chaudhary ZK, Wiljer D, Mylopoulos M, Sockalingam S. Mapping Evidence of Patients' Experiences in Integrated Care: A Scoping Review. Gen Hosp Psychiatry 2019; 61:1-9. [PMID: 31479842 DOI: 10.1016/j.genhosppsych.2019.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Despite the established clinical and cost-effectiveness of integrated care (IC) models for patients with comorbid mental and physical illness, little is known about whether these models facilitate a better care experience from the patient's perspective. The authors conducted a scoping review of the literature to explore how IC influences patients' care experiences. METHODS MEDLINE, EMBASE, PSYC INFO CINAHL, AMED, the Cochrane Library, and grey literature were searched to identify relevant articles. Eligible studies were systematically reviewed and analyzed, using thematic analysis approach, to identify patterns, trends, and variation in patient experience within IC settings. RESULTS Search results yielded 5250 unique resources of which 21 primary studies met our eligibility criteria for analysis. Findings from this scoping review revealed variation in patients' experiences in IC settings. IC models enhanced patients' experience by creating theraputic spaces: improving patient access to care, developing collaborative relationships, and personalizing patient care to address individual needs. CONCLUSION Productive interactions with care team were key to improve patient engagement and experience of centeredness in IC settings. Successful implementation of IC demanded purposeful alignment of IC structural components and care processes to create therapeutic spaces that address patient care needs and preferences.
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Affiliation(s)
- Alaa Youssef
- Institute for Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zarah K Chaudhary
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Wiljer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; University Health Network Centre for Mental Health, Toronto, Ontario, Canada; The Institute for Health Policy, Management and Education, University of Toronto, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Institute for Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network Centre for Mental Health, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
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20
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Brandenberger J, Sontag K, Duchêne-Lacroix C, Jaeger FN, Peterhans B, Ritz N. Perspective of asylum-seeking caregivers on the quality of care provided by a Swiss paediatric hospital: a qualitative study. BMJ Open 2019; 9:e029385. [PMID: 31515424 PMCID: PMC6747639 DOI: 10.1136/bmjopen-2019-029385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study investigated the perspective of asylum-seeking caregivers on the quality of healthcare delivered to their children in a qualitative in-depth interview study. The health of asylum-seeking children is of key interest for healthcare providers, yet knowledge of the perspective of asylum-seeking caregivers when accessing healthcare is limited. SETTING The study took place in a paediatric tertiary care hospital in Basel, Switzerland. PARTICIPANTS Interviews were done with 13 asylum-seeking caregivers who had presented with their children at the paediatric tertiary care hospital. Nine female and four male caregivers from Tibet, Eritrea, Afghanistan, Syria, Iraq, Albania and Macedonia were included. A diverse sample was chosen regarding cultural and social background, years of residence in Switzerland and reasons for seeking care. A previously developed and pilot-tested interview guide was used for semistructured in-depth interviews between 36 and 92 min in duration. Data analysis and reporting was done according to Consolidated Criteria for Reporting Qualitative Research. The number of interviews was determined by saturation of data. RESULTS The interviewees described a mismatch of personal competencies and external challenges. Communication barriers and unfamiliarity with new health concepts were reported as challenges. These were aggravated by isolation and concerns about their child's health. The following factors were reported to strongly contribute to satisfaction of healthcare delivery: a respectful and trusting caregiver-provider relationship, the presence of interpreters and immediate availability of treatment. CONCLUSIONS A mismatch of personal competencies and external challenges importantly influences the caregiver-provider relationship. To overcome this mismatch establishment of confidence was identified as a key factor. This can be achieved by availability of interpreter services, sufficient consultation time and transcultural trainings for healthcare workers. Coordination between the family, the government's asylum system and the medical system is required to facilitate this process.
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Affiliation(s)
- Julia Brandenberger
- Migrant Health Services, Universitats-Kinderspital beider Basel (UKBB), Basel, Switzerland
- Department of Pediatric Emergency Medicine, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Katrin Sontag
- Department of Social Sciences, Subject Area Cultural Anthropology, University of Basel, Basel, Switzerland
| | | | - Fabienne Nicole Jaeger
- Professional Postgraduate Training Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Bernadette Peterhans
- Professional Postgraduate Training Unit, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Nicole Ritz
- Migrant Health Services, Universitats-Kinderspital beider Basel (UKBB), Basel, Switzerland
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21
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Brandenberger J, Tylleskär T, Sontag K, Peterhans B, Ritz N. A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model. BMC Public Health 2019; 19:755. [PMID: 31200684 PMCID: PMC6567460 DOI: 10.1186/s12889-019-7049-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives. METHODS We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information. RESULTS Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model. CONCLUSIONS The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies.
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Affiliation(s)
- Julia Brandenberger
- University Children's Hospital Basel, Migrant Health Service, University of Basel, Spitalstr.33, Basel, Postbox CH 4031, Switzerland. .,Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland. .,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland. .,Paediatric Emergency Department, Inselspital, University of Bern, Bern, Switzerland.
| | | | - Katrin Sontag
- University of Basel, P.O. Box, CH-4003,, Basel, Switzerland.,Department of Social Sciences, Subject Area Cultural Anthropology, University of Basel, Basel, Switzerland
| | - Bernadette Peterhans
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland
| | - Nicole Ritz
- University Children's Hospital Basel, Migrant Health Service, University of Basel, Spitalstr.33, Basel, Postbox CH 4031, Switzerland.,University of Basel, P.O. Box, CH-4003,, Basel, Switzerland.,University Children's Hospital Basel, Pediatric Infectious Disease and Vaccinology, University of Basel, Basel, Switzerland.,Royal Children's Hospital Melbourne, Department of Pediatrics, University of Melbourne, Parkville, Australia
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Salami B, Salma J, Hegadoren K. Access and utilization of mental health services for immigrants and refugees: Perspectives of immigrant service providers. Int J Ment Health Nurs 2019; 28:152-161. [PMID: 29984880 DOI: 10.1111/inm.12512] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2018] [Indexed: 12/01/2022]
Abstract
Immigrant and refugee populations experience life stressors due to difficult migration journeys and challenges in leaving one country and adapting to another. These life stressors result in adverse mental health outcomes when coupled with a lack of adequate support-enhancing resources. One area of support is access to and use of mental health services to prevent and address mental health concerns. Immigrant service providers in Canada support the integration and overall well-being of newcomers. This study focuses on immigrant service providers' perceptions of access to and use of mental health services for immigrants and refugees in Alberta. A qualitative descriptive design was used to collect and analyse the perspectives of 53 immigrant service providers recruited from nine immigrant serving agencies in Alberta between November 2016 and January 2017. Data were collected using a combination of individual interviews and focus groups, followed by thematic data analysis to identify relevant themes. Barriers to access and use of mental health services include language barriers, cultural interpretations of mental health, stigma around mental illness, and fear of negative repercussions when living with a mental illness. Strategies to improve mental health service delivery include developing community-based services, attending to financial barriers, training immigrant service providers on mental health, enhancing collaboration across sectors in mental health service delivery, and advancing the role of interpreters and cultural brokers. Overall, immigrant service providers present a nuanced view of the complex and inter-related barriers immigrants and refugees experience and identify potential approaches to enhancing mental health service delivery.
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Affiliation(s)
- Bukola Salami
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Jordana Salma
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen Hegadoren
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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Jarlby F, Goosen S, Derluyn I, Vitus K, Jervelund SS. What can we learn from unaccompanied refugee adolescents' perspectives on mental health care in exile? Eur J Pediatr 2018; 177:1767-1774. [PMID: 30225635 DOI: 10.1007/s00431-018-3249-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/13/2018] [Accepted: 09/10/2018] [Indexed: 11/27/2022]
Abstract
Unaccompanied refugee adolescents who have fled war and persecution often have poor mental health. Yet, little is known about their own perspectives on what can relieve their mental health problems. The aim was to explore unaccompanied refugee adolescents' perspectives on healing and the mental healthcare offered to them when resettled. The study was based on methodical triangulation of participant observation in a Danish municipal institution for unaccompanied refugee minors, semi-structured individual interviews with experts, social workers and male refugee minors and a focus group interview with refugee minors. Results show that the refugee adolescents associated traditional conversational therapy with discussing negative and stigmatising aspects of their past and carrying risks of re-traumatisation. Instead, alternative activities were proposed, through which resources could be accumulated and they could be met without stereotype.Conclusion: To enhance the complex mental health needs of unaccompanied minors' mental healthcare, the perspective of the refugee adolescents should be taken into account. This calls for a holistic approach to mental healthcare in their daily lives, where they are met in a non-stigmatising manner in which their unique capabilities are the main focus. Moreover, a trusting relationship constitutes the fundament to support good mental health among refugee adolescents. What is Known: • Unaccompanied refugee adolescents are at risk of poor mental health outcomes, e.g., depression, anxiety, PTSD and psychosocial stress. • Stigma, lack of social support, stressful life events and lack of intercultural competency among mental health professionals are barriers to good mental health. What is New: • There is a need for informal and tailored health promotion initiatives in the refugee adolescents' everyday lives. • To treat the refugee adolescents as equal human beings through curiosity and receptiveness to their resources is important in order to build trust and address stigma.
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Affiliation(s)
- Frederikke Jarlby
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, Copenhagen University, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Simone Goosen
- Netherlands Association for Community Health Services, Zwarte Woud 2, 3524 SJ, Utrecht, Netherlands
| | - Ilse Derluyn
- Department of Social Work and Social Pedagogy, Ghent University, Henri Dunantlaan 2, 9000, Gent, Belgium
| | - Kathrine Vitus
- Department of Sociology and Social Work, Aalborg University, Frederikskaj 10B, 2450, Copenhagen, Denmark
| | - Signe Smith Jervelund
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, Copenhagen University, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
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