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Boykin DM, Smith TL, Rakel B, Rodrigues M, Embree J, Woods K, Chaison AD, Dindo L. Demystifying the virtualization process: A call for standard reporting of virtual modifications to evidence-based psychotherapies, using the FRAME model. Transl Behav Med 2024; 14:452-460. [PMID: 38777341 PMCID: PMC11282574 DOI: 10.1093/tbm/ibae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
The sudden onset of the coronavirus disease led to a rapid expansion of video telehealth to deliver mental healthcare. Although video telehealth was not a new clinical practice, there was limited guidance on how best to modify evidence-based psychotherapies (EBPs) for virtual delivery (a process also referred to as virtualization). The virtualization process for EBPs remains unclear as newly emerging reports on this topic do not consistently report modification decisions. This commentary calls attention to the need to improve documentation practices to allow a greater understanding of modifications needed to maximize the positive effects of EBPs transported to a virtual format. We used the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to capture details about the nature, process, and outcomes of intervention modifications across a given clinical setting or population. To illustrate the use of the FRAME, we present a case example describing our experiences with transporting a 1-day in-person Acceptance and Commitment Therapy group workshop to a virtual format. Workshop modifications primarily involved changes to the delivery format, administration procedures, and content. The case example walks through how, why, and by whom specific modifications were made as well as the degree to which fidelity was maintained. In the wake of the telemedicine revolution, further investigation into the virtualization process for EBPs is warranted. Improving reporting practices by using the FRAME or a similar adaptation framework will promote a more rigorous study of virtual modifications to EBPs that inform future guidelines and best practices.
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Affiliation(s)
- Derrecka M Boykin
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- South Central Mental Illness Research, Education, and Clinical Center (virtual center), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Tracey L Smith
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Barbara Rakel
- University of Iowa College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Merlyn Rodrigues
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jennie Embree
- University of Iowa College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Ken Woods
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education, and Clinical Center (virtual center), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Angelic D Chaison
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Lilian Dindo
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- South Central Mental Illness Research, Education, and Clinical Center (virtual center), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- University of Iowa College of Nursing, University of Iowa, Iowa City, IA, USA
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Fitzke RE, Bouskill KE, Sedano A, Tran DD, Saba SK, Buch K, Hummer JF, Davis JP, Pedersen ER. Barriers and Facilitators to Behavioral Healthcare for Women Veterans: a Mixed-Methods Analysis of the Current Landscape. J Behav Health Serv Res 2024; 51:164-184. [PMID: 37798569 PMCID: PMC10940443 DOI: 10.1007/s11414-023-09862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
Women veterans have historically faced barriers to behavioral health treatment, particularly through the VA. In conjunction, there have been changes in behavioral healthcare delivery resulting from efforts to improve care for women veterans and the COVID-19 pandemic (e.g., widespread telehealth implementation). The current study draws on a quantitative and qualitative study centering current perspectives of women veterans in their choices to seek or not seek behavioral healthcare in VA and non-VA settings through interviewing 18 women recruited from a larger survey study on veteran behavioral health (n = 83 women, n = 882 men) on their experiences with behavioral health care access and satisfaction, including barriers and facilitators to seeking care. Quantitative findings are descriptively reported from the larger study, which outlined screening for behavioral health problems, behavioral health utilization, treatment modality preferences, and barriers/facilitators to care. While women in the survey sample screened for various behavioral health disorders, rates of treatment seeking remained relatively low. Women reported positive and negative experiences with telehealth and endorsed many barriers to treatment seeking in interviews not captured by survey findings, including lack of women-specific care (e.g., care for military sexual trauma, women-only groups), reports of stranger harassment at the VA, and lack of female providers. Women veterans continue to face barriers to behavioral healthcare; however, ongoing efforts to improve care access and quality, including the implementation of telehealth, show promise in reducing these obstacles. Continued efforts are needed to ensure diverse treatment modalities continue to reach women veterans as this population grows.
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Affiliation(s)
- Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA.
| | | | - Angeles Sedano
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Denise D Tran
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
| | - Shaddy K Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Keegan Buch
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
| | - Justin F Hummer
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA
| | - Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th St, Los Angeles, CA, 90089, USA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, University of Southern California Keck School of Medicine, 2250 Alcazar St., Suite 2200, Los Angeles, CA, 90089, USA
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Choi J, Kim G, Choi S, Chang JE. A Year After Implementation of the Telehealth Waiver: Being Offered and Utilizing Video-Specific Telehealth Among Dual-Eligible Medicare Recipients During the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:255-266. [PMID: 37938810 DOI: 10.1097/phh.0000000000001845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE Telehealth is an essential tool to provide access to care while reducing infection exposure for high-risk populations during the COVID-19 pandemic. Our study aims to examine factors associated with telehealth availability and usage among Medicare and dual-eligible recipients 1 year after implementation of the Medicare's temporary telehealth waiver. DESIGN, SETTING, AND PARTICIPANT A cross-sectional, phone survey with a national representative sample of Medicare recipients. We obtained a final study sample from the Winter 2021 COVID-19 Supplement of Medicare Current Beneficiary Survey dataset (N = 10 586). We examined associations for being offered and having had telehealth visits or any video telehealth visits during the pandemic since November 1, 2020. MAIN OUTCOME MEASURES Our primary outcomes were being offered any telehealth, being offered any video telehealth, having had any telehealth visit, and having had any video telehealth. RESULTS Although dual eligibility was not significantly associated with being offered or having had any telehealth services during the pandemic, those who were dual eligible were more likely to have had video telehealth visits (adjusted odds ratio = 1.39, 95% confidence interval 1.04-1.86, P = .03) compared with those with non-dual eligibility. Recipients with disability eligibility, technology access, and severe chronic conditions were more likely to have been offered or have had telehealth. At the same time, those who lived in the nonmetropolitan area were less likely to have been offered or have had telehealth, including video telehealth. CONCLUSIONS Our findings suggest that the federal waivers to expand telehealth services were successful in continuing care for vulnerable Medicare recipients. The providers' specific outreach and intervention efforts to offer telehealth visits are crucial for dual-eligible recipients. To increase video telehealth uptake, technology access and services to rural areas should be prioritized.
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Affiliation(s)
- Jasmin Choi
- Departments of Social and Behavioral Sciences (Ms J. Choi) and Public Health Policy and Management (Dr Chang), School of Global Public Health, New York University, New York, New York; Robert F. Wagner Graduate School of Public Service, New York University, New York, New York (Dr Kim); and Department of Population Health, Grossman School of Medicine, New York University, New York, New York (Dr S. Choi)
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Wray TB, Kemp JJ, Adams Larsen M. Virtual reality (VR) treatments for anxiety disorders are unambiguously successful, so why are so few therapists using it? Barriers to adoption and potential solutions. Cogn Behav Ther 2023; 52:603-624. [PMID: 37376984 PMCID: PMC10592498 DOI: 10.1080/16506073.2023.2229017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Anxiety disorders are a significant cause of disability globally, yet only one in ten sufferers receives adequate quality treatment. Exposure-based therapies are effective in reducing symptoms associated with a number of anxiety disorders. However, few therapists use exposure techniques to treat these conditions, even when they are adequately trained in them, often because of concerns about provoking distress, drop out, logistical barriers, and other concerns. Virtual reality exposure therapy (VRET) can address many of these concerns, and a large body of research decisively shows that VRET is as efficacious for treating these conditions as in vivo exposures. Yet, use of VRET remains low. In this article, we discuss several factors we believe are contributing to low VRET adoption among therapists and raise potential solutions to address them. We consider steps that VR experience developers and researchers might take, such as leading studies of VRET's real-world effectiveness and treatment optimization trials and continuing to improve the fit of platforms with clinicians' workflows. We also discuss steps to address therapist reservations using aligned implementation strategies, as well as barriers for clinics, and the roles that professional organizations and payers could have in improving care by encouraging adoption of VRET.
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Affiliation(s)
- Tyler B. Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI
| | - Joshua J. Kemp
- Pediatric Anxiety Research Center, Warren Alpert Medical School of Brown University, Providence, RI
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Dindo L, Chaison A, Rodrigues M, Woods K, Mark A, Boykin D. Feasibility of delivering a virtual 1-day acceptance and commitment therapy workshop to rural veterans through community partnerships. Contemp Clin Trials Commun 2023; 34:101178. [PMID: 37409189 PMCID: PMC10318448 DOI: 10.1016/j.conctc.2023.101178] [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: 04/04/2023] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
Background This single-arm, open pilot study examined the feasibility and initial efficacy of a 1-day virtual Acceptance and Commitment Therapy (ACT) group workshop for distressed veterans. Methods We collaborated with veteran-serving community-based organizations to enhance outreach to veterans, especially those in rural areas. Veterans completed a baseline assessment and two follow-up assessments (1 month, 3 months) after workshop participation. Feasibility outcomes included reach (workshop recruitment and completion rates; veteran characteristics) and acceptability (open-ended survey question about satisfaction). Clinical outcomes included psychological distress (Outcome Questionnaire-45), stressor-related distress (PTSD Checklist-5), community reintegration (Military to Civilian Questionnaire), and meaning and purpose (PROMIS Short Form). Psychological flexibility (Action and Acceptance Questionnaire-II) - the proposed change mechanism underlying ACT - was also measured. Results Sixty-four veterans (50% rural, 39% self-identified as female) participated in a virtual workshop (97.1% completion rate). Overall, veterans liked the format and interactive nature of workshops. Convenience was noted as a benefit, while connectivity issues were highlighted as a drawback. Veterans showed improvements in psychological distress (F(2,109) = 3.30; p = 0.041), stressor-related distress (F(2,110) = 9.50; p = 0.0002), community reintegration (F(2,108) = 4.34; p = 0.015), and meaning and purpose (F(2,100) = 4.06; p = 0.020) over time. No between-group differences were detected, based on rurality or gender. Conclusion Pilot findings were promising and warrant a larger randomized trial to assess the efficacy of the 1-day virtual ACT workshop. Integrating community-engaged and participatory-research designs can enhance the external validity of these future studies and promote greater health equity.
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Affiliation(s)
- Lilian Dindo
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Angelic Chaison
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Merlyn Rodrigues
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Ken Woods
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- South Central Mental Illness, Research, Education and Clinical Center, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Alicia Mark
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Derrecka Boykin
- VA Office of Rural Health, Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- Menninger Department of Psychiatry and Behavioral Medicine, Baylor College of Medicine, Houston, TX, USA
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Pomales-Ramos A, Tokish H, Howard M, Straiton D, Ingersoll B. A mixed-methods examination of clinicians' perceived barriers to telehealth delivered applied behavior analysis. Front Psychol 2023; 14:1173644. [PMID: 37546433 PMCID: PMC10399227 DOI: 10.3389/fpsyg.2023.1173644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/14/2023] [Indexed: 08/08/2023] Open
Abstract
Following the COVID-19 pandemic, clinicians relied on telehealth to ensure continuity of essential healthcare services, such as Applied Behavior Analysis (ABA). Identifying barriers and examining them in the context of other implementation outcomes is important to support appropriate adaptations and sustainability of telehealth-delivered ABA services. Convergent mixed methods design was utilized to identify barriers experienced by ABA clinicians (N = 388) when delivering ABA services over telehealth to autistic children and their families following the first six months of the COVID-19 pandemic. Additionally, barriers were examined in relation to telehealth implementation outcomes and intentions for continued adoption. Findings reveal that clinicians rated providing direct services (M = 3.52, SD = 1.14) as more difficult than conducting assessments (M = 3.29, SD = 1.06), and both as more difficult than providing parent-mediated interventions [(M = 2.47, SD = 1.11), F(2, 381) = 162.26, p < 0.001]. A principal components analysis indicated a 3-factor solution of barriers related to: (1) technology (α = 0.82), (2) administrative tasks (α = 0.88), and (3) client characteristics (α = 0.88). The most frequently endorsed barriers were related to client characteristics, including increased difficulty providing telehealth services to children who elope (M = 4.37, SD = 0.81), children who exhibit challenging behaviors (M = 4.31; SD = 0.83), and children who are in the preverbal stage or use nonverbal language to communicate (M = 4.07; SD = 1.00). Fewer barriers related to client characteristics uniquely predicted implementation variables including acceptability, appropriateness, and feasibility. Thematic analysis revealed challenges related to technology, caregiver involvement, child engagement, implementation of intervention strategies over telehealth, and administrative or logistical barriers. These findings highlight the need for targeted strategies that facilitate telehealth use to address specific client needs and support the implementation of telehealth services in usual care settings.
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Lin B, Costakis A, John M, Linder H. Decreased inpatient psychiatric admissions with telepsychiatry use during the COVID-19 pandemic. Front Psychiatry 2023; 14:1172019. [PMID: 37351003 PMCID: PMC10284274 DOI: 10.3389/fpsyt.2023.1172019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/17/2023] [Indexed: 06/24/2023] Open
Abstract
Objective This study examines the quality of care provided through telepsychiatry by comparing psychiatric hospitalization rates among patients receiving in-person psychiatric care prior to the COVID-19 pandemic with rates among patients receiving virtual psychiatric care during the COVID-19 pandemic. Methods Mental health-related hospitalization rates among patients enrolled in a large academic hospital's outpatient psychiatry programs between March 1, 2018 and February 28, 2022 were retrospectively analyzed. Four time periods were created, spanning March 1 to February 28 of the following year. Demographic and clinical data were collected from the electronic health record, and descriptive statistics were calculated. Change in hospitalization rate between time periods was evaluated using McNemar's test. Results In the 2018 time period, 7.38% of all enrolled patients were hospitalized, compared to 7.70% hospitalized in the 2019 period, 5.74% in the 2020 period, and 5.38% in the 2021 period. Patients enrolled in both the 2018 and the 2019 periods saw no difference in hospitalization rate between the 2 years (2.93% in 2018, 2.83% in 2019; p = 0.830); patients enrolled in both 2019 and 2020 saw significantly lower hospitalization rates in 2020 (5.47% in 2019, 4.58% in 2020; p = 0.022); and patients enrolled in both 2020 and 2021 saw no difference (3.34% in 2020, 3.23% in 2021; p = 0.777). Conclusion Psychiatric hospitalization rates significantly decreased between the 2019 and the 2020 periods, suggesting a decrease in admissions associated with adoption of telepsychiatry. Future research should differentiate the roles played by telepsychiatry and COVID-19-related factors in reducing hospitalization rates during the pandemic.
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Affiliation(s)
- Brendon Lin
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Anna Costakis
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
| | - Majnu John
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Howard Linder
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, United States
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Walton CJ, Gonzalez S, Cooney EB, Leigh L, Szwec S. Engagement over telehealth: comparing attendance between dialectical behaviour therapy delivered face-to-face and via telehealth for programs in Australia and New Zealand during the Covid-19 pandemic. Borderline Personal Disord Emot Dysregul 2023; 10:16. [PMID: 37208784 DOI: 10.1186/s40479-023-00221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/24/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND While the COVID-19 crisis has had numerous global negative impacts, it has also presented an imperative for mental health care systems to make digital mental health interventions a part of routine care. Accordingly, through necessity, many Dialectical Behaviour Therapy (DBT) programs transitioned to telehealth, despite little information on clinical outcomes compared with face-to-face treatment delivery. This study examined differences in client engagement (i.e. attendance) of DBT: delivered face-to-face prior to the first COVID-19 lockdown in Australia and New Zealand; delivered via telehealth during the lockdown; and delivered post-lockdown. Our primary outcomes were to compare: [1] client attendance rates of DBT individual therapy delivered face-to-face with delivery via telehealth, and [2] client attendance rates of DBT skills training delivered face-to-face compared with delivery via telehealth. METHODS DBT programs across Australia and New Zealand provided de-identified data for a total of 143 individuals who received DBT treatment provided via telehealth or face-to-face over a six-month period in 2020. Data included attendance rates of DBT individual therapy sessions; attendance rates of DBT skills training sessions as well as drop-out rates and First Nations status of clients. RESULTS A mixed effects logistic regression model revealed no significant differences between attendance rates for clients attending face-to-face sessions or telehealth sessions for either group therapy or individual therapy. This result was found for clients who identified as First Nations persons and those who didn't identify as First Nations persons. CONCLUSIONS Clients were as likely to attend their DBT sessions over telehealth as they were face-to-face during the first year of the Covid-19 pandemic. These findings provide preliminary evidence that providing DBT over telehealth may be a viable option to increase access for clients, particularly in areas where face-to-face treatment is not available. Further, based on the data collected in this study, we can be less concerned that offering telehealth treatment will compromise attendance rates compared to face-to-face treatment. Further research is needed comparing clinical outcomes between treatments delivered face-to-face compared delivery via telehealth.
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Affiliation(s)
- Carla J Walton
- Centre for Psychotherapy, Hunter New England Mental Health Service, 2300, PO Box 833, Newcastle, NSW, Australia
| | - Sharleen Gonzalez
- Centre for Psychotherapy, Hunter New England Mental Health Service, 2300, PO Box 833, Newcastle, NSW, Australia
| | - Emily B Cooney
- Department of Psychological Medicine, Wellington Medical School, University of Otago (Te Whare, Wānanga o Otāgo ki Te Whanga-Nui-a-Tara), Newtown, Wellington, New Zealand
- Yale University, New Haven, Connecticut, United States of America
| | - Lucy Leigh
- Data Sciences Unit, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, 2305, New Lambton Heights, NSW, Australia
| | - Stuart Szwec
- Data Sciences Unit, Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, 2305, New Lambton Heights, NSW, Australia
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Dixon LJ, Witcraft SM, Schadegg MJ. COVID-19 anxiety and mental health among university students during the early phases of the U.S. pandemic. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1152-1160. [PMID: 34398707 DOI: 10.1080/07448481.2021.1923504] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/23/2021] [Accepted: 04/25/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study examined the impact of COVID-19 in the early stages of the pandemic on university students in the U.S. by: (1) characterizing COVID-19-related disruptions; (2) evaluating health anxiety, obsessive-compulsive (OC), depression, and stress symptoms; and (3) analyzing the unique role of COVID-19 anxiety on mental health outcomes, after accounting for relevant variables. PARTICIPANTS Participants included 263 students (63.9% female). METHODS Data were collected online between March 19, 2020 and May 1, 2020. RESULTS Participants screened positive for health anxiety (6.5%), OC symptoms (48.7%), or depression (29.7%). COVID-19 anxiety was positively associated with mental health symptoms. After controlling for demographics and COVID-19 impact, COVID-19 anxiety accounted for significant variance in health anxiety, OC symptoms, and stress. CONCLUSIONS Findings demonstrate the vast impact of COVID-19 on mental health among university students and provide guidance for identifying mental health priorities in the context of public health crises.
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Affiliation(s)
- Laura J Dixon
- Departmentof Psychology, Universityof Mississippi, University, Mississippi, USA
| | - Sara M Witcraft
- Departmentof Psychology, Universityof Mississippi, University, Mississippi, USA
| | - Mary J Schadegg
- Departmentof Psychology, Universityof Mississippi, University, Mississippi, USA
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Fast N, van Kessel R, Humphreys K, Ward NF, Roman-Urrestarazu A. The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review. CURRENT ADDICTION REPORTS 2023; 10:187-197. [PMID: 37266192 PMCID: PMC10126560 DOI: 10.1007/s40429-023-00480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/03/2023]
Abstract
Purpose of Review This article aims to review and synthesize the current research evidence regarding the efficacy of telepsychiatry-delivered substance use disorder treatment using a narrative review with a focus on the effects of remote healthcare delivery within the substance abuse treatment space. Recent Findings The COVID-19 pandemic exerted substantial pressures on all levels of society. Social isolation, loss of employment, stress, physical illness, overburdened health services, unmet medical needs, and rapidly changing pandemic restrictions had particularly severe consequences for people with mental health issues and substance use disorders. Since the start of the pandemic, addiction treatment (and medical treatment overall) using remote health platforms has significantly expanded to different platforms and delivery systems. The USA, in particular, reported transformational policy developments to enable the delivery of telehealth during the COVID-19 pandemic. However, systemic barriers such as a widespread lack of internet access and insufficient patient and provider digital skills remain. Summary Overall, telepsychiatry is a promising approach for the treatment of substance use disorders, but more randomized controlled trials are needed in the future to assess the evidence base of available interventions.
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Affiliation(s)
- Noam Fast
- START Treatment & Recovery Centers, New York City, USA
- Addiction Psychiatry Fellowship Faculty, Department of Psychiatry, Columbia University, New York City, USA
| | - Robin van Kessel
- Department of Health Policy, London School of Economics and Political Science, LSE Health, London, UK
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Keith Humphreys
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Natalie Frances Ward
- Department of International Development Studies, University of Amsterdam, Amsterdam, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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Zimmerman M, D'Avanzato C, King BT. Telehealth treatment of patients with major depressive disorder during the COVID-19 pandemic: Comparative safety, patient satisfaction, and effectiveness to prepandemic in-person treatment. J Affect Disord 2023; 323:624-630. [PMID: 36521663 PMCID: PMC9742046 DOI: 10.1016/j.jad.2022.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic impelled a transition from in-person to telehealth psychiatric treatment. There are no studies of partial hospital telehealth treatment for major depressive disorder (MDD). In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the effectiveness of partial hospital care of patients with MDD treated virtually versus in-person. METHODS Outcome was compared in 294 patients who were treated virtually from May 2020 to December 2021 to 542 patients who were treated in the in-person partial program in the 2 years prior to the pandemic. Patients completed self-administered measures of patient satisfaction, symptoms, coping ability, functioning, and general well-being. RESULTS In both the in-person and telehealth groups, patients with MDD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups also reported a significant improvement in positive mental health, general well-being, coping ability, and functioning. A large effect size of treatment was found in both treatment groups. Contrary to our hypothesis, the small differences in outcome favored the telehealth-treated patients. The length of stay and the likelihood of staying in treatment until completion were significantly greater in the virtually treated patients. LIMITATIONS The treatment groups were ascertained sequentially, and telehealth treatment was initiated after the COVID-19 pandemic began. Outcome assessment was limited to a self-administered questionnaire. CONCLUSIONS In an intensive acute care setting, delivering treatment to patients with MDD using a virtual, telehealth platform was as effective as treating patients in-person.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States.
| | - Catherine D'Avanzato
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
| | - Brittany T King
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, United States
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12
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Kashikar-Zuck S, Barnett KA, Williams SE, Pfeiffer M, Thomas S, Beasley K, Chamberlin LA, Mundo K, Ittenbach RF, Peugh J, Gibler RC, Lynch-Jordan A, Ting TV, Gadd B, Taylor J, Goldstein-Leever A, Connelly M, Logan DE, Williams A, Wakefield EO, Myer GD. FIT Teens RCT for juvenile fibromyalgia: Protocol adaptations in response to the COVID 19 pandemic. Contemp Clin Trials Commun 2022; 30:101039. [PMID: 36467389 PMCID: PMC9707024 DOI: 10.1016/j.conctc.2022.101039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/14/2022] [Accepted: 11/19/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To describe protocol adaptations to the Fibromyalgia Integrative Training for Teens (FIT Teens) randomized controlled trial in response to the COVID-19 pandemic. The overarching aims of the FIT Teens multi-site 3-arm comparative effectiveness trial are to assess whether a specialized neuromuscular exercise training intervention combined with cognitive-behavioral therapy (CBT) is superior to CBT alone or graded aerobic exercise alone. Design/methods The trial was originally designed as an in-person, group-based treatment with assessments at baseline, mid- and post-treatment, and four follow-up time points. The original study design and methodology was maintained with specific modifications to screening, consenting, assessments, and group-based treatments to be delivered in remote (telehealth) format in response to COVID-19 restrictions. Results Study enrollment was paused in March 2020 for five months to revise operations manuals, pilot remote treatment sessions for accuracy and fidelity, complete programming of REDCap assent/consent and assessment materials, train study staff for new procedures and obtain regulatory approvals. The trial was relaunched and has been successfully implemented in remote format since July 2020. Trial metrics thus far demonstrate a consistent rate of enrollment, strong attendance at remote treatment sessions, high retention rates and high treatment fidelity after protocol adaptations were implemented. Conclusions Preliminary findings indicate that FIT Teens protocol adaptations from in-person to remote are feasible and allowed for sustained enrollment, retention, and treatment fidelity comparable to the in-person format. Methodologic and statistical considerations resulting from the adaptations are discussed as well as implications for interpretation of results upon completion of the trial.
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Affiliation(s)
- Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kimberly A. Barnett
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sara E. Williams
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Megan Pfeiffer
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Staci Thomas
- Division of Sports Medicine, SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katie Beasley
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leigh Ann Chamberlin
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katiliya Mundo
- Department Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Richard F. Ittenbach
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James Peugh
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert C. Gibler
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Anne Lynch-Jordan
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy V. Ting
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brooke Gadd
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Janalee Taylor
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alana Goldstein-Leever
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
| | - Mark Connelly
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Deirdre E. Logan
- Division of Pain Medicine, Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Amy Williams
- Riley Children's Hospital, Indianapolis, IN, USA
| | - Emily O. Wakefield
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Gregory D. Myer
- Sports Performance and Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - for the FIT Teens Clinical Trial Study Group and the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Pain Workgroup Investigators
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Sports Medicine, SPORT Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City, MO, USA
- Division of Pain Medicine, Department of Anesthesia, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Riley Children's Hospital, Indianapolis, IN, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
- Sports Performance and Research Center, Emory University School of Medicine, Atlanta, GA, USA
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13
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Mallory JB, Ponder WN, Sherrill T, Carbajal J, Schuman DL, Jetelina KK, Stafford J. The Impact of COVID-19 on Veterans’ Resilience, Attachment, and Negative Affect. JOURNAL OF VETERANS STUDIES 2022. [DOI: 10.21061/jvs.v8i3.324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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14
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O’Callaghan E, Sullivan S, Gupta C, Belanger HG, Winsberg M. Feasibility and acceptability of a novel telepsychiatry-delivered precision prescribing intervention for anxiety and depression. BMC Psychiatry 2022; 22:483. [PMID: 35854281 PMCID: PMC9297585 DOI: 10.1186/s12888-022-04113-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/05/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Major Depressive Disorder and Generalized Anxiety Disorder are pervasive and debilitating conditions, though treatment is often inaccessible and based on trial-and-error prescribing methods. The present observational study seeks to describe the use of a proprietary precision prescribing algorithm piloted during routine clinical practice as part of Brightside's telepsychiatry services. The primary aim is to determine the feasibility and acceptability of implementing this intervention. Secondary aims include exploring remission and symptom improvement rates. METHODS Participants were adult patients enrolled in Brightside who completed at least 12 weeks of treatment for depression and/or anxiety and received a prescription for at least one psychiatric medication. A prescription recommendation was made by Brightside's algorithm at treatment onset and was utilized for clinical decision support. Participants received baseline screening surveys of the PHQ-9 and GAD-7, and at weeks 2,4,6,8,10 and 12. Intent-to-treat (ITT) sensitivity analyses were conducted. Feasibility of the implementation was measured by the platform's ability to enroll and engage participants in timely psychiatric care, as well as offer high touch-point treatment options. Acceptability was measured by patient responses to a 5-star satisfaction rating. RESULTS Brightside accessed and treated 6248 patients from October 2018 to April 2021, treating a majority of patients within 4-days of enrollment. The average plan cost was $115/month. 89% of participants utilized Brightside's core medication plan at a cost of $95/month. 13.4% of patients in the study rated Brightside's services as highly satisfactory, averaging a 4.6-star rating. Furthermore, 90% of 6248 patients experienced a MCID in PHQ-9 or GAD-7 score. Remission rates were 75% (final PHQ-9 or GAD-7 score < 10) for the study sample and 59% for the ITT sample. 69.3% of Brightside patients were treated with the medication initially prescribed at intake. CONCLUSIONS Results suggest that the present intervention may be feasible and acceptable within the assessed population. Exploratory analyses suggest that Brightside's course of treatment, guided by precision recommendations, improved patients' symptoms of anxiety and depression.
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Affiliation(s)
- Erin O’Callaghan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Scott Sullivan
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
| | - Carina Gupta
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA, 94607-1703, USA.
| | - Heather G. Belanger
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA ,grid.170693.a0000 0001 2353 285XDepartments of Psychology and Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL USA
| | - Mirène Winsberg
- Brightside Health Inc., 2471 Peralta Street, Oakland, CA 94607-1703 USA
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15
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Zimmerman M, Ward M, D'Avanzato C, Tirpak JW. Telehealth Treatment of Patients With Borderline Personality Disorder in a Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness of In-Person Treatment. J Pers Disord 2022; 36:277-295. [PMID: 34747648 DOI: 10.1521/pedi_2021_35_539] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There are no studies of the safety and effectiveness of telehealth psychiatric treatment of partial hospital level of care, in general, and for borderline personality disorder (BPD) in particular. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors compared the effectiveness of their partial hospital treatment program in treating patients with BPD. For both the in-person and telehealth partial hospital level of care, patients with BPD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups reported a significant improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment was found in both treatment groups. No patients attempted suicide. Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, and improved functioning and well-being for patients with BPD.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Madeline Ward
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Catherine D'Avanzato
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Julianne Wilner Tirpak
- Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
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16
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Better than expected: client and clinician experiences of videoconferencing therapy (VT) during the COVID-19 pandemic. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Videoconferencing therapy (VT) has been an emerging medium of psychological therapy, and during the COVID-19 pandemic there has been substantial growth in its usage as a result of home working. However, there is a paucity of research into client and clinician perceptions of VT. This study sought to assess client and staff experiences of VT. This mixed methods study produced both quantitative and qualitative data. Seven clients who had previously received VT and 11 psychotherapists who had previously delivered VT were recruited from two NHS sites. Clients and psychotherapists took part in qualitative interviews which were analysed using thematic analysis. Quantitative surveys were developed based on themes generated from the interviews and were completed by 172 clients and 117 psychotherapists. These were analysed using simple percentages. VT often exceeded client and psychotherapist expectations and overall experiences of VT were generally positive, although there were mixed findings regarding the therapeutic alliance. Several barriers to VT were cited, such as IT issues, and challenges identified in conducting behavioural experiments, and potential exclusion of certain populations were also cited. The medium of VT was received well by both clients and clinicians, with advantages around convenience seemingly outweighing losses in quality of therapeutic relationship. Future research should focus on overcoming barriers to accessing VT in populations prone to digital exclusion. NHS services not currently employing VT may wish to reconsider their stance, expanding choice of therapy delivery and improving accessibility.
Key learning aims
(1)
To gain insight into client and clinician experiences of VT during the COVID-19 pandemic.
(2)
To assess the acceptability and feasibility of VT within two NHS short-term psychological support services.
(3)
To identify barriers and facilitators to the implementation of VT within two NHS short-term psychological support services.
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17
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Pompa-Craven P, Tierman E, Martino J, Lotfizadeh AD. Caregiver Satisfaction with Delivery of Telehealth Autism Services. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:196-205. [PMID: 35531083 PMCID: PMC9058747 DOI: 10.1007/s41252-022-00256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The purpose of this study was to assess satisfaction with telehealth interventions for a large nonprofit organization that transitioned interventions for individuals with autism spectrum disorder (ASD) to telehealth during a pandemic. Services provided via telehealth included applied behavior analysis (ABA), speech and language, and occupational therapies. A secondary survey evaluated reasons for declining telehealth services. METHODS A survey was administered to 10,567 families who were receiving autism interventions. A total of 440 respondents answered all the questions on the survey, and their results were included in this study. A secondary survey was administered to 223 individuals who declined to have telehealth autism interventions. RESULTS There was not a clinically meaningful difference in satisfaction across service types. Although all ratings were in the high range, caregivers ranked speech therapists as more dependable than ABA therapists, and this difference was statistically significant. The findings suggested that the majority of caregivers were generally satisfied with services provided in a telehealth format. For those who declined services, the majority indicated a discomfort with the use of technology. CONCLUSIONS The participants of telehealth autism interventions reported high general satisfaction and indicated an improvement in their quality of life. Results provide suggestive evidence that increased satisfaction of telehealth services may allow for further acceptability and access for participants. Future research should evaluate participant and clinician satisfaction with telehealth versus in-person interventions.
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Affiliation(s)
- Paula Pompa-Craven
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Emily Tierman
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Joelle Martino
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
| | - Amin D. Lotfizadeh
- Autism Services, Easterseals Southern California, 1063 McGaw Avenue, Irvine, CA 92614 USA
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18
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Ahlquist LR, Yarns BC. Eliciting emotional expressions in psychodynamic psychotherapies using telehealth: a clinical review and single case study using emotional awareness and expression therapy. PSYCHOANALYTIC PSYCHOTHERAPY 2022; 36:124-140. [PMID: 36711048 PMCID: PMC9881109 DOI: 10.1080/02668734.2022.2037691] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The COVID-19 pandemic and ensuing social distancing requirements resulted in an abrupt transition in the provision of most mental healthcare to telehealth; yet it was, at first, unclear whether patients' emotional expressions - of great import to the success of many psychodynamic therapies - could be facilitated using teletherapy. This article first presents a targeted literature review focused on emotional expressions in psychotherapy and implementing psychodynamic therapy over telehealth and then describes our clinical experience transitioning a psychodynamically-informed, evidence-based, and experiential group treatment for chronic pain, emotional awareness and expression therapy (EAET), to video telehealth at VA Greater Los Angeles Healthcare System. We discuss barriers we encountered in our implementation of EAET over video telehealth but also illustrate the ultimate success of the approach using verbatim excerpts from our therapeutic work, which aim to demonstrate the potential to facilitate powerful emotional expressions over video telehealth when conducting a psychodynamically-informed treatment. We examine the possible applications for video telehealth to maintain emotionally focused, psychodynamic psychotherapy administration and enhance its teaching and training. Although we describe limitations of our specific approach, ultimately, our experience supports the potential efficacy of experiential, emotion-focused psychodynamic therapies in a telehealth setting.
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Affiliation(s)
- Lauren R. Ahlquist
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Brandon C. Yarns
- Department of Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA;,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,Corresponding author. 11301 Wilshire Blvd, Mail Code 116AE, Bldg. 401, Rm. A236, Los Angeles, CA 90073, USA
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19
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Carrier JD, Gallagher F, Vanasse A, Roberge P. Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review. PLoS One 2022; 17:e0264368. [PMID: 35231039 PMCID: PMC8887746 DOI: 10.1371/journal.pone.0264368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access. Objective Describe and classify the various strategies reported to improve access to CBT for anxiety disorders. Methods Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo. Results We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation. Implications This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.
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Affiliation(s)
- Jean-Daniel Carrier
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- * E-mail:
| | - Frances Gallagher
- School of nursing, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Alain Vanasse
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Pasquale Roberge
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
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20
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Mitzkovitz C, Dowd SM, Cothran T, Musil S. The Eyes Have It: Psychotherapy in the Era of Masks. J Clin Psychol Med Settings 2022; 29:886-897. [PMID: 35118604 PMCID: PMC8812949 DOI: 10.1007/s10880-022-09856-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/24/2022]
Abstract
Nonverbal communication is integral to the success of psychotherapy and facial expression is an important component of nonverbal communication. The SARS CoV-2 pandemic has caused alterations in how psychotherapy services are provided. In this paper, potential issues that may arise from conducting psychotherapy when both the patient and therapist are wearing masks are explored. These include higher likelihood of misidentifying facial expression, especially when expression is incongruent with body language, and when the lower face is more important for correct identification of emotion. These issues may be particularly problematic for patient populations for whom emotion recognition may be a problem at baseline, or for those more prone to biases in emotional recognition. Suggestions are made for therapists to consider when seeing patients in-person when masks are necessary.
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Affiliation(s)
- Cayla Mitzkovitz
- Department of Psychology, Central Michigan University, Mount Pleasant, MI, USA
| | - Sheila M Dowd
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Thomas Cothran
- Office of Neuropsychology, Community Care Network, Inc., Munster, IN, USA
| | - Suzanne Musil
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA. .,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Ste. 400, Chicago, IL, 60612, USA.
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21
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Kryszak EM, Albright CM, Fell LA, Butter EM, Kuhlthau KA. Clinician Perspectives on Telehealth Assessment of Autism Spectrum Disorder During the COVID-19 Pandemic. J Autism Dev Disord 2022; 52:5083-5098. [PMID: 35103899 PMCID: PMC8804366 DOI: 10.1007/s10803-022-05435-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 01/25/2023]
Abstract
This study examined clinician insights into telehealth assessment services for autism spectrum disorder implemented during the COVID-19 pandemic. 35 clinicians from multiple disciplines across 17 sites in the Autism Care Network were interviewed. Themes identified through qualitative analyses included factors related to confidence in diagnosis (impressions of in-home observation; child and family factors that affected diagnostic confidence; changes in rapport); patient and family factors related to telehealth (perceived family benefits of and barriers to telehealth; factors related to healthcare disparities; factors specific to non-native English speakers); and institutional and workplace factors related to transitioning to telehealth (institutional support; changes to efficacy, attendance, and work satisfaction). Results suggest that telehealth has potential to be an effective tool in autism assessment practice.
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Affiliation(s)
- Elizabeth M Kryszak
- Nationwide Children's Hospital, Columbus, OH, USA. .,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA. .,Child Development Center, Nationwide Children's Hospital, 187 W. Schrock Rd., Westerville, OH, 43081, USA.
| | - Charles M Albright
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Lucy A Fell
- Division of Pediatric Health Outcomes Research, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Eric M Butter
- Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
| | - Karen A Kuhlthau
- Division of Pediatric Health Outcomes Research, Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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22
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Giovanetti AK, Punt SEW, Nelson EL, Ilardi SS. Teletherapy Versus In-Person Psychotherapy for Depression: A Meta-Analysis of Randomized Controlled Trials. Telemed J E Health 2022; 28:1077-1089. [PMID: 35007437 DOI: 10.1089/tmj.2021.0294] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Introduction: The recent surge in telehealth service delivery represents a promising development in the field's ability to address access gaps in health care across underserved populations. Telehealth also carries the potential to help reduce the societal burden of mental illnesses such as major depression, which often go untreated. There is now a sufficiently large corpus of randomized controlled trials to examine the comparative effectiveness of teletherapy and in-person services meta-analytically. Methods: We searched the PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for articles from January 1, 2000 to February 1, 2021 to identify randomized head-to-head trials of video-based versus in-person delivery of psychotherapy to reduce depressive symptoms. We conducted a random-effects meta-analysis to evaluate potential differences in efficacy rates. We calculated and meta-analyzed odds ratios to examine differential attrition rates between video and in-person conditions. Finally, we conducted subgroup analyses based on the primary treatment focus (depression or another condition) of each trial. Results: Primary study analyses yielded evidence that video-based psychotherapy is roughly comparable in efficacy with in-person psychotherapy for reducing depressive symptoms (g = 0.04, 95% confidence interval [CI = -0.12 to 0.20], p = 0.60, I2 = 5%). Likewise, attrition rates between the two conditions were not significantly different (odds ratio = 1.07, 95% CI = [0.78 to 1.49], p = 0.63, I2 = 25%). Finally, we did not observe significant subgroup differences in either efficacy (p = 0.38) or attrition (p = 0.94). Conclusions: The present findings suggest that video-based teletherapy may be a feasible and effective alternative to in-person services for reducing depressive symptoms. Continued research on the effectiveness of telehealth in clinically depressed samples, and further elucidation of the access barriers entailed by each delivery modality, can help the field better determine which patients will derive the greatest benefit from each mode of intervention.
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Affiliation(s)
| | | | - Eve-Lynn Nelson
- Department of Pediatrics and Kansas Center for Telemedicine and Telehealth, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Stephen S Ilardi
- Department of Psychology, University of Kansas, Lawrence, Kansas, USA
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23
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Belanger HG, Winsberg M. Do older adults benefit from telepsychiatric care: Comparison to younger adults. Front Psychiatry 2022; 13:998401. [PMID: 36072453 PMCID: PMC9441623 DOI: 10.3389/fpsyt.2022.998401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Telemental health platforms may increase access to care for older adults. Historically, older adults have tended to adopt new technologies at a slower rate which creates a perception that they may not be able to benefit from them. The purpose of this study was to determine whether or not older adult patients receiving psychiatric care for depression via a telemental health platform achieve the same outcomes as younger adults. METHOD Participant data utilized in the current investigation were obtained from a national mental health telehealth company (i.e., Brightside) and consisted of 12,908 U.S.-based adult patients receiving psychiatric care for depression between October, 2018 and January, 2022. Propensity matching was used to create an older and younger sample (n = 141 in each) using 23 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6 weeks, 8 weeks, 10 weeks, 12 weeks, 14 weeks, and 16 weeks. RESULTS Despite matching, the groups still significantly differed on prior mental health treatment, such that more older adults reported having had prior mental health treatment. There were no other differences between the groups on assessed variables. Both younger and older adults had decreasing scores over time with no significant differences between them. CONCLUSION Older adults have similar improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform. These findings suggest that age is not a barrier to benefitting from telepsychiatric care.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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Belanger HG, Winsberg M. Exploring social determinants of health: Comparing lower and higher income individuals participating in telepsychiatric care for depression. Front Psychiatry 2022; 13:1026361. [PMID: 36683980 PMCID: PMC9849930 DOI: 10.3389/fpsyt.2022.1026361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Telemental health may increase access to care; there has been little research on efficacy with those at the lower end of the income distribution. The purpose of this study was to determine whether lower vs. higher income patients receiving telepsychiatric care for depression achieve: (1) effective symptom reduction and (2) similar outcomes. METHODS Data utilized were obtained from a national mental health telehealth company and consisted of 5,426 U.S.-based patients receiving psychiatric care for moderate to severe depression between October, 2018 and January, 2022. Propensity matching was used to create lower and higher income samples (n = 379 in each) using 22 covariates. These samples were then compared using repeated measures ANOVA on Patient Health Questionnaire-9 (PHQ-9) scores at start of treatment, 6, 8, 10, 12, 14, and 16 weeks. RESULTS Both lower and higher income groups made significant improvement over time, with groups averaging mild symptom severity by week 16. There was a significant group x time interaction, such that the lower income group had significantly greater depression severity at the last two timepoints. CONCLUSION Lower and higher income groups both made significant improvement in depression symptom severity over time following initiation of psychiatric treatment via a telehealth platform, though higher income individuals, all else being equal besides employment, tend to do better. These findings suggest that when lower income individuals do participate in care, good outcomes can be achieved. Further research is needed to better understand the role social determinants of health (SDOH) play in outcome disparities.
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Affiliation(s)
- Heather G Belanger
- Brightside Health Inc., Oakland, CA, United States.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
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Rosas YG, Sigal M, Park A, Barnett ML. Predicting a Rapid Transition to Telehealth-Delivered Parent-Child Interaction Therapy Amid COVID-19: A Mixed Methods Study. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:293-304. [PMID: 36105665 PMCID: PMC9462633 DOI: 10.1007/s43477-022-00057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/29/2022] [Indexed: 12/31/2022]
Abstract
The sudden onset of COVID-19 forced mental health therapists to rapidly transition to telehealth services. While some therapists and organizations were able to achieve an expeditious transition, others struggled. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, which outlines key phases that guide the implementation process, the current mixed methods study examined what factors predicted the transition to internet-based Parent-Child Interaction Therapy (iPCIT), a telehealth-delivered evidence-based practice (EBP). We investigated two areas related to the transition: (1) if PCIT therapists transitioned to provide iPCIT and (2) if they made this transition quickly. In Fall 2019, 324 therapists completed a survey about implementing PCIT. After stay-at-home orders, 223 of those therapists completed a follow-up survey about their transition to telehealth, organizational characteristics, their caseloads, and telehealth training. The majority of therapists (82%) transitioned to provide iPCIT, with 48% making the transition in less than a week. Open-ended responses indicated that therapists who did not transition-faced challenges related to limited client resources, a lack of training, and organizational delays. Qualitative findings informed predictors for two logistic regression models that are statistical models that predict the probability of an event occurring, with criterion variables (1) whether therapists transitioned to provide iPCIT and (2) whether they transitioned in less than a week. Results showed that caseload in Fall 2019 and receipt of iPCIT training were associated with iPCIT transition. Organizational setting, resiliency, and baseline caseload predicted rapid transition to iPCIT. Implications regarding supporting the implementation of telehealth delivery of EBPs are discussed.
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Affiliation(s)
- Yessica Green Rosas
- grid.133342.40000 0004 1936 9676Department of Counseling, Clinical, and School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA 93106-9490 USA
| | - Marika Sigal
- grid.27860.3b0000 0004 1936 9684Department of Human Ecology, University of California, Davis, Davis, CA USA
| | - Alayna Park
- grid.170202.60000 0004 1936 8008Department of Psychology, University of Oregon, Eugene, OR USA
| | - Miya L. Barnett
- grid.133342.40000 0004 1936 9676Department of Counseling, Clinical, and School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA 93106-9490 USA
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Wong ES, Rajan S, Liu CF, Morland LA, Pyne JM, Simsek-Duran F, Reisinger HS, Moeckli J, Fortney JC. Economic costs of implementing evidence-based telemedicine outreach for posttraumatic stress disorder in VA. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221116771. [PMID: 37091111 PMCID: PMC9924252 DOI: 10.1177/26334895221116771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Telemedicine outreach for posttraumatic stress disorder (TOP) is a virtual evidence-based practice (EBP) involving telephone care management and telepsychology that engages rural patients in trauma-focused psychotherapy. This evaluation examined implementation and intervention costs attributable to deploying TOP from a health system perspective. Methods Costs were ascertained as part of a stepped wedge cluster randomized trial at five sites within the Veterans Affairs (VA) Healthcare System. All sites initially received a standard implementation strategy, which included internal facilitation, dissemination of an internal facilitators operational guide, funded care manager, care managing training, and technical support. A subset of clinics that failed to meet performance metrics were subsequently randomized to enhanced implementation, which added external facilitation that focused on incorporating TOP clinical processes into existing clinic workflow. We measured site-level implementation activities using project records and structured activity logs tracking personnel-level time devoted to all implementation activities. We monetized time devoted to implementation activities by applying an opportunity cost approach. Intervention costs were measured as accounting-based costs for telepsychiatry/telepsychology and care manager visits, ascertained using VA administrative data. We conducted descriptive analyses of strategy-specific implementation costs across five sites. Descriptive analyses were conducted instead of population-level cost-effectiveness analysis because previous research found enhanced implementation was not more successful than the standard implementation in improving uptake of TOP. Results Over the 40-month study period, four of five sites received enhanced implementation. Mean site-level implementation cost per month was $919 (SD = $238) during standard implementation and increased to $1,651 (SD = $460) during enhanced implementation. Mean site-level intervention cost per patient-month was $46 (SD = $28) during standard implementation and $31 (SD = $21) during enhanced implementation. Conclusions Project findings inform the expected cost of implementing TOP, which represents one factor health systems should consider in the decision to broadly adopt this EBP. Plain Language Summary: What is already known about the topic: Trauma-focused psychotherapy delivered through telemedicine has been demonstrated as an effective approach for the treatment of post-traumatic stress disorder (PTSD). However, uptake of this evidence-based approach by integrated health systems such as the Veterans Affairs (VA) Health Care System is low. What does this paper add: This paper presents new findings on the costs of two implementation approaches designed to increase adoption telemedicine outreach for PTSD from a health system perspective. What are the implications for practice, research, and policy: Cost estimates from this paper can be used by health systems to inform the relative value of candidate implementation strategies to increase adoption of evidence-based treatments for PTSD or other mental health conditions.
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Affiliation(s)
- Edwin S. Wong
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Suparna Rajan
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
| | - Chuan-Fen Liu
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA
| | - Leslie A. Morland
- VA San Diego Healthcare System, San Diego, CA
- Department of Psychiatry, University of California-San Diego, San Diego, CA
| | - Jeffrey M. Pyne
- Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Fatma Simsek-Duran
- Iowa City VA Health Care System, Iowa City, IA
- Department of Psychiatry, University of Iowa, Iowa City, IA
| | - Heather S. Reisinger
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA
- Department of Internal Medicine, University of Iowa, Iowa
City, IA
| | - Jane Moeckli
- Center for Access & Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, IA
| | - John C. Fortney
- Center for Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System, Seattle, WA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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A qualitative exploration of adolescents’ experiences of digital Dialectical Behaviour Therapy during the COVID-19 pandemic. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract
The UK government implemented national social-distancing measures in response to the global COVID19 pandemic. As a result, many appointments in the National Health Service (NHS) took place virtually, including psychological interventions in out-patient settings. This study explored the experiences of adolescents participating in a dialectical behaviour therapy (DBT-A) programme via teletherapy (i.e. via video or telephone call) in a Children and Adolescent Mental Health Service (CAMHS). Thirteen adolescents with emotion dysregulation and related problems completed an online qualitative survey about their experience and acceptance of DBT-A delivered virtually. Thematic analysis was conducted on the survey data and generated three over-arching themes: (1) sense of loss; (2) feeling uncontained; and (3) benefits of virtual DBT. These over-arching themes were composed of eight subthemes (‘loss of connection with group and therapist’; ‘loss of skills-building opportunities’; ‘limited privacy’; ‘lack of safe therapy space’; ‘difficult endings’; ‘home comforts’; ‘convenience and accessibility’; and ‘easier to participate with others’). This study suggests that adolescents doing virtual DBT-A need approaches that acknowledge and address the additional relational, emotional and practical challenges of online therapy while maintaining fidelity to the evidence-based treatment model. Suggestions for further research and preliminary practice guidelines are discussed.
Key learning aims
(1)
To learn about the experiences of adolescents participating in a DBT programme for adolescents (DBT-A) conducted virtually, including the challenges and benefits they identified.
(2)
To learn about implications for clinical practice and future research directions.
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Lau JSP, Lai SMK, Ip FTS, Wong PWC, Team WC, Servili C, Salomone E, Pacione L, Shire S, Brown FL. Acceptability and feasibility of the World Health Organization's Caregiver Skills Training Programme (WHO CST) delivered via eLearning, videoconferencing, and in-person hybrid modalities in Hong Kong. Front Psychiatry 2022; 13:915263. [PMID: 36172515 PMCID: PMC9511500 DOI: 10.3389/fpsyt.2022.915263] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/27/2022] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Local children with developmental disabilities were deprived of learning opportunities due to recent social and health incidents, resulting in elevating challenging behaviors and familial conflicts. This study explored the acceptability and feasibility of the World Health Organization's Caregiver Skills Training Programme (WHO CST) in alternative delivery modes under new normal and post COVID-19 period. METHOD CST was delivered via eLearning (EL), videoconferencing (VC), and in-person hybrid (IP) modes to 34 parent-child dyads, being randomly assigned to modes of asynchronous non-interfering EL (n = 9), synchronous with online coaching VC (n = 7), synchronous with in-person coaching IP (n = 9) and Wait-list Control WLC (n = 9). Data from two standardized scales of General Health Questionnaire (GHQ-12) and Strengths and Difficulties Questionnaire (SDQ), and Post-session and Home Visit Feedback Form by Caregivers that included both structured and open-ended questions were collected before and after intervention. Both quantitative and qualitative approaches were used in studying the collected data. RESULTS High levels of acceptability and feasibility of the training programme were supported by ratings on comprehensiveness and relevance, agreement with their personal values, duration, and usefulness. IP and VC groups yielded more positive changes than EL and WLC groups with 3, 16, 13, and -3% in General Health Questionnaire (GHQ-12), -13, -15, -6 and 0% in Difficulties-total, and 36.5, 35.5, 5.8 and 2.4% in Prosocial Scale at Strengths and Difficulties Questionnaire (SDQ) for EL, VC, IP, and WLC groups respectively from baseline to 12 weeks after intervention. Results from two standardized scales echoed with qualitative observations that the programme helped improve caregivers' well-being, child's communication, and behaviors across intervention groups. CONCLUSIONS Current findings revealed that CST delivered in three alternative modes were acceptable and feasible, and yielded positive impacts toward both caregivers and children. In-person coaching, and skill-practicing sessions were effective in mitigating child's challenging behaviors while personal interaction, either face-to-face or virtual, is a significant factor in uplifting caregivers' well-being, whereas the self-learning model was appreciated by the busy caregivers. In clinical practice, needs and goals of families and the constraints of remote interventions at the settings should be balanced.
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Affiliation(s)
- Janet Siu-Ping Lau
- The University of Hong Kong, Hong Kong, Hong Kong SAR, China.,WHO CST Regional Technical Focal Point, Geneva, Switzerland
| | | | | | | | - Who Cst Team
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Erica Salomone
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.,The University of Milano-Bicocca, Milan, Italy
| | - Laura Pacione
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland.,Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Felicity L Brown
- Research and Development Department, War Child Holland, Amsterdam, Netherlands.,Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
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Roben CKP, Kipp E, Schein SS, Costello AH, Dozier M. Transitioning to telehealth due to COVID-19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants. Infant Ment Health J 2021; 43:173-184. [PMID: 34964152 PMCID: PMC9015513 DOI: 10.1002/imhj.21963] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Maintaining treatment fidelity when implementing evidence‐based interventions is a significant challenge. The inability to deliver in‐person services due to the COVID‐19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch‐Up (ABC) program is an evidence‐based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and “in‐the‐moment” commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5‐min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in‐the‐moment comments. On average, parent coaches were able to exceed in‐person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.
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Affiliation(s)
| | - Evan Kipp
- University of Delaware, Newark, Delaware, USA
| | | | | | - Mary Dozier
- University of Delaware, Newark, Delaware, USA
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Kruszyńska-Fischbach A, Sysko-Romańczuk S, Rafalik M, Walczak R, Kludacz-Alessandri M. Organizational E-Readiness for the Digital Transformation of Primary Healthcare Providers during the COVID-19 Pandemic in Poland. J Clin Med 2021; 11:jcm11010133. [PMID: 35011873 PMCID: PMC8745320 DOI: 10.3390/jcm11010133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 12/20/2022] Open
Abstract
The COVID-19 pandemic has forced many countries to implement a variety of restrictive measures to prevent it from spreading more widely, including the introduction of medical teleconsultations and the use of various tools in the field of inpatient telemedicine care. Digital technologies provide a wide range of treatment options for patients, and at the same time pose a number of organizational challenges for medical entities. Therefore, the question arises of whether organizations are ready to use modern telemedicine tools during the COVID-19 pandemic. The aim of this article is to examine two factors that impact the level of organizational e-readiness for digital transformation in Polish primary healthcare providers (PHC). The first factor comprises operational capabilities, which are the sum of valuable, scarce, unique, and irreplaceable resources and the ability to use them. The second factor comprises technological capabilities, which determine the adoption and usage of innovative technologies. Contrary to the commonly analyzed impacts of technology on operational capabilities, we state the reverse hypothesis. The verification confirms the significant influence of operational capabilities on technological capabilities. The research is conducted using a questionnaire covering organizational e-readiness for digital transformation prepared by the authors. Out of the 32 items examined, four are related to the operational capabilities and four to the technological capabilities. The result of our evaluation shows that: (i) a basic set of four variables can effectively measure the dimensions of OC, namely the degree of agility, level of process integration, quality of resources, and quality of cooperation; (ii) a basic set of three variables can effectively measure the dimensions of TC, namely adoption and usage of technologies, customer interaction, and process automation; (iii) the empirical results show that OC is on a higher level than TC in Polish PHCs; (iv) the assessment of the relationship between OC and TC reveals a significant influence of operational capabilities on technological capabilities with a structural coefficient of 0.697. We recommend increasing the level of technological capability in PHC providers in order to improve the contact between patients and general practitioners (GPs) via telemedicine in lockdown conditions.
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Affiliation(s)
| | - Sylwia Sysko-Romańczuk
- Faculty of Management, Warsaw University of Technology, 02-524 Warsaw, Poland; (A.K.-F.); (M.R.)
- Correspondence: (S.S.-R.); (R.W.); (M.K.-A.)
| | - Mateusz Rafalik
- Faculty of Management, Warsaw University of Technology, 02-524 Warsaw, Poland; (A.K.-F.); (M.R.)
| | - Renata Walczak
- Faculty of Civil Engineering, Mechanics and Petrochemistry, Warsaw University of Technology, 09-400 Plock, Poland
- Correspondence: (S.S.-R.); (R.W.); (M.K.-A.)
| | - Magdalena Kludacz-Alessandri
- College of Economics and Social Sciences, Warsaw University of Technology, 09-400 Plock, Poland
- Correspondence: (S.S.-R.); (R.W.); (M.K.-A.)
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Penney E, Reynolds J, Knott V, Green H. Lessons from 2020: practical and clinical aspects of rapid telepsychology adoption in clinical psychology postgraduate programs. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.2001294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Erika Penney
- Graduate School of Health, University of Technology, Sydney, Australia
| | - Julia Reynolds
- Research School of Psychology, Australian National University, Australia
| | - Vikki Knott
- School of Psychological Science, Australian College of Applied Psychology
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Peck KR, Moxley-Kelly N, Badger GJ, Sigmon SC. Posttraumatic stress disorder in individuals seeking treatment for opioid use disorder in Vermont. Prev Med 2021; 152:106817. [PMID: 34599919 PMCID: PMC8641000 DOI: 10.1016/j.ypmed.2021.106817] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 11/27/2022]
Abstract
Posttraumatic stress disorder (PTSD) and opioid use disorder (OUD) may be associated with poor outcomes in rural areas where access to mental health services and opioid agonist treatment (OAT) is limited. This study examined the characteristics associated with a history of PTSD among a sample of individuals seeking buprenorphine treatment for OUD in Vermont, the second-most rural state in the US. Participants were 89 adults with OUD who participated in one of two ongoing randomized clinical trials examining the efficacy of an interim buprenorphine dosing protocol for reducing illicit opioid use during waitlist delays to OAT. Thirty-one percent of participants reported a history of PTSD. Those who did (PTSD+; n = 28) and did not (PTSD-; n = 61) report a history of PTSD were similar on sociodemographic and drug use characteristics. However, the PTSD+ group was less likely to have received prior OUD treatment compared to the PTSD- group (p = .02) despite being more likely to have a primary care physician (p = .009) and medical insurance (p = .002). PTSD+ individuals also reported greater mental health service utilization, more severe psychiatric, medical and drug use consequences, and greater pain severity and interference vs. PTSD- individuals (ps < 0.05). These findings indicate that a history of PTSD is prevalent and associated with worse outcomes among individuals seeking treatment for OUD in Vermont. Dissemination of screening measures and targeted interventions may help address the psychiatric and medical needs of rural individuals with OUD and a history of PTSD.
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Affiliation(s)
- Kelly R Peck
- The Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
| | | | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
| | - Stacey C Sigmon
- The Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA.
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Cassiello-Robbins C, Rosenthal MZ, Ammirati RJ. Delivering Transdiagnostic Treatment Over Telehealth During the COVID-19 Pandemic: Application of the Unified Protocol. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:555-572. [PMID: 34108830 PMCID: PMC8177307 DOI: 10.1016/j.cbpra.2021.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/19/2021] [Indexed: 01/23/2023]
Abstract
The COVID-19 pandemic has necessitated an abrupt transition to remote delivery of psychology services at a time when patients and practicing clinicians are experiencing an increase in life stressors (e.g., job loss, social isolation, need to adapt to telehealth practice), which can exacerbate mental health concerns and contribute to clinician burnout. Because the COVID-19 pandemic is affecting diverse individuals in myriad ways, these circumstances can elicit a wide range of emotions and emotional responses. Thus, treatment during this time must be able to address heterogeneous presenting problems while placing minimal burden on clinicians who are adjusting to continuously changing circumstances. Transdiagnostic, emotion-focused, cognitive behavioral treatments (CBT), such as the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), may be particularly well suited to address the challenges faced by practicing psychologists, and their patients, in the current COVID-19 pandemic. This paper discusses the applicability and adaptability of transdiagnostic treatments to telehealth, focusing primarily on the UP in the context of the COVID-19 pandemic. Further, while many CBT skills (e.g., mindfulness) can be easily translated to tele-delivery, other skills, such as exposure, can be more difficult to implement remotely, especially in the midst of a pandemic. Thus, this paper also provides practical suggestions for clinicians with regard to implementing the UP remotely.
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A Preliminary Examination of the Acceptability, Feasibility, and Effectiveness of a Telehealth Cognitive-Behavioral Therapy Group for Social Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Peros OM, Webb L, Fox S, Bernstein A, Hoffman L. Conducting Exposure-Based Groups via Telehealth for Adolescents and Young Adults With Social Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:679-689. [PMID: 34690482 PMCID: PMC8523107 DOI: 10.1016/j.cbpra.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/03/2021] [Indexed: 11/30/2022]
Abstract
The rapid spread of COVID-19 and subsequent social distancing measures posed unprecedented challenges in providing mental health care and a swift transition of services to telehealth platforms. Social distancing measures create unique concerns for young people with social anxiety disorder who already struggle with social connection and isolation; therefore, the continuation of care via telehealth platforms is especially important for this population. To date, there is little literature regarding use of telehealth groups for this population and the current commentary aims to fill in this gap in the literature while also providing general guidelines for telehealth groups. The commentary discusses the delivery of an exposure-based cognitive behavioral therapy group for adolescents and young adults via telehealth and provides considerations, challenges, and benefits of conducting a group through a telehealth platform. In conjunction with clinically relevant examples and in-depth exposure discussions, we aim to provide guidance for youth-focused practitioners who are considering conducting groups in a telehealth format for a range of presentations.
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Affiliation(s)
- Olivia M Peros
- The Columbia University Clinic for Anxiety and Related Disorders and Hofstra University
| | - Lauren Webb
- The Columbia University Clinic for Anxiety and Related Disorders and Hofstra University
| | - Schuyler Fox
- The Columbia University Clinic for Anxiety and Related Disorders
| | - Alyssa Bernstein
- The Columbia University Clinic for Anxiety and Related Disorders
| | - Lauren Hoffman
- The Columbia University Clinic for Anxiety and Related Disorders
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Held P, Klassen BJ, Coleman JA, Thompson K, Rydberg TS, Van Horn R. Delivering Intensive PTSD Treatment Virtually: The Development of a 2-Week Intensive Cognitive Processing Therapy-Based Program in Response to COVID-19. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:543-554. [PMID: 34629839 PMCID: PMC8488183 DOI: 10.1016/j.cbpra.2020.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/18/2020] [Indexed: 11/24/2022]
Abstract
Of the many vulnerable groups affected by the spread of COVID-19, veterans have been especially impacted by the pandemic. Beginning in March 2020, nationwide shelter-in-place orders rapidly led to widespread job loss and economic upheaval; disruption and breakdown of multiple support systems; and increases in family stress, all of which may exacerbate underlying PTSD symptoms. Although telehealth has proven an effective means of delivering evidence-based psychotherapies for PTSD, little is known about the delivery of these treatments in an intensive, daily format over telehealth. There is growing need for intensive treatment options to reduce treatment-interfering barriers such as high dropout rates. In order to address this gap in the literature, this paper details several design considerations as well as patient selection procedures for a 2-week virtual intensive treatment program (vITP) for veterans with posttraumatic stress disorder (PTSD), consisting of daily individual Cognitive Processing Therapy (CPT) and other adjunctive interventions. We also describe two cases of veterans who successfully completed the vITP including their clinical outcomes, therapist reflections on the process, feedback regarding the program, as well as challenges patients encountered with the telehealth platform. Intensive evidence-based psychotherapy for PTSD delivered through a virtual format seems to show promise, but more systemic research is needed.
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Hogue A, Becker SJ, Wenzel K, Henderson CE, Bobek M, Levy S, Fishman M. Family involvement in treatment and recovery for substance use disorders among transition-age youth: Research bedrocks and opportunities. J Subst Abuse Treat 2021; 129:108402. [PMID: 34080559 PMCID: PMC8380649 DOI: 10.1016/j.jsat.2021.108402] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 12/30/2022]
Abstract
This article presents a narrative review and conceptual framework for research on family involvement across the continuum of substance use disorder (SUD) services for transition-age youth (ages 15-26). Though families are powerful resources for enhancing treatment and recovery success among youth with SUDs, they are not routinely included in clinical practice. This article summarizes youth SUD prevalence and service utilization rates and presents developmental and empirical rationale for increasing family involvement in services. It then describes key research issues on family involvement across the SUD services continuum: Problem Identification, Treatment Engagement, Active Treatment, Recovery Support. Within each phase, it highlights bedrock research findings and suggests promising opportunities for advancing the scientific knowledge base on family involvement. The main goals are to endorse family-oriented practices for immediate adoption in routine care and identify areas of research innovation that could significantly enhance the quality of youth SUD services.
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Affiliation(s)
- Aaron Hogue
- Partnership to End Addiction, United States of America.
| | - Sara J Becker
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, United States of America
| | - Kevin Wenzel
- Maryland Treatment Centers, United States of America
| | | | - Molly Bobek
- Partnership to End Addiction, United States of America
| | - Sharon Levy
- Boston Children's Hospital, Harvard Medical School, United States of America
| | - Marc Fishman
- Maryland Treatment Centers, United States of America
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Medenblik AM, Calhoun PS, Maisto SA, Kivlahan DR, Moore SD, Beckham JC, Wilson SM, Blalock DV, Dedert EA. Pilot Cohorts for Development of Concurrent Mobile Treatment for Alcohol and Tobacco Use Disorders. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2021; 15:11782218211030524. [PMID: 34552330 PMCID: PMC8451000 DOI: 10.1177/11782218211030524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
Abstract
Alcohol and tobacco are the 2 most frequently used drugs in the United States and represent the highest co-occurrence of polysubstance use. The objective of this study was to refine an intervention combining mobile contingency management with cognitive-behavioral telephone counseling for concurrent treatment of alcohol and tobacco use disorders. Two cohorts (n = 13 total, n = 5 women) of participants were enrolled, with 10/13 completing treatment and 7/13 completing the 6-month follow-up. At enrollment, participants were drinking a mean of 28.9 drinks per week (SD = 14.1), with a mean of 14.7 heavy drinking days in the past month (SD = 9.9), and a mean of 18.1 cigarettes per day (SD = 11.7). Treatment included a mobile application that participants used to record carbon monoxide and breath alcohol content readings to bioverify abstinence. Participants received up to 4 sessions of phone cognitive-behavioral therapy and monetary reinforcement contingent on abstinence. In cohort 1, 4/6 participants reported abstinent or low-risk drinking post-monitoring. Six weeks post quit-date, 2/6 participants were CO-bioverified abstinent from tobacco use, with 2/6 in dual remission. These results were maintained at 6-months. In cohort 2, 6/7 reported abstinent or low-risk drinking post-monitoring, 5 weeks post quit-date. At the post-monitoring visit, 5/7 were CO-bioverified abstinent from smoking, with 5/7 in dual remission. At 6-months, 3/7 reporting abstinent or low-risk drinking, 1/7 had bioverified abstinence from smoking, with 1/7 in dual remission. Observations suggest that it is possible to develop a concurrent mobile treatment for alcohol and tobacco use disorders.
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Affiliation(s)
- Alyssa M Medenblik
- Psychology Department, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Stephen A Maisto
- Veterans Affairs Center for Integrated Health Care, Syracuse, NY, USA.,Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Daniel R Kivlahan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Scott D Moore
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Sarah M Wilson
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dan V Blalock
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Health Care System, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Eric A Dedert
- Durham Veterans Affairs Health Care System, Durham, NC, USA.,Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Zayde A, Kilbride A, Kucer A, Willis HA, Nikitiades A, Alpert J, Gabbay V. Connection During COVID-19: Pilot Study of a Telehealth Group Parenting Intervention. Am J Psychother 2021; 75:67-74. [PMID: 34525847 PMCID: PMC9490759 DOI: 10.1176/appi.psychotherapy.20210005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has resulted in considerable stress for families, placing parents at risk for heightened psychological distress, while prompting widespread changes in mental health service delivery. This study evaluated treatment engagement, acceptability, and psychiatric distress among participants in the telehealth adaptation of the Connecting and Reflecting Experience (CARE) program after the onset of COVID-19. METHODS CARE is a transdiagnostic, bigenerational, mentalizing-focused group parenting intervention based out of an outpatient child mental health clinic in an underserved urban community. Individuals participating in CARE during the clinic's transition to telehealth services were recruited for participation in this pre-post design pilot study. Participants (N=12) completed self-report surveys before and after their first telehealth group session and at their 20-week follow-up. Quantitative and qualitative measures were used to evaluate psychiatric symptoms, treatment engagement, and preliminary acceptability of the adaptation. RESULTS Self-reported mood and anxiety symptoms decreased significantly after 20 weeks of telehealth therapy. Participants reported high levels of therapeutic alliance and group cohesion in the telehealth format. Results also showed minimal participant-reported privacy concerns and a trend toward increased treatment engagement. CONCLUSIONS These findings have implications regarding the acceptability of teletherapy interventions for caregivers of children during this period of heightened vulnerability and limited access to social support and health services. They also are relevant to establishing the preliminary acceptability of mentalizing-focused parenting inventions delivered via telehealth.
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Affiliation(s)
- Amanda Zayde
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (all authors); Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Gabbay)
| | - Anna Kilbride
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (all authors); Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Gabbay)
| | - Audrey Kucer
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (all authors); Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Gabbay)
| | - Henry A Willis
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (all authors); Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Gabbay)
| | - Adella Nikitiades
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (all authors); Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Gabbay)
| | - Jonathan Alpert
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (all authors); Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Gabbay)
| | - Vilma Gabbay
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center, New York City (all authors); Division of Clinical Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York (Gabbay)
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Pi HJ, Kallapiran K, Munivenkatappa S, Kandasamy P, Kirubakaran R, Russell P, Eapen V. Meta-Analysis of RCTs of Technology-Assisted Parent-Mediated Interventions for Children with ASD. J Autism Dev Disord 2021; 52:3325-3343. [PMID: 34318434 DOI: 10.1007/s10803-021-05206-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 12/27/2022]
Abstract
Technology-assisted parent-mediated interventions improve accessibility and are acceptable but not proven to be effective. We conducted a systematic search of 6 databases. We included and analysed results from studies on social and communication outcomes. Sixteen Randomised-Controlled-Trials (RCTs) with 748 participants were included. Most studies were rated as of good quality. Meta-analysis suggested that interventions were probably effective in improving emotion recognition. No significant differences were found in social communication, social functioning or language outcomes. At present, isolated tech interventions do not fulfil criteria for promising or established evidence-based interventions for ASD. Future research needs to focus on improving the effectiveness of technology-assisted parent-mediated interventions for ASD. Prospero Registration Number: CRD42020162825.
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Affiliation(s)
- Hong Ji Pi
- Darling Downs Health Service, The Toowoomba Hospital, Toowoomba, QLD, Australia
| | - Kannan Kallapiran
- Gold Coast Health Service, Gold Coast, QLD, Australia. .,Southport Health Precinct, 16-30 High Street, Gold Coast, QLD, 4215, Australia.
| | | | | | - Richard Kirubakaran
- Prof BV Moses Center for Evidence-Informed Health Care and Health Policy, Vellore, India
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Gullslett MK, Kristiansen E, Nilsen ER. Therapists' Experience of Video Consultation in Specialized Mental Health Services During the COVID-19 Pandemic: Qualitative Interview Study. JMIR Hum Factors 2021; 8:e23150. [PMID: 34096505 PMCID: PMC8284340 DOI: 10.2196/23150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/27/2020] [Accepted: 06/06/2021] [Indexed: 01/20/2023] Open
Abstract
Background As part of political and professional development with increased focus on including service users within mental health services, these services are being transformed. Specifically, they are shifting from institutional to noninstitutional care provision with increased integration of the use of electronic health and digitalization. In the period from March to May 2020, COVID-19 restrictions forced rapid changes in the organization and provision of mental health services through the increased use of digital solutions in therapy. Objective The aim of this study was to develop and advance comprehensive knowledge about how therapists experience the use of video consultation (VC). To reach this objective, we evaluated therapists’ experiences of using VC in specialized mental health services in the early phase of COVID-19 restrictions. The following questions were explored through interviews: Which opportunities and challenges appeared when using VC during the period of COVID-19 restrictions? In a short-term care pathway, for whom does VC work and for whom does it not work? Methods This study employed a qualitative approach based on an abductive strategy and hermeneutic-phenomenological methodology. Therapists and managers in mental health departments in a hospital were interviewed via Skype for Business from March to May 2020, using a thematic interview guide that aimed to encourage reflections on the use of VC during COVID-19 restrictions. Results Therapists included in this study experienced advantages in using VC under circumstances that did not permit face-to-face consultations. The continuity that VC offered the service users was seen as a valuable asset. Various negative aspects concerning the therapeutic environment such as lack of safety for the most vulnerable service users and topics deemed unsuitable for VC lowered the therapists’ overall impression of the service. The themes that arose in the data analysis have been categorized in the following main topics: (1) VC—“it’s better than nothing”; (2) VC affects therapists’ work situation—opportunities and challenges in working conditions; and (3) challenges of VC when performing professional assessment and therapy on the screen. Conclusions Experiences with VC in a mental health hospital during COVID-19 restrictions indicate that there are overall advantages to using VC when circumstances do not permit face-to-face consultations. Nevertheless, various negative aspects in the use of VC lowered the therapists’ overall impression of VC. Further qualitative research is needed, and future studies should focus on service users’ experiences, cocreation between different stakeholders, and how to scale up the use of VC while ensuring that the service provided is appropriate, safe, and available.
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Affiliation(s)
- Monika K Gullslett
- Norwegian Center for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Eli Kristiansen
- Norwegian Center for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Etty R Nilsen
- School of Business and Economics, University of Tromsø (UiT), Alta, Norway
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Zimmerman M, Benjamin I, Tirpak JW, D'Avanzato C. Patient satisfaction with partial hospital telehealth treatment during the COVID-19 pandemic: Comparison to in-person treatment. Psychiatry Res 2021; 301:113966. [PMID: 33990071 PMCID: PMC8074532 DOI: 10.1016/j.psychres.2021.113966] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/21/2021] [Indexed: 12/04/2022]
Abstract
Most research evaluating telehealth psychiatric treatment has been conducted in outpatient settings. There is a lack of research assessing the efficacy of telehealth treatment in more acute, intensive treatment settings such as a partial hospital. In the face of the COVID-19 pandemic, much of ambulatory behavioral health treatment has transitioned to a telehealth, or virtual, format. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared patient satisfaction of partial hospital services delivered via telehealth to in-person treatment provided to patients treated prior to the COVID-19 outbreak. The sample included 240 patients who were treated virtually from May, 2020 to October, 2020, and a comparison group of 240 patients who were treated in the in-person partial program a year earlier. Patients completed self-administered measures of patient satisfaction after the initial evaluation and at the end of treatment. For both the in-person and telehealth methods of delivering partial hospital level of care, patients were highly satisfied with the initial diagnostic evaluation and were optimistic at admission that treatment would be helpful. At the completion of treatment, both groups were highly satisfied with all components of the treatment program and almost all would recommend treatment to a friend or family member. Thus, patient satisfaction was as high with telehealth partial hospital treatment as with in-person treatment.
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Affiliation(s)
- Mark Zimmerman
- From the Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, 146 West River Street, Providence, RI 02904.
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43
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Jones M, Howe AJ. Taking the therapeutic community outside in the COVID-19 pandemic. THERAPEUTIC COMMUNITIES 2021. [DOI: 10.1108/tc-12-2020-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The COVID-19 pandemic has affected psychotherapy practice. A common change is a move to online sessions over video calls. In their therapeutic community (TC) for those with personality disorders, the authors have used video calls but not all clients could work in this way. The authors decided to meet patients outside and walked with them while adhering to government guidelines. This study aims to present the authors’ experience with one client who was interviewed afterwards about the experience.
Design/methodology/approach
A total of 10 walking therapy sessions of 60-min duration were conducted with the patient. After the sessions, both the patient and therapist were interviewed about their experience. The resulting interviews with both patient and therapist were thematically analysed independently by both authors.
Findings
There were common themes to both the client and therapist’s account following thematic analysis. These were: modelling and normalising in the real world, replacing what COVID-19 had taken away from the TC experience, changes at home, therapist disclosure, outcomes and good endings and being outside of the clinical environment.
Research limitations/implications
The authors have presented a single case of the patient and therapist experience of outdoor therapy sessions in a TC context response to the COVID-19 pandemic. The findings are not generalisable and can only provide a suggestion at the positive potential for working in this way. The authors hope that the positive effects of outdoor therapy noted here may inspire other clinicians to consider similar novel approaches in their work.
Originality/value
This study describes a novel way that a TC has adapted to the COVID-19 pandemic.
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Harper LM. Telehealth Approaches to Improve Opioid Use Care in Pregnancy. Clin Obstet Gynecol 2021; 64:352-365. [PMID: 33882519 DOI: 10.1097/grf.0000000000000607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although pharmacotherapy is the mainstay of treatment for opioid use disorder, the US faces a shortage of qualified pharmacotherapy providers, even in high-need areas. Telemedicine is a promising method of increasing the availability of opioid use disorder treatments, but several barriers must first be addressed before implementation. This article presents a case study of using telemedicine to provide pharmacotherapy in pregnancy, examines the barriers to providing pharmacotherapy via telemedicine, and proposes solutions to overcome these barriers.
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Affiliation(s)
- Lorie M Harper
- Department of Women's Health, University of Texas at Austin, Dell Medical School, Austin, Texas
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45
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Little J, Schmeltz A, Cooper M, Waldrop T, Yarvis JS, Pruitt L, Dondanville K. Preserving Continuity of Behavioral Health Clinical Care to Patients Using Mobile Devices. Mil Med 2021; 186:137-141. [PMID: 33499516 DOI: 10.1093/milmed/usaa281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/17/2020] [Accepted: 08/19/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The current model for treating behavioral health patients requires that providers and patients be in the same location for appointments. However, deploying warfighters present a challenge to this current model. Recent advances in technology make telehealth or virtual visits a viable option to replace the current model. This project leveraged mobile technology to see if performing tele-behavioral health visits presented a viable option to the current in-person model for future deployed warfighters. At the time of this publication, the authors note the current pandemic lends all the more urgency to the need for enhancing our video communication platforms for remote monitoring with the Military Health System. MATERIALS AND METHODS The research team assessed existing Internet protocol-based desktop teleconferencing solutions, generically known as a Web Real-Time Communications (WebRTC) system, for establishing a secure connection to a Service Members personal mobile device outside of the Department of Defense (DoD) network. Of the five existing WebRTC systems evaluated, only the backbone component to the existing Defense Information Systems Agency Global Video Services (DISA GVS) known as Vidyo, was suitable to meet DoD security requirements and still connect with both major operating systems (OS) on mobile devices. An existing DoD program of record mobile application, mCare, was integrated with Vidyo desktop technologies to form what the research team called "Mobile Connect." RESULTS Deployment of the Mobile Connect product yielded distinct differences and high levels or variability between the .osd.mil and the army.mil network connections over time. These network differences impacted quality of service solution where Mobile Connect could not be used to provide care between the .mil and patient's personal mobile devices from a osd.mil domain connection. The current DoD WebRTC systems offer potential solutions but presently cannot connect with personal mobile devices in their current configurations. Additionally, any WebRTC system used by the DoD for future connections to personal mobile device must leverage commercial Single Socket Layer certificates (e.g., not DoD issued), or the communications with the mobile device will fail as a result of an authentication error. CONCLUSION It is technically feasible to provide desktop Video Tele-Conference capabilities from a .mil computer to a personal mobile device without compromising DoD security and information assurance requirements using future WebRTC systems. Approved ports, protocols, and system settings must be configured to accept both inbound and outbound, encrypted traffic to/from personal mobile devices to maintain consistent quality of service with all DoD networks. Of the current DoD WebRTC options, working with the DISA GVS Program Manager to expand services to support commercial mobile devices has the highest probability of future success.
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Affiliation(s)
- Jeanette Little
- Telemedicine and Advanced Technology Research Center, Mobile Health Innovation Center, Fort Gordon, GA 10905, USA
| | - Amanda Schmeltz
- Telemedicine and Advanced Technology Research Center, Mobile Health Innovation Center, Fort Gordon, GA 10905, USA
| | - Mabel Cooper
- Telemedicine and Advanced Technology Research Center, Mobile Health Innovation Center, Fort Gordon, GA 10905, USA
| | - Tabitha Waldrop
- Telemedicine and Advanced Technology Research Center, Mobile Health Innovation Center, Fort Gordon, GA 10905, USA
| | - Jeffrey S Yarvis
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.,9th Hospital Center, Fort Hood, TX 76544, USA
| | - Larry Pruitt
- Puget Sound Health Care System, U.S. Department of Veteran Affairs, Seattle, WA 98108, USA
| | - Katy Dondanville
- University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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Fernandez E, Woldgabreal Y, Day A, Pham T, Gleich B, Aboujaoude E. Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clin Psychol Psychother 2021; 28:1535-1549. [PMID: 33826190 DOI: 10.1002/cpp.2594] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/14/2022]
Abstract
In-person psychotherapy (IPP) has a long and storied past, but technology advances have ushered in a new era of video-delivered psychotherapy (VDP). In this meta-analysis, pre-post changes within VDP were evaluated as were outcome differences between VDP versus IPP or other comparison groups. A literature search identified k = 56 within-group studies (N = 1681 participants) and 47 between-group studies (N = 3564). The pre-post effect size of VDP was large and highly significant, g = +0.99 95% CI [0.67-0.31]. VDP was significantly better in outcome than wait list controls (g = 0.77) but negligible in difference from IPP. Within-groups heterogeneity of effect sizes was reduced after subgrouping studies by treatment target, of which anxiety, depression, and posttraumatic stress disorder (PTSD) (each with k > 5) had effect sizes nearing 1.00. Disaggregating within-groups studies by therapy type, the effect size was 1.34 for CBT and 0.66 for non-CBT. Adjusted for possible publication bias, the overall effect size of VDP within groups was g = 0.54. In conclusion, substantial and significant improvement occurs from pre- to post-phases of VDP, this in turn differing negligibly from IPP treatment outcome. The VDP improvement is most pronounced when CBT is used, and when anxiety, depression, or PTSD are targeted, and it remains strong though attenuated by publication bias. Clinically, therapy is no less efficacious when delivered via videoconferencing than in-person, with efficacy being most pronounced in CBT for affective disorders. Live psychotherapy by video emerges not only as a popular and convenient choice but also one that is now upheld by meta-analytic evidence.
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Affiliation(s)
- Ephrem Fernandez
- Department of Psychology, University of Texas at San Antonio, USA
| | | | - Andrew Day
- School of Social & Political Sciences, University of Melbourne, Melbourne, Australia
| | - Tuan Pham
- Department of Psychology, University of Texas at San Antonio, USA
| | - Bianca Gleich
- Department of Psychology, University of Texas at San Antonio, USA
| | - Elias Aboujaoude
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, USA
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Heiden-Rootes K, Ferber M, Meyer D, Zubatsky M, Wittenborn A. Relational teletherapy experiences of couple and family therapy trainees: "Reading the room," exhaustion, and the comforts of home. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:342-358. [PMID: 33449401 DOI: 10.1111/jmft.12486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/09/2020] [Accepted: 12/22/2020] [Indexed: 06/12/2023]
Abstract
Couple and family therapists are increasingly using telehealth platforms to deliver services. Unfortunately, the literature on relational teletherapy is not well developed. This study sought to understand experiences of teletherapy with couples and families as it contrasts with individual clients and in-person therapy. We utilized a hermeneutic phenomenological approach to qualitative inquiry from data collected through open-ended questions on a web-based survey of graduate student trainees (n = 66) in COAMFTE-accredited couple and family therapy programs. Thematic analysis identified the body-of-the-therapist and client as they exist (and are obstructed) due to technology for creating barriers and opportunities in translating CFT intervention to telehealth platforms. Relational teletherapy cultivated therapist creativity and exhaustion. It also made plain the need for systemic interventions with children and adolescents that engages their parents and home environments. Implications for CFT practice, training, and intervention research are outlined.
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Affiliation(s)
- Katie Heiden-Rootes
- Medical Family Therapy Program, Department of Family & Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Megan Ferber
- Medical Family Therapy Program, Department of Family & Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Dixie Meyer
- Medical Family Therapy Program, Department of Family & Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Max Zubatsky
- Medical Family Therapy Program, Department of Family & Community Medicine, Saint Louis University, St. Louis, Missouri, USA
| | - Andrea Wittenborn
- Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
- Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, Michigan, USA
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Hogue A, Bobek M, Levy S, Henderson CE, Fishman M, Becker SJ, Dauber S, Porter N, Wenzel K. Conceptual framework for telehealth strategies to increase family involvement in treatment and recovery for youth opioid use disorder. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:501-514. [PMID: 33760249 PMCID: PMC9830952 DOI: 10.1111/jmft.12499] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 01/29/2021] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
With opioid use at crisis levels, it is imperative to support youth ages with opioid use disorders (OUD) in taking medication and accessing behavioral services over long periods. This article presents a conceptual framework for telehealth strategies that can be adopted to increase family involvement across a four-stage continuum of youth OUD treatment and recovery: Treatment Preparation, Treatment Initiation, Treatment Stabilization, OUD Recovery. It first identifies provider-delivered tele-interventions that can enhance OUD services in each of the four stages, including family outreach, family engagement, family-focused intervention, and family-focused recovery maintenance. It then introduces several types of direct-to-family tele-supports that can be used to supplement provider-delivered interventions. These include both synchronous tele-supports (remote interactions that occur in real time) such as helplines, peer-to-peer coaching, and online support groups; and asynchronous tele-supports (communications that occur without participants being simultaneously present) such as automated text messaging, self-directed internet-based courses, and digital web support.
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Affiliation(s)
- Aaron Hogue
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Molly Bobek
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Craig E. Henderson
- Department of Psychology, Sam Houston, State University, Huntsville, TX, USA
| | | | - Sara J. Becker
- Center for Alcohol and Addictions, Studies, Brown University School of Public, Health, Providence, RI, USA
| | - Sarah Dauber
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
| | - Nicole Porter
- Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, New York, NY, USA
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Reifegerste D, Harst L, Otto L. Sauerbruch, STARPAHC, and SARS: Historical Perspectives on Readiness and Barriers in Telemedicine. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2021; 30:11-20. [PMID: 33777654 PMCID: PMC7987372 DOI: 10.1007/s10389-021-01513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/09/2021] [Indexed: 08/30/2023]
Abstract
Aim Telemedicine is a promising solution to extend traditional health care services. Even though mainly discussed during the past two decades, its roots go back into the past century and even further, considering the use of bonfires to warn other villages of diseases. Insights from historical cases can therefore be useful for the ongoing discussion regarding the successful implementation of telemedicine. Subject and Methods We analyzed three historical telemedicine cases (varying regarding time and place) and extracted their success factors and barriers as well as assessed their maturity by using the Telemedicine Community Readiness Model (TCRM). Evidence-based categories of success factors and barriers as well as the TCRM’s dimensions were used as deductive categories to analyze the study material’s content. Results The analysis showed that the readiness for telemedicine is higher when the technology is the only option to access health care services. In all three cases, core readiness played a central role. However, the health sector, existing technology, and finance were barriers present at all times, while during pandemics, some barriers are only temporarily removed, for example, by putting legal issues on hold. The analyzed cases were all on lower levels of maturity as they mainly represent pilot tests or exceptional circumstances. Conclusion Results indicate the important core functions in telemedicine initiatives as well as the diversity of their circumstances. Insights from such historical meta-perspectives can, for example, help to strengthen the sustainability of the increased use of telemedicine during the COVID-19 pandemic and scale up current telemedicine projects.
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Affiliation(s)
- Doreen Reifegerste
- School of Public Health, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - Lorenz Harst
- Technische Universität Dresden, Dresden, Germany
| | - Lena Otto
- Technische Universität Dresden, Dresden, Germany
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Sklar M, Reeder K, Carandang K, Ehrhart MG, Aarons GA. An observational study of the impact of COVID-19 and the rapid implementation of telehealth on community mental health center providers. Implement Sci Commun 2021; 2:29. [PMID: 33706815 PMCID: PMC7948664 DOI: 10.1186/s43058-021-00123-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/01/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has remarkably altered community mental health service delivery through the rapid implementation of telehealth. This study reports provider perspectives on the impact that COVID-19 and the transition to telehealth had on their work and their ability to deliver evidence-based practices (EBPs). METHODS Providers (n = 93) completed online surveys with quantitative measures and open-ended items exploring their reactions to COVID-19 and to the transition to providing services via telehealth. RESULTS Perceptions of personal risk and rumination around COVID-19 were low, while telehealth was viewed positively by providers. Three major themes emerged regarding the major impacts of COVID-19 on work: (1) the altered nature of interactions between patient/client and provider due to telehealth implementation, (2) changes in provider expectations regarding productivity, and (3) challenges maintaining work-life balance. In regard to the major impacts of COVID-19 on EBP delivery, three themes emerged: (1) increased difficulty delivering certain therapies via telehealth, (2) potential limitations to session confidentiality, and (3) challenge of engaging children in telehealth. CONCLUSIONS In the context of the COVID-19 pandemic, community mental health providers continued to engage with clients and deliver EBPs while navigating a number of changes related to the rapid transition to and implementation of telehealth. This study highlights the need for further work on what supports providers need to effectively engage with clients and deliver EBPs via telehealth, and has implications for how telehealth is sustained or de-implemented post-COVID-19.
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Affiliation(s)
- Marisa Sklar
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- UC San Diego Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, San Diego, USA
| | - Kendal Reeder
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- University of California Los Angeles Department of Psychology, Psychology Building 1285, Box 951563, Los Angeles, CA 90095-1563 USA
| | - Kristine Carandang
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
| | - Mark G. Ehrhart
- University of Central Florida Department of Psychology, P.O. Box 161390, Orlando, FL 32816-1390 USA
| | - Gregory A. Aarons
- University of California San Diego Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
- UC San Diego Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, San Diego, USA
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