Telepsychotherapy With Children and Families: Lessons Gleaned From Two Decades of Translational Research

The needs of families caring for patients with traumatic brain injury: a scoping review

PURPOSE

This scoping review was conducted to synthesize existing literature into a map of the common needs of families caring for patients with traumatic brain injury (TBI) at home.

MATERIALS AND METHODS

A systematic search of studies published between January 2012 and December 2022 was conducted across databases. The selected studies reported the needs or unmet needs of patients with TBI and/or their family caregivers (FCs).

RESULTS

A total of 12 publications were identified. The results suggest that the common needs of families caring for patients with TBI at home include: information about TBI as a disease; information about the continuum of TBI healthcare services; information about adaptive technologies; education and skilling of FCs; psychological support and counseling; physical and occupational therapy services; follow-up care and transitional care management; respite care; peer support; financial assistance, advocacy, and legal services; emotional support from the family and community; and assistance with physical patient care and instrumental activities of daily living.

CONCLUSION

The mapped needs provide insight into supportive interventions required to enhance the health outcomes of patients with TBI and their families during and after rehabilitation. The needs also highlight directions for research and healthcare services for patients with TBI.

Explaining the Parenting Styles of Epileptic Children: A Content Analysis

Objectives

Understanding the parenting practices of parents of children with epilepsy can be a practical guide for care and education planners to prevent mental disorders in these children. This study aimed to explain the parenting practices of parents of children with epilepsy in Shahrekord.

Materials & Methods

This study is a qualitative study with conventional content analysis. Participants in the study consisted of 20 mothers with epileptic children in Shahrekord, who were included in the study by purposive sampling method with maximum variance in terms of child age, number of family children, and child sex. The data collection method was a semi-structured interview using the interview guide. Data analysis was performed using a conventional content analysis at the same time as data collection. Interviews continued until data saturation was reached.

Results

The present study revealed five main themes in discipline methods, including over-support / over-protection, forcing to support, rejecting, parental conflict in discipline methods, and using harmful discipline methods.

Conclusion

In conclusion, the experiences of mothers in the present study show that using inappropriate discipline methods can have adverse effects on the mental-emotional and social health of the child in the future and raise the need to design educational interventions to empower parents of epileptic children in coping with parenting stress effectively.

Online therapy with families - what can families tell us about how to do this well? A qualitative study assessing families' experience of remote Dyadic Developmental Psychotherapy compared to face-to-face therapy

Dyadic Developmental Psychotherapy (DDP) is a family-based therapy for adopted children aiming to achieve secure attachment between the child and parent. Due to restrictions under the COVID-19 pandemic, delivery of DDP transitioned from face-to-face to online methods. This study aimed to explore families experience of online DDP compared to face-to-face DDP, looking at the advantages and disadvantages of remote delivery methods and the implications this has on future service delivery for clinicians. Semi-structured interviews with 6 families were conducted online. Analysis of transcripts using Interpretative Phenomenological Analysis (IPA) revealed four superordinate themes: environment and child engagement, non-verbal communication, travel and familiarity with remote interactions. Parents recognised the influence the physical and online environment had on their child's engagement levels, however, varied in their experience and hence preference of delivery method. All families emphasised the importance of non-verbal communication within DDP sessions and majority highlighted this may be lost online. For families who travelled to face-to-face DDP, car journeys provided a unique opportunity to decompress and reflect after sessions. For families where travel is unfeasible, online DDP was a lifeline, demonstrating the ability of remote therapy to widen access to specialist healthcare. Familiarity with online work emerged as a strong indicator of positive attitudes towards remote DDP, especially if the previous experience is positive and the child is confident using technology. Overall, families differed greatly in their experience of remote and face-to-face DDP indicating a new approach must be undertaken with each family beginning therapy, ensuring it is unique and individual to their needs.

'Family first' - feasibility and pilot outcomes of a community intervention for families of children in recovery following brain injury

PURPOSE

Feasibility and pilot outcomes of a new community-based program for families of children with acquired brain injury (ABI) are presented. Interventions, delivered by home-visiting and teletherapy, were underpinned by problem-solving therapy, narrative meaning making, goal-directed interventions and community system psychoeducation.

METHODS

Eighty-three families of children, who had sustained an ABI before 12 years of age, had an average of 13 sessions of the 'Family First' (FF) intervention. A mixed-methods prospective design was employed. Feasibility was evaluated through measures of accessibility and acceptability. Goal attainment scaling and pre-post changes on standardized questionnaires assessed changes in psychosocial adjustment and quality of life.

RESULTS

Feasibility analyses suggested engagement and retention of often hard to reach families and children with high psychosocial needs. Qualitative analyses suggested themes related to the accessibility of a unique service ('Nothing else like this out there' and 'Accessible and flexible') which facilitated 'Empowerment' within a family context ('A family affair'). Promising changes on standardized scales of behavior problems, competencies and child and family quality of life were discerned. Increased goal attainment scores were observed.

CONCLUSION

The FF program showed feasibility and promise. It impacted positively on the lives of children and families and improved capacity in supporting systems.

Group-based parent training programme for children with neurological conditions: a feasibility study

OBJECTIVE AND DESIGN

This study aimed to determine the feasibility and effectiveness of a parent training programme for parents of children with neurological conditions and behaviours that challenge.

SETTING

Child and adolescent mental health service within a specialist children's hospital.

PARTICIPANTS

Parents of 31 children with neurological conditions and behaviours that challenge.

INTERVENTIONS

Parents attended a 6-week evidence-based behavioural parenting programme delivered in a group format, either face-to-face or remote.

MAIN OUTCOME MEASURES

Feasibility was determined by attendance rates. Effectiveness was analysed primarily using parent-reported measures of child behaviour (Strengths and Difficulties Questionnaire, Paediatric Quality of Life and Goal-Based Outcomes). Secondary measures of parental well-being were also reported (Brief Parental Self-Efficacy Scale, Depression Anxiety Stress Scale Short Form and Parental Sense of Competence). Paired t-tests or Wilcoxon rank-sum tests were conducted to analyse differences preintervention and postintervention.

RESULTS

The attendance rates for the face-to-face and remote groups were 80% and 79%, respectively. Medium to large effect sizes were reported for most measures of child behaviour and parental well-being. There were statistically significant improvements found postintervention in children's behaviour (p=0.014), quality of life (p<0.001), goal-based outcomes (p<0.001), parental self-efficacy (p<0.001) and parental anxiety (p=0.030). Anecdotal feedback showed that parents indicated the group format was acceptable.

CONCLUSIONS

The group parenting intervention for parents of children with heterogeneous neurological conditions and behaviours that challenge appears feasible and effective in improving child behaviour and parental well-being.

Emotional and social functioning after stroke in childhood: a systematic review

PURPOSE

To provide an overview of the effects of pediatric stroke on emotional and social functioning in childhood.

METHODS

A literature review was completed in accordance with the Preferred Reporting Items for Systematic Reviews. A systematic search of studies on internalizing problems and social functioning after pediatric stroke in PsycInfo, PsycArticles, and PubMed databases was conducted from inception to November 2021. A total of 583 studies were identified, and 32 met the inclusion criteria.

RESULTS

The review suggests that children after stroke are at risk of developing internalizing problems and a wide range of social difficulties. Internalizing problems are often associated with environmental factors such as family functioning and parents' mental health. In addition, a higher risk of developing psychosocial problems is associated with lower cognitive functioning and severe neurological impairment.

CONCLUSIONS

The assessment of psychological well-being and social functioning after pediatric stroke is helpful to provide adequate support to children and their families. Future studies are needed to better investigate these domains and to develop adequate methodologies for specific interventions.Implication for rehabilitationThis paper reviews research concerning emotional and social functioning following pediatric stroke in order to provide helpful information to clinicians and families and to improve rehabilitation pathways.Emotional and social functioning should be addressed during post-stroke evaluation and follow-up, even when physical and cognitive recovery is progressing well.Care in pediatric stroke should include volitional treatment and address emotional and social issues.

Traumatic Brain Injury Positive Strategies for Families: A Pilot Randomized Controlled Trial of an Online Parent-Training Program

OBJECTIVE

To determine program satisfaction and preliminary efficacy of Traumatic Brain Injury Positive Strategies (TIPS), a web-based training for parenting strategies after child brain injury.

DESIGN

A randomized controlled trial with parallel assignment to TIPS intervention or usual-care control (TAU). The three testing time-points were pretest, posttest within 30 days of assignment, and 3-month follow-up. Reported in accordance with CONSORT extensions to randomized feasibility and pilot trials SETTING: Online.

PARTICIPANTS

Eighty-three volunteers recruited nationally who were 18 years of age or older, U.S. residents, English speaking and reading, had access to high-speed internet, and were living with and caring for a child who was hospitalized overnight with a brain injury (ages 3-18 years, able to follow simple commands; N=83).

INTERVENTIONS

Eight interactive behavioral training modules on parent strategies. The usual-care control was an informational website.

MAIN OUTCOME MEASURES

The proximal outcomes were User Satisfaction, Usefulness, Usability, Feature Preference, Strategy Utilization and Effectiveness, and Learning and Self-Efficacy for TIPS program participants. The primary outcomes were: Strategy Knowledge, Application, and Strategy-Application Confidence; Family Impact Module of Pediatric Quality of Life Inventory (PedsQL); and Caregiver Self-Efficacy Scale. The secondary outcomes were TIPS vs TCore PedsQL and Health Behavior Inventory (HBI) RESULTS: Pre- and posttest assessments were completed by 76 of 83 caregivers; 74 completed their 3-month follow-up. Linear growth models indicated that relative to TAU, TIPS yielded greater increases in Strategy Knowledge over the 3-month study (d=.61). Other comparisons did not reach significance. Outcomes were not moderated by child age, SES, or disability severity measured by Cognitive Function Module of PedsQL. All TIPS participants were satisfied with the program.

CONCLUSIONS

Of the 10 outcomes tested, only TBI knowledge significantly improved relative to TAU.

Child therapists' views and experiences of video conference psychotherapy with children

Although important research on remote psychotherapies was conducted for many years, the COVID-19 pandemic has accelerated the spread of remote therapies. However, studies focusing on children and the family population are still quite new. Exploration of therapists' views and experiences of using online psychotherapy interventions is of importance. In addition to these, confusion caused by referring to remote therapies with different names and using them for different purposes and forms makes it difficult to know which evidence is available for tools and forms. Therefore, this study aims to investigate psychotherapists' views and experiences of video conferencing psychotherapy (VCP) for children using a qualitative description method. In line with this purpose, semi-structured individual interviews were conducted with seven female specialists who conducted VCP with children in different cities in Turkey. Data collected from the interviews were analyzed using an inductive content analysis approach. Analysis results indicated two themes and ten sub-themes that described benefits, new opportunities as well as limitations and difficulties of VCP provided to children. Results showed that VCP enhanced accessibility for both therapists and children and their families, enabled comfort and flexibility, and was economic. Besides, such psychotherapy was found to increase fathers' participation in psychotherapy. On the other hand, difficulties are experienced in therapeutic relationships in the VCP process; the child's characteristics affected the applicability of the psychotherapy; maintaining focus became difficult; lack of materials and toys affected psychotherapy applications; children's connecting to psychotherapy from home caused privacy issues; and technological problems affected communication and sustainability.

Internet-based parenting intervention: A systematic review

Digital technology has become an essential part of people's lives, and the Internet's innovation made it easier for humans to carry out activities. This systematic review aims to examine parenting with a specific internet-based intervention designed to help them gain information about child-rearing. Specifically, it analyses: 1) how the internet-based parenting intervention is studied, 2) how was the study of an internet-based parenting intervention done, and 3) what themes emerged from the systematic review. The finding suggests that most internet-based parenting interventions use transmitting information techniques visually, as the content is displayed through exciting and informative content. Four themes emerged from the thematic analysis: technology-assisted parenting programs, parenting interventions as support for mothers, professional support online, and improved parenting skills. Positive responses from parents as users show that this online parenting intervention can meet their needs and has the potential to continue to be developed. The literature is quite limited regarding assessing internet-based parenting intervention in early childhood education and developmental psychology. Because of that, further research to develop internet-based parenting interventions becomes essential to give parenting professional support.

Telehealth services for cardiac neurodevelopmental care during the COVID-19 pandemic: a site survey from the Cardiac Neurodevelopmental Outcome Collaborative

OBJECTIVE

COVID-19 has markedly impacted the provision of neurodevelopmental care. In response, the Cardiac Neurodevelopmental Outcome Collaborative established a Task Force to assess the telehealth practices of cardiac neurodevelopmental programmes during COVID-19, including adaptation of services, test protocols and interventions, and perceived obstacles, disparities, successes, and training needs.

STUDY DESIGN

A 47-item online survey was sent to 42 Cardiac Neurodevelopmental Outcome Collaborative member sites across North America within a 3-week timeframe (22 July to 11 August 2020) to collect cross-sectional data on practices.

RESULTS

Of the 30 participating sites (71.4% response rate), all were providing at least some clinical services at the time of the survey and 24 sites (80%) reported using telehealth. All but one of these sites were offering new telehealth services in response to COVID-19, with the most striking change being the capacity to offer new intervention services for children and their caregivers. Only a third of sites were able to carry out standardised, performance-based, neurodevelopmental testing with children and adolescents using telehealth, and none had completed comparable testing with infants and toddlers. Barriers associated with language, child ability, and access to technology were identified as contributing to disparities in telehealth access.

CONCLUSIONS

Telehealth has enabled continuation of at least some cardiac neurodevelopmental services during COVID-19, despite the challenges experienced by providers, children, families, and health systems. The Cardiac Neurodevelopmental Outcome Collaborative provides a unique platform for sharing challenges and successes across sites, as we continue to shape an evidence-based, efficient, and consistent approach to the care of individuals with CHD.

Transitioning to Telehealth Services in a Pediatric Diabetes Clinic During COVID-19: An Interdisciplinary Quality Improvement Initiative

COVID-19 necessitated a rapid shift to telehealth for psychologists offering consultation-liaison services in pediatric medical settings. However, little is known about how psychologists providing these services adapted to using telehealth service delivery formats. This report details how our interdisciplinary team identified declining psychosocial screener completion and psychology consultation rates as primary challenges following a shift to telehealth within a pediatric diabetes clinic. We utilized the Plan-Do-Study-Act (PDSA) quality improvement framework to improve screening and consultation rates, which initially declined during the telehealth transition. Screening and consultation rates dropped initially, but recovered to nearly pre-pandemic levels following three PDSA intervention cycles. During implementation, challenges arose related to the feasibility of patient interactions, interdisciplinary collaboration, patient engagement, and ethical issues. Clinics shifting psychology consultation-liaison services to telehealth should prioritize interdisciplinary communication, elicit perspectives from all clinic professionals, leverage the electronic health record, and develop procedures for warm handoffs and navigating ethical issues.

Dyadic associations between COVID-19-related stress and mental well-being among parents and children in Hong Kong: An actor-partner interdependence model approach

The spread of COVID-19 and its subsequent social distancing policies have profoundly impacted the lives of parents and children. Prolonged exposure to parenting-related responsibilities and heightened levels of family conflict under stay-at-home orders coupled with reduced access to support systems and resources have rendered parents and children more prone to stress and mental health difficulties. Drawing on a transactional model of parent-child interactions, the present study applied an actor-partner interdependence model approach to examine the transactional relationship between COVID-19-related stress and mental well-being among parents and children. Data from 109 Chinese parent-child dyads in Hong Kong were included in the study. Parents and their 8- to 10-year-old children completed a questionnaire on COVID-19-related stress, parent-child relationships, and mental well-being. The results showed that 53.2% and 30.3% of the parents and children, respectively, showed poor mental well-being, indicating possible emotional problems. Both actor and partner effects of parent COVID-19-related stress were found. Parent COVID-19-related stress was indirectly related to lower levels of parent and child mental well-being, through the mediation of parent-child conflict. To facilitate psychological adjustment following the COVID-19 outbreak, effective family-based mental health and parenting interventions are needed to promote family cohesion and alleviate stress-induced psychological symptoms. Even in the time of social distancing, telepsychotherapy and other online non-psychotherapeutic interventions can serve as a valid alternative for parents and children who experience excessive distress. Implications for psychological services, family-friendly policies, and social protection measures are also discussed.

Pandemic Perils and Promise: Implementation of a Virtual Parenting Intervention during COVID-19 among Children with Early Neurological Conditions

OBJECTIVE

In this study, we examined feasibility, acceptability, and preliminary efficacy of a telepsychological positive parenting intervention (I-InTERACT-North, Internet-basedInteracting Together Everyday: Recovery After Childhood Traumatic Brain Injury) during the COVID-19 pandemic among Canadian families of children at-risk for neurodevelopmental challenges given congenital or neonatal conditions. I-InTERACT-North was developed to improve behavioral and emotional outcomes in children with neurological conditions by utilizing and adapting parenting strategies from several established family-focused programmes.

METHODS

A pragmatic prospective pre-post single-site pilot study design was used to assess feasibility, acceptabilty, and preliminary efficacy of I-InTERACT North during the COVID-19 pandemic.

RESULTS

Thirty-five families of children ages three to nine years were referred between March 2020 and January 2021. Eighteen families enrolled, and 12 (67% adherence) completed the programme. Parents reported strong therapeutic alliance and programme acceptability with barriers due to competing time demands. Therapists reported high acceptability but perceived parental burnout. Parenting confidence (d = 0.70), and child behavior (d = 1.30) improved following the intervention.

CONCLUSIONS

Results demonstrate the programme's value to families during the pandemic, while underscoring unique participation barriers. Future research and clinicial implications are discussed.

Mood Disorders in Young People With Acquired Brain Injury: An Integrated Model

Purpose/Objective

Young people with paediatric acquired brain injury (pABI) are twice as likely to develop a mood disorder as their peers, frequently have significant unmet socio-emotional needs, and are at over double the risk of going on to use adult mental health services. Recent years have seen significant advances in the development of interventions for young people with mood disorders. However, evidence-based approaches to mood disorders in pABI are lacking and surprisingly little work has evaluated clinical and neuro-developmental models of mood disorders in this population.

Method

We review the literature regarding key mechanisms hypothesised to account for the increased vulnerability to mood disorders in pABI: First, we summarise the direct neurocognitive consequences of pABI, considering the key areas of the brain implicated in vulnerability to mood disorders within a neurodevelopmental framework. Second, we outline five key factors that contribute to the heightened prevalence of mood disorders in young people following ABI. Finally, we synthesise these, integrating neuro-cognitive, developmental and systemic factors to guide clinical formulation.

Results and Implications

We present a framework that synthesises the key mechanisms identified in our review, namely the direct effects of pABI, neurocognitive and neuroendocrine factors implicated in mood and anxiety disorders, maladaptive neuroplasticity and trauma, structural and systemic factors, and psychological adjustment and developmental context. This framework is the first attempt to provide integrated guidance on the multiple factors that contribute to elevated life-long risk of mood disorders following pABI.

The effective delivery of digital CBT: a service evaluation exploring the outcomes of young people who completed video conferencing therapy in 2020

Despite its impressive evidence base, there is a widening access gap to receiving cognitive behavioural therapy (CBT). Video conferencing therapy (VCT) offers an effective solution for logistical barriers to treatment, which has been salient throughout the Coronavirus pandemic. However, research concerning the delivery of CBT via VCT for children and young people (CYP) is in its infancy, and clinical outcome data are limited. The aim of this service evaluation was to explore the effectiveness of a VCT CBT intervention for CYP referred from Child and Adolescent Mental Health Services (CAMHS) in the UK. A total of 989 records of CYP who had completed CBT via VCT in 2020 with Healios, a digital mental health company commissioned by the National Health Service (NHS), were examined to determine changes in anxiety, depression and progress towards personalised goals. Routine outcome measures (ROMs) were completed at baseline and endpoint, as well as session by session. Feedback was collected from CYP and their families at the end of treatment. There was a significant reduction in symptoms of anxiety and depression and significant progress towards goals, with pre- to post-effect sizes (Cohen’s d) demonstrating medium to large effects (d=.45 to d=−1.39). Reliable improvement ranged from 31 to 80%, clinical improvement ranged from 33 to 50%, and 25% clinically and reliably improved on at least one measure; 92% reported that they would recommend Healios. This service evaluation demonstrates that Healios’ CBT delivered via VCT is effective for CYP receiving it as part of routine mental health care.

Key learning aims

(1)

Healthcare providers' perceptions of virtual-care with children's mental health in a pandemic: A hospital and community perspective

AIM

The purpose of the present study was to explore the experiences of a diverse group of mental health clinicians both in hospital and in the community, who were required to rapidly adopt virtual-care practices in the delivery of mental health services to children, adolescents, and their families.

METHODS

Mental health clinicians (N = 117) completed the Clinician Virtual-Care Experience Survey assessing the following domains: ease of technology use, client/patient-provider interaction quality, and clinician wellbeing.

RESULTS

Although over 70% of clinicians had not used virtual-care to deliver mental health services prior to the Coronavirus Disease 2019 pandemic, more than 80% felt it was easy to operate the virtual platforms. Clinicians were divided in their perceptions of the effectiveness of virtual-care, with only 42% reporting that they felt they were as effective in delivering healthcare services virtually as compared to in-person. Virtual-care was described as being more effective for specific populations, while challenges were described in building rapport and when delivering difficult or unexpected feedback.

CONCLUSIONS

Clinicians felt there were some benefits of adopting virtual-care practices, while challenges were also identified. Understanding of the impact of virtual-care on service providers is essential in order to strengthen mental healthcare for children, adolescents, and their families even beyond the pandemic.

The Use of Information and Communication Technologies in Family Support across Europe: A Narrative Review

The COVID-19 pandemic has accelerated the use of information and communication technology (ICT) to deliver parenting and mental health support services to families. This narrative review illustrates the diverse ways in which ICT is being used across Europe to provide family support to different populations. We distinguish between the use of ICT in professional-led and peer-led support and provide implementation examples from across Europe. We discuss the potential advantages and disadvantages of different ways of using ICT in family support and the main developments and challenges for the field more generally, guiding decision-making as to how to use ICT in family support, as well as critical reflections and future research on its merit.

Parent Coaching Fidelity Trajectories of In-Person and Telehealth Sessions during the COVID-19 Pandemic

The COVID-19 pandemic has posed significant challenges to delivery of preventive and mental health services, and providers have rapidly transitioned to telehealth service provision. Factors such as sudden isolation, financial strain, and physical and mental health stress presented unique challenges for providers and families and highlight the need for accessible and effective services. Thus, providers' fidelity of implementation during the pandemic is an important area for research. The current observational study compared providers' fidelity across in-person and telehealth-delivered sessions before and during the COVID-19 pandemic in Attachment and Biobehavioral Catch-up (ABC), a preventive parent coaching intervention for infants and toddlers. Participants included 24 providers (95% female, 42% White, M age = 37) who participated in ABC training and consultation during the COVID-19 pandemic. Providers' fidelity data (N = 593 sessions) were modeled longitudinally using hierarchical linear modeling, and separate intercepts and slopes were estimated for in-person and telehealth-delivered sessions. When data were modeled across all available sessions, results indicated that providers demonstrated improving fidelity over the course of training. When in-person and telehealth-delivered sessions were compared, providers' fidelity in telehealth-delivered ABC sessions was not significantly different from their fidelity in in-person sessions. Providers demonstrated improving fidelity over time in telehealth-delivered sessions. Thus, providers were able to maintain and improve ABC fidelity during the COVID-19 pandemic when provided with implementation support. Rapid transition to telehealth delivery can be successful when ongoing support such as consultation is provided.

Adapting intervention approaches to new contexts: Three case studies of international adaptation of the Teen Online Problem Solving (TOPS) program

PURPOSE/OBJECTIVE

To describe the process of adapting the evidence-based Teen Online Problem Solving (TOPS) program, a telehealth problem-solving treatment addressing executive function and behavior regulation challenges in adolescents with traumatic brain injury, in Italy, New Zealand, and the United Kingdom. Research Method/Design: We describe the process of adapting and translating the TOPS program in 3 case studies with unique methods and samples. In Italy, 14 parents of adolescents with TBI participated in focus groups, and 2 adolescents with TBI and their parents and 2 physicians provided input on the resulting translation. In New Zealand, an independent Māori cultural advisor reviewed the content, and 6 adolescent-parent dyads and 2 health professionals completed the 10 modules independently over a five-week period to inform adaptation. In the United Kingdom, a team of neuropsychologists and a parent of an adolescent with ABI reviewed and adapted the content through successive iterations.

RESULTS

In Italy, suggested changes included greater emphasis on nonverbal communication and clearer examples of inappropriate problem-solving responses. In New Zealand, parents and adolescents rated the program as acceptable and helpful. Suggestions included incorporating familiar Māori settings, integrating religion, and developing videos with New Zealand adolescents. In the United Kingdom, iterative refinements focused on adapting TOPS for other acquired brain injuries and reflecting cross-national differences (e.g., drinking age).

CONCLUSIONS/IMPLICATIONS

These 3 case studies suggest that programs such as TOPS developed in 1 cultural context can be broadly acceptable in other contexts, with adaptations focusing on tailoring to reflect the unique cultural and linguistic setting. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

COVID-19 mental health impact among children with early brain injury and associated conditions

This study describes the impact of COVID-19 among a clinical research sample of children with early brain injury and associated conditions. Between March 2020 and March 2021, 64 children and their parents participated. Children ranged in age between 3 and 14 years (M = 6 years, 3 months; SD = 2 years, 4 months) with a range of diagnoses (i.e., neonatal stroke, hypoxic ischemic encephalopathy (HIE), congenital heart disease (CHD) and preterm birth (<32 weeks)). The abbreviated CoRonavIrus Health Impact Survey (CRISIS) was completed by parents as part of their child's routine intake for neuropsychological services. Questions included COVID-19 specific ratings of child mental health impact, child, and parent stressors, with open-ended questions regarding negative and positive COVID-19 related changes. Over 40% of parents described moderate to extreme influence of COVID-19 on their child's mental health. Common child stressors reported included restrictions on leaving the home and social isolation. Among parents, the most common stress reported was caring for their child's education and daily activities. Children's mental health impact was associated with social isolation, parent mental health, COVID-19 economic concern, and number of siblings in the home. Child's age, sex, brain injury severity, or intellectual functioning were not associated with reported COVID-19 mental health impact. Some COVID-19 positives were identified, namely increased quality family time. Findings reflect the significant pandemic mental health impact among neurologically at-risk children and their families. Implications to future clinical needs and considerations for neuropsychological practice are discussed.

Telemental Health Use in the COVID-19 Pandemic: A Scoping Review and Evidence Gap Mapping

Background: The COVID-19 pandemic has highlighted telemedicine use for mental illness (telemental health). Objective: In the scoping review, we describe the scope and domains of telemental health during the COVID-19 pandemic from the published literature and discuss associated challenges. Methods: PubMed, EMBASE, and the World Health Organization's Global COVID-19 Database were searched up to August 23, 2020 with no restrictions on study design, language, or geographical, following an a priori protocol (https://osf.io/4dxms/). Data were synthesized using descriptive statistics from the peer-reviewed literature and the National Quality Forum's (NQF) framework for telemental health. Sentiment analysis was also used to gauge patient and healthcare provider opinion toward telemental health. Results: After screening, we identified 196 articles, predominantly from high-income countries (36.22%). Most articles were classified as commentaries (51.53%) and discussed telemental health from a management standpoint (86.22%). Conditions commonly treated with telemental health were depression, anxiety, and eating disorders. Where data were available, most articles described telemental health in a home-based setting (use of telemental health at home by patients). Overall sentiment was neutral-to-positive for the individual domains of the NQF framework. Conclusions: Our findings suggest that there was a marked growth in the uptake of telemental health during the pandemic and that telemental health is effective, safe, and will remain in use for the foreseeable future. However, more needs to be done to better understand these findings. Greater investment into human and financial resources, and research should be made by governments, global funding agencies, academia, and other stakeholders, especially in low- and middle- income countries. Uniform guidelines for licensing and credentialing, payment and insurance, and standards of care need to be developed to ensure safe and optimal telemental health delivery. Telemental health education should be incorporated into health professions curricula globally. With rapidly advancing technology and increasing acceptance of interactive online platforms amongst patients and healthcare providers, telemental health can provide sustainable mental healthcare across patient populations. Systematic Review Registration: https://osf.io/4dxms/.

Telepsychotherapy During the COVID-19 Pandemic: The Experience of Lebanese Mental Health Professionals

The COVID-19 pandemic has taken the mental health system by surprise, with the state of lockdown forcing businesses to close their doors, including many mental health services. This has driven many psychotherapists and other mental health professionals towards telepsychotherapy, relying on online consultations to provide continuity of care. However, the adoption of telepsychotherapy required major adaptations from both mental health professionals and patients. This study set out to explore the predictors of the use of online consultations and the perceived level of comfort using telepsychotherapy in a sample of 73 Lebanese mental health professionals. Data was collected via online dissemination of a survey. Results show that 82% of participants made use of online consultations in the past few days, reflecting the adaptation of Lebanese mental health professionals to the atypical newly imposed situation triggered by the COVID-19 pandemic and its consequent lockdown. Having previous experience in the use of online consultations and perceived level of telepresence were significant predictors of the level of comfort of mental health professionals in the execution online consultations. We suggest that more awareness and trainings are required around the practice of telepsychotherapy outside the context of the COVID-19 pandemic.

Implementing Group Parent Training in Telepsychology: Lessons Learned During the COVID-19 Pandemic

OBJECTIVE

We recently transitioned from in-person delivery of a brief behavioral parent intervention to telepsychology delivery to meet families' needs during the COVID-19 pandemic. In this topical review, we describe how we used treatment fidelity as a guiding principle to orient adaptations for telepsychology, as well as preliminary findings and early lessons learned in this implementation. Methods: Using rapid-cycle quality improvement methods, we adapted a brief parent training group (Bootcamp for Attention-Deficit/Hyperactivity Disorder; BC-ADHD) to three groups of caregivers (i.e., 5-7 families) of school-aged children with ADHD (n = 20; 85% males). Families were from the following ethnic backgrounds: 75% White non-Hispanic, 15% White Hispanic, and 10% Black. Clinicians completed measures on their implementation experience. Observers completed measures on content/process fidelity and attendance. Caregivers completed measures on demographics, treatment satisfaction, and telepsychology experience.

RESULTS

Telepsychology BC-ADHD can be implemented with comparably high levels of content and process fidelity and treatment satisfaction to in-person groups; and it appears to be feasible and acceptable to caregivers. Caregiver and clinician qualitative feedback revealed themes of appreciating the convenience of telepsychology, while experiencing some challenges in relating to others and sharing over video.

CONCLUSIONS

When treatment fidelity is used as a guiding tool, telepsychology parent training groups can be delivered with high fidelity and appear to be acceptable and feasible to caregivers and clinicians. Future research using larger and more diverse samples, multimethod and multi-informant measurement approaches, and controlled designs is needed to further assess the generalizability and efficacy of telepsychology parent training groups.

Terapia On-line com Casais e Famílias: Prática e Formação na Pandemia de Covid-19

Resumo A pandemia de Covid-19 potencializou o já emergente processo de intensificação das conexões virtuais. Para terapeutas de casal e família, essa grave crise de saúde pública acarretou mudanças na forma de atender clientes e interagir com colegas, exigindo a rápida transição da modalidade presencial para a modalidade remota, em muitos casos. O presente estudo sistematizou conhecimentos sobre terapia on-line com casais e famílias, trazendo considerações para a prática e a formação profissional diante da pandemia. Por meio de revisão narrativa da literatura, foram sumarizados resultados de estudos empíricos, bem como recomendações sobre aspectos técnicos, éticos e formativos. Destacaram-se, em particular, potencialidades e desafios para a utilização de tecnologias da informação e da comunicação na prática clínica com casais e famílias, incluindo indicações e contraindicações, recursos mais apropriados e seguros, relação terapêutica on-line, capacitação e supervisão. Entende-se que a Covid-19 representa uma oportunidade para revisão e reflexão da prática clínica e da formação profissional de terapeutas de casal e família no Brasil, país em que as intervenções on-line permaneciam relativamente pouco exploradas até a pandemia.