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Wang J, Pasyk SP, Slavin-Stewart C, Olagunju AT. Barriers to Mental Health care in Canada Identified by Healthcare Providers: A Scoping Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:826-838. [PMID: 38512557 DOI: 10.1007/s10488-024-01366-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 03/23/2024]
Abstract
The mental health treatment gap remains wide across the world despite mental illness being a significant cause of disability globally. Both end-user and healthcare provider perspectives are critical to understanding barriers to mental healthcare and developing interventions. However, the views of providers are relatively understudied. In this review, we synthesized findings from current literature regarding providers' perspectives on barriers to mental healthcare in Canada. We searched Medline, PsycINFO, Embase, and CINAHL for eligible Canadian studies published since 2000. Analysis and quality assessment were conducted on the included studies. Of 4,773 reports screened, 29 moderate-high quality studies were reviewed. Five themes of barriers emerged: health systems availability and complexity (reported in 72% of the studies), work conditions (55%), training/education (52%), patient accessibility (41%), and identity-based sensitivity (17%). Common barriers included lack of resources, fragmented services, and gaps in continuing education. Interestingly, clinicians often cited confusion in determining the ideal service for patients due to an overwhelming number of potential services without clear descriptions. These five domains of barriers present a synthesized review of areas of improvement for mental healthcare spanning both patients and clinicians. Canadian mental health systems face a need to improve capacity, clinician training, and in particular service navigability and collaboration.
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Affiliation(s)
- Jeffrey Wang
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Stanislav P Pasyk
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Claire Slavin-Stewart
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada
| | - Andrew T Olagunju
- Department of Psychiatry and Behavioral Neurosciences, McMaster University/St Joseph's Healthcare Hamilton, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.
- Discipline of Psychiatry, The University of Adelaide, North Terrace, Adelaide, SA, 5000, Australia.
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Saunders E, Pevie NW, Bedford S, Gosselin J, Harris N, Rash JA. Moms in motion: Predicting healthcare utilization patterns among mothers in Newfoundland and Labrador. PLoS One 2024; 19:e0304815. [PMID: 38980863 PMCID: PMC11233017 DOI: 10.1371/journal.pone.0304815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/18/2024] [Indexed: 07/11/2024] Open
Abstract
Mothers have a significant influence on family dynamics, child development, and access to family services. There is a lack of literature on the typical Canadian maternal experience and its influence on access to services for mothers despite recognizing the importance of mothers. A cross-sectional study was conducted to address this research gap that employed Andersen's Behavioral Model of Health Service Use in conjunction with a feminist lens. A total of 1,082 mothers who resided in Newfoundland and Labrador (NL) participated in a province-wide survey in 2017 and reported on their wellbeing, family life, and healthcare utilization. Stepwise binomial logistic regressions and linear regressions were used to predict initiation and continued service utilization within the preceding 12 months, respectively. Mothers who participated in this survey were older, and were more likely to be in a relationship than those in the Canadian census, while no difference was observed in annual income. Approximately half of mothers accessed services for themselves over the previous 12-months, with the overwhelming majority accessing services for their children. Medical services were the most likely to be utilized, and mental health and behavioural services were the most likely services to be needed, but not available. Sociodemographic (e.g., age, education attainment), familial relationships and role satisfaction, health need, and health practices predicted maternal initiation and continued use of services, with a larger number of variables influencing maternal service initiation as compared to continuous use of services. Sociodemographic (e.g., maternal age, community population), maternal social support, health need, and maternal health practices predicted maternal access of at least one child service while family relationships, health need, and maternal health practices predicted maternal use of a range of child services conditional on initial access. These results can support the provincial health system to better support access to care by acknowledging the interdependent nature of maternal and child health care utilization. They also highlight the importance of equitable healthcare access in rural locations. Results are discussed in terms of their clinical relevance to health policy.
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Affiliation(s)
- Emily Saunders
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Noah W. Pevie
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Shannon Bedford
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Julie Gosselin
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Nick Harris
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Joshua A. Rash
- Department of Psychology, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
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Marmura H, Cozzi RRF, Blackburn H, Ortiz-Alvarez O. Adolescents Identify Modifiable Community-Level Barriers to Accessing Mental Health and Addiction Services in a Rural Canadian Town: A Survey Study. Pediatr Rep 2024; 16:353-367. [PMID: 38804374 PMCID: PMC11130897 DOI: 10.3390/pediatric16020031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/18/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Adolescents are particularly vulnerable to inadequate provision of mental health and addictions care, as services have been traditionally conceptualized to serve the needs of children or adults. Additionally, rural communities have been largely excluded from research investigating mental healthcare access and exhibit unique barriers that warrant targeted interventions. Finally, perspectives from the target population will be most important when understanding how to optimize adolescent mental health and addictions care. Therefore, the purpose of this study was to identify what adolescents in a rural town perceive as barriers to accessing mental health services. We conducted a cross-sectional survey study with high school students to generate ranked lists of the top perceived individual-level, community-level, and overall barriers. A total of 243 high school students responded to the survey. Perceived barriers were predominantly at the community level. Overall, the top barriers reported were a lack of awareness and education regarding mental health, resources, and the nature of treatment. Students who had previously accessed mental health services identified primary barriers related to mental health professionals, whereas students who had not accessed care reported fear and uncertainty as primary barriers. Modifiable community-level factors related to (1) mental health literacy and (2) mental healthcare professionals were identified by adolescents as the main perceived barriers to accessing mental health and addiction services in a rural town. The findings of this preliminary study should inform intervention strategies and further rigorous research for this traditionally underserved target population.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, ON N6A 3K7, Canada;
| | - Regina R. F. Cozzi
- Biology Department, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada;
| | - Heather Blackburn
- Sexual Violence Prevention and Response Advocate Team, St. Francis Xavier University, Antigonish, NS B2G 2W5, Canada;
| | - Oliva Ortiz-Alvarez
- Women’s and Children’s Health, Saint Martha’s Regional Hospital, Antigonish, NS B2G 2G4, Canada
- Departments of Pediatrics and Family Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Sanders JE, Seale A, Lewis V, Arundel M, Csiernik R. A Feasibility Study of the SAFE Pilot Program: A University-School Board Partnership in Ontario. RESEARCH ON SOCIAL WORK PRACTICE 2024; 34:201-216. [PMID: 38047058 PMCID: PMC10691957 DOI: 10.1177/10497315231159059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
The Support and Aid to Families Electronically (SAFE) pilot program was developed through a community-university partnership to support parents of elementary students in Ontario, while providing stable practicums for social work students in the midst of COVID-19 restrictions. Purpose: The aim of the current study was to examine the feasibility of the SAFE pilot program as a mental health support to families by examining three feasibility objectives: demand, acceptably, and implementation. Method: Qualitative data from interviews, focus groups, and qualitative surveys involving service users, social work students, referring school board and university professionals (n = 37) were examined. Results: Demand for SAFE extended beyond the pandemic. A high-level of acceptance of SAFE was identified. Areas of success and considerations for implementation are outlined. Discussion: This study provides practice guidance on implementing this unique program, with potential to address gaps in service provision and the ongoing crisis in field education.
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Affiliation(s)
- Jane E. Sanders
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
| | - Ariel Seale
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
| | - Victoria Lewis
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
| | - M.K. Arundel
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
| | - Rick Csiernik
- School of Social Work, King's University College at Western University Canada, London, Ontario, Canada
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Palomin A, Takishima-Lacasa J, Selby-Nelson E, Mercado A. Challenges and Ethical Implications in Rural Community Mental Health: The Role of Mental Health Providers. Community Ment Health J 2023; 59:1442-1451. [PMID: 37314531 DOI: 10.1007/s10597-023-01151-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/27/2023] [Indexed: 06/15/2023]
Abstract
This manuscript reviews the unique challenges, barriers, and ethical implications of providing mental health services in rural and underserved areas. Community mental health centers in rural areas are often underserved due to shortages of mental health providers and limited resources. Individuals living in rural areas are at increased risk of developing mental health condition with limited access to mental health clinicians and healthcare facilities. These access to care issues are often exacerbated by geographical barriers as well as social, cultural, and economic challenges. A rural mental health professional may encounter several barriers to providing adequate care to individuals living in rural areas. For example, limited services and resources, geographic barriers, conflict between professional guidelines and community values, managing dual relationships, and challenges pertaining to confidentiality and privacy are several barriers to providing adequate care in rural areas. We will briefly summarize the primary ethical domains that are especially influenced by rural culture and the complex responsibilities of mental health providers in rural areas including barriers to care, crisis intervention, confidentiality, multiple relationships/dual roles, limits of competency, and rural mental healthcare practice implications.
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Affiliation(s)
- Amanda Palomin
- Department of Psychological Science, University of Texas Rio Grande Valley, 1201 W. University Dr, Edinburg, TX, 78539, USA.
| | | | | | - Alfonso Mercado
- Department of Psychological Science, University of Texas Rio Grande Valley, 1201 W. University Dr, Edinburg, TX, 78539, USA
- School of Medicine, Department of Psychiatry, The University of Texas Rio Grande Valley, Edinburg, USA
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Klinner C, Glozier N, Yeung M, Conn K, Milton A. A qualitative exploration of young people's mental health needs in rural and regional Australia: engagement, empowerment and integration. BMC Psychiatry 2023; 23:745. [PMID: 37833680 PMCID: PMC10571294 DOI: 10.1186/s12888-023-05209-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Australian rural and regional communities are marked by geographic isolation and increasingly frequent and severe natural disasters such as drought, bushfires and floods. These circumstances strain the mental health of their inhabitants and jeopardise the healthy mental and emotional development of their adolescent populations. Professional mental health care in these communities is often inconsistent and un-coordinated. While substantial research has examined the barriers of young people's mental health and help-seeking behaviours in these communities, there is a lack of research exploring what adolescents in rural and regional areas view as facilitators to their mental health and to seeking help when it is needed. This study aims to establish an in-depth understanding of those young people's experiences and needs regarding mental health, what facilitates their help-seeking, and what kind of mental health education and support they want and find useful. METHOD We conducted a qualitative study in 11 drought-affected rural and regional communities of New South Wales, Australia. Seventeen semi-structured (14 group; 3 individual) interviews were held with 42 year 9 and 10 high school students, 14 high school staff, and 2 parents, exploring participants' experiences of how geographical isolation and natural disasters impacted their mental health. We further examined participants' understandings and needs regarding locally available mental health support resources and their views and experiences regarding mental illness, stigma and help-seeking. RESULTS Thematic analysis highlighted that, through the lens of participants, young people's mental health and help-seeking needs would best be enabled by a well-coordinated multi-pronged community approach consisting of mental health education and support services that are locally available, free of charge, engaging, and empowering. Participants also highlighted the need to integrate young people's existing mental health supporters such as teachers, parents and school counselling services into such a community approach, recognising their strengths, limitations and own education and support needs. CONCLUSIONS We propose a three-dimensional Engagement, Empowerment, Integration model to strengthen young people's mental health development which comprises: 1) maximising young people's emotional investment (engagement); 2) developing young people's mental health self-management skills (empowerment); and, 3) integrating mental health education and support programs into existing community and school structures and resources (integration).
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Affiliation(s)
- Christiane Klinner
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nick Glozier
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course, Sydney, Australia
| | - Margaret Yeung
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katrina Conn
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NSW Department of Education, NSW, Australia
| | - Alyssa Milton
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course, Sydney, Australia.
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Wong R, Podolsky A, Levitt A, Da Silva A, Kodeeswaran S, Markoulakis R. A Qualitative Exploration of Ontario Caregivers' Perspectives of Their Role in Navigating Mental Health and/or Addiction Services for Their Youth. J Behav Health Serv Res 2023; 50:486-499. [PMID: 37311969 DOI: 10.1007/s11414-023-09843-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/15/2023]
Abstract
Many youth experiencing mental health and/or addiction (MHA) concerns rely on their caregivers to find and access services. Considering that caregivers often play a significant role in their youth's treatment trajectory, a descriptive qualitative study was used to explore how caregivers (n = 26) in the Greater Toronto Area perceive their role in navigating MHA care for their youth (ages 13 to 26). The Person-Environment-Occupation model was used to guide the thematic analysis. The findings reveal three main themes (1) the internal experience of caregiving, which describes caregivers' emotions and thought processes; (2) the external factors impacting the caregiver's ability to find and access youth MHA services, which explores systemic and social factors that impact navigation; and (3) the demands of the caregiving role. The discussion highlights the importance of supporting the wellbeing of caregivers as they navigate youth MHA services and can provide useful information for healthcare professionals and policy-makers to increase equitable access to youth MHA services.
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Affiliation(s)
- Rachel Wong
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anna Podolsky
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, ON, Canada
- Family Navigation Project, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue, RM 205, Toronto, ON, M4G 3E8, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, 1929 Bayview Avenue, RM 205, Toronto, ON, M4G 3E8, Canada
| | - Roula Markoulakis
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada.
- Sunnybrook Research Institute, Toronto, ON, Canada.
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Mahinpey N, Pollock NJ, Liu L, Contreras G, Thompson W. Self-harm and rurality in Canada: an analysis of hospitalization data from 2015 to 2019. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1161-1170. [PMID: 37029322 PMCID: PMC10081931 DOI: 10.1007/s00127-023-02463-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/08/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE The incidence of self-harm is an important indicator in suicide surveillance and a target outcome for suicide prevention. Self-harm rates vary by geographic location and rurality appears to be a risk factor. The objectives of this study were to estimate rates of self-harm hospitalization in Canada over a 5-year period by sex and age group, and examine relationships between self-harm and rurality. METHODS Hospitalizations related to self-harm were identified in a national dataset (the Discharge Abstract Database) for all patients aged 10 years or older who were discharged from hospital between 2015 and 2019. Self-harm hospitalization rates were calculated and stratified by year, sex, age group, and level of rurality, as measured using the Index of Remoteness. A Poisson regression was fit to estimate rate ratios for the levels of rurality. RESULTS Rates of self-harm hospitalization were higher for females than males across all levels of rurality and increased with each level for both sexes, except for among young males. The widest rural-to-urban disparities were observed for the 10-19 and 20-34-year old age groups. Females aged 10-19 in very remote areas had the highest self-harm hospitalization rate. CONCLUSION The rate of self-harm hospitalization in Canada varied by sex, age group, and level of rurality. Clinical and community-based interventions for self-harm, such as safety planning and increased access to mental health services, should be tailored to the differential risks across geographic contexts.
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Affiliation(s)
- Newsha Mahinpey
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Nathaniel J Pollock
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada.
- School of Arctic and Subarctic Studies, Labrador Campus, Memorial University, Happy Valley-Goose Bay, NL, Canada.
| | - Li Liu
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Gisèle Contreras
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Wendy Thompson
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON, Canada
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Markoulakis R, Cader H, Chan S, Kodeeswaran S, Addison T, Walsh C, Cheung A, Charles J, Sur D, Scarpitti M, Willis D, Levitt A. Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators. BMC Health Serv Res 2023; 23:470. [PMID: 37165343 PMCID: PMC10171912 DOI: 10.1186/s12913-023-09430-7] [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: 10/20/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care. METHODS This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12-29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking). RESULTS A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families' needs are met, barriers are mitigated, and facilitators are enhanced. CONCLUSION This review provides essential contextual information regarding TAY with MHA concerns and their families' needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population's needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.
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Affiliation(s)
- Roula Markoulakis
- Sunnybrook Research Institute, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
| | - Hinaya Cader
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | - Cathy Walsh
- Family Advisory Council, Family Navigation Project at Sunnybrook, Toronto, ON, Canada
| | - Amy Cheung
- Sunnybrook Research Institute, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jocelyn Charles
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Deepy Sur
- Ontario Association of Social Work, Toronto, ON, Canada
| | | | - David Willis
- Keystone Child, Youth, and Family Services, Owen Sound, ON, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Stewart SL, Vasudeva AS, Mistry D, Poss JW. The impact of child maltreatment on mental health outcome improvements among children and youth accessing community mental health care. CHILD ABUSE & NEGLECT 2023; 139:106066. [PMID: 36791630 DOI: 10.1016/j.chiabu.2023.106066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although children with histories of maltreatment are more likely to engage with mental healthcare than non-maltreated children, few studies have examined the impact of maltreatment on children's mental health outcome improvement over time. OBJECTIVE The current study addresses this gap in the present literature by exploring the ways that histories of physical, sexual, and emotional abuse and exposure to domestic violence can influence children's improvement on mental health outcomes commonly associated with trauma. PARTICIPANTS AND SETTING De-identified routine care data from 58 community mental health agencies across Ontario, Canada, representing 16,517 children was obtained. This data represented assessments that occurred between February 2015 and December 2021. METHODS General linear models were used to illustrate the effect of each trauma type on change scores computed between baseline and follow-up assessments of externalizing behaviours, risk of harm to others, depressive symptoms, risk of suicide and self-harm, and anxiety, while adjusting for baseline scores, inpatient status, time between assessments, and select demographic variables. RESULTS When the effects of each trauma type was considered separately, children without histories of trauma consistently showed greater improvement than those with that trauma across all mental health outcomes (0.07-0.44, p < 0.01). When all trauma types were considered together, sexual abuse was associated with some of the most significant negative impacts on children's mental health improvements. CONCLUSIONS Our findings highlight an urgent need for the implementation of standardized, evidence-based assessments that screen trauma histories of children accessing mental health supports and research examining the impact of trauma on children's treatment responsiveness.
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Affiliation(s)
- Shannon L Stewart
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada
| | - Aadhiya S Vasudeva
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada.
| | - Divya Mistry
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada
| | - Jeffrey W Poss
- Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
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Berry KR, Gliske K, Schmidt C, Cray LDE, Killian M, Fenkel C. LGBTQIA+ Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment (Preprint). JMIR Form Res 2023; 7:e45796. [PMID: 37083637 PMCID: PMC10163404 DOI: 10.2196/45796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. OBJECTIVE This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. METHODS Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. RESULTS LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. CONCLUSIONS This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically.
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Affiliation(s)
| | - Kate Gliske
- Charlie Health, Inc, Bozeman, MT, United States
| | | | | | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
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Roberts C, Darroch F, Giles A, van Bruggen R. You’re carrying so many people’s stories: vicarious trauma among fly-in fly-out mental health service providers in Canada. Int J Qual Stud Health Well-being 2022; 17:2040089. [PMID: 35195506 PMCID: PMC8925925 DOI: 10.1080/17482631.2022.2040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Candace Roberts
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Francine Darroch
- Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Audrey Giles
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
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13
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Lange S, Gossmann E, Hofmann S, Fegert JM. Condemn or Treat? The Influence of Adults' Stigmatizing Attitudes on Mental Health Service Use for Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15951. [PMID: 36498023 PMCID: PMC9740034 DOI: 10.3390/ijerph192315951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Stigmatizing attitudes towards mental disorders influence parents’ help-seeking behavior for their child’s mental health problems. As untreated mental disorders can cause morbidity and mortality, such parental attitudes are a serious barrier for public health promotion. Therefore, the help-seeking readiness in a distressed child’s broad social environment is essential. However, the role of stigma was unexplored in this context. This study empirically investigated the influence of adults’ stigmatizing attitudes towards mentally disabled people on their readiness to seek professional help for children’s mental health issues. Data from a representative German sample (N = 1906; 52% female) were collected between July and October 2021. A heteroscedastic ordered probit model was used for estimation. An empirical analysis provides evidence for a significant negative relationship between adults’ stigmatizing attitudes and their readiness to initiate mental health support for children (ß = −0.01; p < 0.001). Support acceptance seems to be independent of having children. To tackle stigmatizing attitudes and to promote public health, mental health literacy should be fostered through broad-based approaches. Awareness should be raised that children are also entitled to mental health care, just as they are in other health areas. Policy makers need to promote comprehensive information about mental illnesses and create incentives for acute and preventive service use.
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Affiliation(s)
- Stephanie Lange
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Emily Gossmann
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Sophie Hofmann
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Leadership Personality Center Ulm (LPCU), University Ulm, Kornhausgasse 9, 89073 Ulm, Germany
| | - Jörg M. Fegert
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
- Competence Area Mental Health Prevention in the Competence Network Preventive Medicine Baden-Württemberg, Clinic for Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
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Garbacz SA, Im S, Young K, Godfrey E, Stelter C, Twombly T, Deng XF, Albers CA. Promoting Youth Mental Health in Rural Communities. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-022-09526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Stewart SL, Celebre A, Semovski V, Hirdes JP, Vadeboncoeur C, Poss JW. The interRAI Child and Youth Suite of Mental Health Assessment Instruments: An Integrated Approach to Mental Health Service Delivery. Front Psychiatry 2022; 13:710569. [PMID: 35370860 PMCID: PMC8967950 DOI: 10.3389/fpsyt.2022.710569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 02/14/2022] [Indexed: 12/20/2022] Open
Abstract
Various biological, social, psychological, and environmental factors impact children and youth living with mental health problems across their lifespan. To meet the wide-ranging challenges of mental illness, service system integration is needed to improve efficiencies and reduce fragmentation. Unfortunately, the mental health system has been plagued by the lack of coordination across services. There is a general consensus that mental health service delivery must ensure a child or youth's needs are addressed in a collaborative, coordinated, and seamless manner. A key element to successful integration is the development of a comprehensive standardized screening and assessment system. Numerous assessments have been developed to assess child mental health and functioning, but they typically have a very narrow focus with limited use and utility. Not only does this reduce the ability to take a life course perspective to mental health, but this uncoordinated approach also results in redundancies in information collected, additional resources, and increased assessor burden for children, youth, and their families. The interRAI child and youth mental health assessment suite was developed in response to the need for an integrated mental health system for young persons. This suite includes screening and assessment instruments for in-patient and community settings, emergency departments, educational settings, and youth justice custodial facilities. The instruments form a mental health information system intentionally designed to work in an integrated fashion beginning in infancy, and incorporate key applications such as care planning, outcome measurement, resource allocation, and quality improvement. The design of these assessment tools and their psychometric properties are reviewed. Data is then presented using examples related to interpersonal trauma, illustrating the use and utility of the integrated suite, along with the various applications of these assessment systems.
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Affiliation(s)
| | - Angela Celebre
- Faculty of Education, Western University, London, ON, Canada
| | | | - John P. Hirdes
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Jeffrey W. Poss
- Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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16
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Song K, Markoulakis R, Levitt A. Predictors of strain for Canadian caregivers seeking service navigation for their youth with mental health and/or addictions issues. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:735-743. [PMID: 33064317 DOI: 10.1111/hsc.13188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 05/26/2023]
Abstract
Caring for youth with mental health and/or addictions (MHA) concerns is associated with caregiver strain, which may lead to negative consequences for youth and their caregivers. These consequences may be mitigated by caregivers and/or youth receiving assistance in navigating the healthcare system. Understanding what factors are associated with caregiver strain may be important in developing and implementing navigation services for such families; nonetheless, limited evidence currently exists regarding the predictors of strain in caregivers seeking navigation support. This study aimed to determine whether (a) the mental health profile of youth and (b) the home and family situation for youth with MHA concerns contribute significantly to strain in caregivers engaged in navigation. Data were collected from 66 adults caring for at least one youth with MHA issues accessing navigation service in Toronto, Ontario, between March and August 2018. Multiple linear regressions were conducted to determine which factors were associated with caregiver strain. The first regression model exploring youth-specific independent variables (adjusted r2 = .478, F6,47 = 9.086, p < .001) demonstrated that lower levels of caregiver-rated youth health (β = -0.577, p = .001) and higher levels of youth mental health symptom severity (β = 0.077, p < .001) significantly predicted higher levels of strain. The second regression model (adjusted r2 = .348, F5,54 = 7.287, p < .001) showed that lower levels of family functioning (β = -0.089, p < .001) significantly predicted higher levels of strain. Higher levels of caregiver strain in caregivers of youth with MHA concerns who are accessing navigation services are associated with lower levels of caregiver-rated youth health, higher levels of youth mental health symptom severity, and lower levels of family functioning. These predictors may be potential targets for providers aiming to reduce caregiver strain, as part of navigation or other healthcare services.
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Affiliation(s)
- Kaiwen Song
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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17
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Javier JR, Deavenport-Saman A, Florendo E, Bantol KEA, Palinkas LA. Health Equity and Enrollment in Preventive Parenting Programs: A Qualitative Study of Filipino Parents. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2021; 7:245-259. [PMID: 35783995 PMCID: PMC9246343 DOI: 10.1080/23794925.2021.2013141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This qualitative study identified the parent health beliefs and normative beliefs related to child behavioral and mental health problems and examined the benefits and barriers of enrolling in an evidence-based parenting intervention among Filipino parents of school-aged children. A secondary aim was to also use the results to inform the development of a theory-based video intervention to increase enrollment in parenting interventions. Semi-structured interviews were conducted with fifteen parents who had or had not participated in the Incredible Years® parenting program, an evidence-based parenting intervention. Interviews were recorded and transcribed verbatim. Using a "Coding Consensus, Co-occurrence, and Comparison" methodology, emergent themes were mapped into a matrix against a priori-coded health belief model (HBM) and Theory of Planned Behavior (TPB) constructs. Parents believed that perceived susceptibility could be influenced by including knowledge of health disparities affecting Filipino youth in the U.S. Perceived severity was related to behavioral and mental health concerns about school, family dynamics, bullying and parent coping strategies. Perceived benefits included strengthening parent-child relationships, creating support systems, and learning positive parenting skills. Perceived barriers included logistics, stigma, and the perception of the relevance of the program, cultural factors such as generational differences about parenting, and family issues. Social norms and subjective norms related to parent participation were also discussed. Applying the HBM and TPB to enrollment in parenting interventions may explain low enrollment rates. Future interventions need to target perceived susceptibility to future behavioral health problems, barriers, and benefits to enrollment, and influence subjective and social norms.
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Affiliation(s)
- Joyce R. Javier
- Children’s Hospital Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Alexis Deavenport-Saman
- Children’s Hospital Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ellynore Florendo
- Children’s Hospital Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Kamil Evy A. Bantol
- Children’s Hospital Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Lawrence A. Palinkas
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California, USA
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18
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Henson A, Ruglis J, Sinacore A, Fitzpatrick M, Lanteigne D. Self‐compassion for youth in small city centres: A school‐based pilot project. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Alisha Henson
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
- Pembroke Psychological Services Pembroke ON Canada
| | - Jessica Ruglis
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
| | - Ada Sinacore
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
| | - Marilyn Fitzpatrick
- Department of Educational & Counselling Psychology Faculty of Education McGill University Montreal QC Canada
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19
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MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol 2021; 56:339-361. [PMID: 33206200 DOI: 10.1007/s00127-020-01976-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 10/24/2020] [Indexed: 01/28/2023]
Abstract
Worldwide, growing concern with young people's mental health is spurring service reform efforts. Such reform requires a full understanding of the experiences of young people and their carers when seeking mental health help. To generate such an understanding, we conducted a meta-synthesis of qualitative literature on the perspectives of youths and their carers on navigating mental health systems. Five electronic databases were searched (Medline, PsycINFO, EMBASE, CINAHL, HealthSTAR). Studies were included if they explored the experiences of pathways to mental health services of persons aged 11-30 years and/or their carers; were published in English or French; and used qualitative methodology. Quality appraisal was conducted using the CASP tool. The synthesis of 31 included studies yielded three themes-initiating contact with mental health services; characteristics of services' response; and youths' and carers' appraisal of services. Themes about initiating contact included mental health literacy, structural barriers, and social support. Service response-related themes included complex pathways, waitlists, eligibility, and fragmented care. In terms of service appraisal, positive encounters featured providers who were accessible and perceived as caring. Negative appraisals resulted from feeling misunderstood and excluded and being ill-informed about treatment. Across diagnoses and settings, youths and carers had difficult experiences accessing mental healthcare. While individual, social, and healthcare factors shaping pathways to care varied, systemic complexities were a common inhibitor. This synthesis informs recommendations for improving mental health services and youths' pathways to them. It underlines the need for grounding reform in youths' and carers' perspectives and needs.
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Affiliation(s)
- Kathleen MacDonald
- Department of Psychiatry, McGill University, Montreal, Canada. .,Douglas Research Centre, Montreal, Canada. .,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada. .,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada.
| | - Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
| | - Nina Fainman-Adelman
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada.,Douglas Research Centre, Montreal, Canada.,ACCESS Open Minds, Pan-Canadian Youth Mental Health Services Research Network, Montreal, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Montreal, Canada
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20
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Socioeconomic Status, Race and Parental Initial Response to Children's Mental Illness. J Immigr Minor Health 2020; 23:463-469. [PMID: 33037550 DOI: 10.1007/s10903-020-01098-z] [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: 09/22/2020] [Indexed: 10/23/2022]
Abstract
To examine how socioeconomic status (SES) and race affect parents' initial response (IR) to their child's mental illness (MI) including 1. Parental confidant(s); 2. Lag time in professional help-seeking; and 3. Referral source. 70 parents of patients new to a Child Psychiatry clinic completed a survey to assess their IR to their child's MI. SES was determined using the United States Census Bureau median income by zip codes. Summary statistics are frequencies and percentages for categorical data, and medians and quartiles for continuous data. Twenty-five percent of parents reported low SES and 31% Non-Caucasian Children (NCC). Confidants of Caucasian and NCC were Pediatrician (77% vs 50%, p = 0.03), and family (73% vs 32%, p = 0.002). Comparing help-seeking Lag Times 66% reported a delay of 1 year or more (p = 0.040). Overall Pediatricians were the leading confidant. Lag times were one year or more with stronger trends in NCC.
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21
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Waid J, Kelly M. Supporting family engagement with child and adolescent mental health services: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1333-1342. [PMID: 31951087 DOI: 10.1111/hsc.12947] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 05/10/2023]
Abstract
A key challenge facing the mental health field is connecting children and families to services when symptoms first appear. Multiple barriers inhibit timely access to treatment, and interventions to resolve barriers to care are not common among health and social care organisations. To address this research-to-practice gap this study undertook a scoping review of the empirical literature aimed at identifying key factors in the social ecology of families which influence family engagement with child and adolescent mental health services, then identifying and describing models of intervention designed to help facilitate access to care. Forty studies published between 1 January 2000 and 28 February 2019 were reviewed. Key factors associated with child and adolescent mental health service engagement included family attitudes towards mental illness and help seeking, the flexibility and availability of needed services, community attitudes and stigma surrounding mental illness and mental health treatment, and the degree of coordination and integration across systems of health and social care. Models of intervention to facilitate engagement with mental health services included family outreach, telephone and digital health strategies, and integrated care approaches. Empirical support is strongest for family outreach and integrated care, although telephone and digital health strategies are underexplored with children and families and a potentially promising avenue for future research. To support family engagement with child and adolescent mental health services health and social care organisations should be prepared to identify barriers in their local practice settings and integrate efficacious engagement approaches into their continuum of available services.
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Affiliation(s)
- Jeffrey Waid
- School of Social Work, University of Minnesota - Twin Cities, Paul, MN, USA
| | - Meredith Kelly
- School of Social Work, University of Minnesota - Twin Cities, Paul, MN, USA
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22
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Markoulakis R, Chan S, Levitt A. The needs and service preferences of caregivers of youth with mental health and/or addictions concerns. BMC Psychiatry 2020; 20:409. [PMID: 32795285 PMCID: PMC7427896 DOI: 10.1186/s12888-020-02801-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 07/30/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Caregivers experience significant strains as a result of navigating the complex mental health and/or addiction (MHA) system for their youth with MHA issues. We examined the characteristics of Ontario families with youth with MHA issues and their service needs. METHODS A cross-sectional survey study investigated the characteristics and service needs of families with youth with MHA issues across the province of Ontario, Canada. A total of 840 caregivers were recruited. RESULTS 259 participants (Mage = 45.94, SD = 7.11) identified as caregiving for at least one youth with MHA issues. The majority of the participants were female (70.7%), married (73.4%), and completed at least some college/Bachelor degree (59.1%). The mean age of youth was 16.72 years (SD = 5.33) and the most frequently reported diagnoses were Depression (30.1%), ADHD (27.8%) and Generalized Anxiety Disorder (21.2%). Regression results demonstrated that presently accessing services, presently seeking services, and higher levels of barriers MHA services were significantly predictive of identifying navigation as helpful for finding appropriate MHA services (χ2(7) = 28.69, p < .001, Nagelkerke R2 = .16). Furthermore, presently accessing services was significantly predictive of identifying case management as helpful (χ2(7) = 29.59, p < .001, Nagelkerke R2 = .156), and of identifying a primary healthcare provider as helpful (χ2(7) = 38.75, p < .001, Nagelkerke R2 = .197) for finding appropriate MHA services. CONCLUSION Identifying the nature and extent of youth MHA issues, service needs, and family preferences can inform the development of services that address families' needs and lend vital support for accessing services within a complex system.
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Affiliation(s)
- Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada.
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Samantha Chan
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program and Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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23
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Establishing cross-systems collaborations for implementation: protocol for a longitudinal mixed methods study. Implement Sci 2020; 15:55. [PMID: 32677987 PMCID: PMC7364639 DOI: 10.1186/s13012-020-01016-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background Cross-system interventions can help integrate services across different service delivery systems but require organizations to establish strong collaborative relationships for implementation. Contingency theory suggests that the effectiveness of different collaborative strategies (i.e. specific ways organizations align operations and services) varies by context. This paper describes a study of different strategies for fostering collaboration between child welfare and substance abuse treatment agencies and the conditions under which they are effective for implementation. We also describe the development and piloting of the Collaborating Across Systems for Program Implementation (CASPI) tool—a decision-making guide intended to help researchers and organizational leaders identify and use appropriate collaborative strategies for their context. Methods/design This multisite longitudinal, mixed methods study, leverages a naturally occurring implementation initiative -- in up to 17 Ohio counties -- to implement Ohio START (Sobriety Treatment and Reducing Trauma). START is a child welfare model that requires strong collaboration with local substance use treatment organizations to promote integrated services. During the first two years, we will identify collaborative strategies associated with improved START implementation (penetration and fidelity) and service delivery outcomes (timeliness), given system, and organizational features. We will conduct a convergent mixed methods study drawing on worker surveys, agency documents, administrative data, formal partner agreements, and group interviews. Data will be integrated and analyzed using Qualitative Comparative Analysis (QCA). To develop the CASPI, an expert panel comprised of implementation experts, and community stakeholders will convene to synthesize our findings and develop contents (including a decision tree). During the final year of the study, we will assess the acceptability, appropriateness, and feasibility of the CASPI in a randomized vignette experiment, and a pilot-test with 3 child welfare agencies that have not yet implemented START. Discussion Our results will lay the groundwork for a larger controlled trial that will test the CASPI’s effectiveness for supporting effective and efficient implementation of cross-system interventions like START. The CASPI is expected to help leaders and researchers select and use collaboration strategies tailored to their context and be applicable in a wide range of settings including rural communities. Our work also advances system-level implementation strategies. Trial registration NCT03931005, Registered April 29, 2019.
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Espinet SD, Gotovac S, Knight S, Wissow L, Zwarenstein M, Lingard L, Steele M. Primary Care Practitioner Training in Child and Adolescent Psychiatry (PTCAP): A Cluster-Randomized Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:319-329. [PMID: 31813273 PMCID: PMC7265617 DOI: 10.1177/0706743719890161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. METHODS The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. RESULTS Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. CONCLUSION PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.
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Affiliation(s)
- Stacey D Espinet
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada
| | - Sandra Gotovac
- Division of Child and Adolescent Psychiatry, London Health Sciences Center, London, Ontario, Canada
| | - Sommer Knight
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada
| | - Larry Wissow
- School of Medicine, University of Washington, DC, USA
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, The University of Western Ontario, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Health Sciences Addition, The University of Western Ontario, London, Ontario, Canada
| | - Margaret Steele
- Discipline of Psychiatry, Faculty of Medicine, Memorial University of Newfoundland, Saint John's, Newfoundland, Canada
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25
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D'Arcey J, Collaton J, Kozloff N, Voineskos AN, Kidd SA, Foussias G. The Use of Text Messaging to Improve Clinical Engagement for Individuals With Psychosis: Systematic Review. JMIR Ment Health 2020; 7:e16993. [PMID: 32238334 PMCID: PMC7163420 DOI: 10.2196/16993] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/03/2020] [Accepted: 01/14/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Individuals experiencing psychosis are at a disproportionate risk for premature disengagement from clinical treatment. Barriers to clinical engagement typically result from funding constraints causing limited access to and flexibility in services. Digital strategies, such as SMS text messaging, offer a low-cost alternative to potentially improve engagement. However, little is known about the efficacy of SMS text messaging in psychosis. OBJECTIVE This review aimed to address this gap, providing insights into the relationship between SMS text messaging and clinical engagement in the treatment of psychosis. METHODS Studies examining SMS text messaging as an engagement strategy in the treatment of psychosis were reviewed. Included studies were published from the year 2000 onward in the English language, with no methodological restrictions, and were identified using 3 core databases and gray literature sources. RESULTS Of the 233 studies extracted, 15 were eligible for inclusion. Most studies demonstrated the positive effects of SMS text messaging on dimensions of engagement such as medication adherence, clinic attendance, and therapeutic alliance. Studies examining the feasibility of SMS text messaging interventions found that they are safe, easy to use, and positively received. CONCLUSIONS Overall, SMS text messaging is a low-cost, practical method of improving engagement in the treatment of psychosis, although efficacy may vary by symptomology and personal characteristics. Cost-effectiveness and safety considerations were not adequately examined in the studies included. Future studies should consider personalizing SMS text messaging interventions and include cost and safety analyses to appraise readiness for implementation.
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Affiliation(s)
- Jessica D'Arcey
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - Joanna Collaton
- Department of Clinical Psychology, University of Guelph, Guelph, ON, Canada
| | - Nicole Kozloff
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sean A Kidd
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medial Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Lal S, Starcevic DJ, Fuhrer R. Youth Experiences With Referrals to Mental Health Services in Canada: Protocol for a Web-Based Cross-Sectional Survey Study. JMIR Res Protoc 2020; 9:e16945. [PMID: 32207698 PMCID: PMC7139421 DOI: 10.2196/16945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 01/01/2023] Open
Abstract
Background Youth mental health is an important public health concern affecting low-, middle-, and high-income countries, and many young people in need of mental health services do not receive the care they need when they need it. An early step in accessing mental health care is the referral process, yet most of the research done on pathways to care has focused on clinical populations (eg, first-episode psychosis) recruited from mental health care settings. There has been limited research attention on the experiences of referral to mental health services from the perspectives of youth recruited from the general population who may or may not have received the services they need. Objective This study aims to investigate the experiences that youth between the ages of 17 and 30 years have with referrals to mental health services and to better understand their perspectives on the use of technology to facilitate referrals. Methods This study will use a cross-sectional, Web-based survey design. A convenience sample of 400 participants from 3 Canadian provinces (Quebec, Ontario, and British Columbia), between the ages of 17 and 30 years, will be recruited via Facebook and will be invited to complete a Web-based survey anonymously. A questionnaire including a series of quantitative and qualitative questions will ask participants about their sociodemographic characteristics, past experiences with referral and access to mental health services, and opinions about using technology to facilitate the referral process. Results Participant recruitment is planned to be initiated by early January 2020 and is estimated to be completed by May 2020. Data will be analyzed using descriptive statistics and logistic regression or chi-square tests for quantitative data, and descriptive content analysis will be used for the qualitative data. Conclusions The results of this study can help inform the improvement of referral policies and procedures in youth mental health service delivery. A better understanding of young people’s perspectives on referral processes and their opinions on how these processes can be improved are essential to providing appropriate and timely access to mental health care. International Registered Report Identifier (IRRID) PRR1-10.2196/16945
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada.,Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, QC, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Danielle Joanna Starcevic
- Youth Mental Health and Technology Lab, University of Montréal Hospital Research Centre, Montréal, QC, Canada.,Dept of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Rebecca Fuhrer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montréal, QC, Canada.,Dept of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada
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Duncan L, Georgiades K, Reid GJ, Comeau J, Birch S, Wang L, Boyle MH. Area-Level Variation in Children’s Unmet Need for Community-Based Mental Health Services: Findings from the 2014 Ontario Child Health Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:665-679. [DOI: 10.1007/s10488-020-01016-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rehder K, Lusk J, Chen JI. Deaths of Despair: Conceptual and Clinical Implications. COGNITIVE AND BEHAVIORAL PRACTICE 2019; 28:40-52. [PMID: 34168422 DOI: 10.1016/j.cbpra.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Since the late 1990s, mortality rates for middle-aged (45-55), White non-Hispanic (WNH) Americans began to rise while rates declined for all other demographic and age groups. Coinciding with the rise in mortality, rates of death due to suicide, drug- and alcohol-related overdoses, and alcohol-related liver diseases increased as well for this demographic. Research suggests these causes of death (i.e., suicide, poisoning, alcohol-related liver disease) are driving the overall mortality rate for middle-aged WNHs and have been described as "deaths of despair" in the literature. In the current paper, we describe the social and clinical features of "deaths of despair," explore theoretical models of psychopathology (e.g., depression, posttraumatic stress disorder) that may inform our understanding of mechanisms of risk for negative mental health outcomes, and propose an initial conceptual model of "deaths of despair" to identify intervention targets. We then review an applied case example demonstrating how this model could be used for clinical application. We conclude our paper by describing how current cognitive-behavioral interventions may address these mechanisms of "despair."
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Affiliation(s)
- Kristoffer Rehder
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| | - Jaimie Lusk
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
| | - Jason I Chen
- Pacific University, Salem Vet Center Information, HSR&D Center to Improve Veteran Involvement in Care and Oregon Health & Science University
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Groth T, Boccio DE. Psychologists' Willingness to Provide Services to Individuals at Risk of Suicide. Suicide Life Threat Behav 2019; 49:1241-1254. [PMID: 30091151 DOI: 10.1111/sltb.12501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 07/16/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study examined psychologists' willingness to accept a new client into their private practice as a function of the client's clinical presentation (with or without overt suicidality). Psychologists' openness to working with a client at risk of suicide was evaluated in the context of potential barriers to treatment provision, such as practitioners' endorsement of stigmatizing attitudes, concerns over liability and inadequate training, and limited access to community resources. METHOD Eighty-six licensed psychologists practicing within the United States were surveyed via e-mail and randomly assigned to one of two conditions, consisting of exposure to a vignette describing either a client reporting current suicidal ideation and a history of attempts or a client without explicitly elevated suicide risk. All participants were asked to complete a questionnaire assessing their likelihood of accepting the hypothetical client into their practice and examining possible explanations for disinclination to provide treatment. RESULTS Psychologists were less willing to work with a client experiencing suicidality than an individual without elevated suicide risk. Those indicating a reluctance to provide services reported greater concerns over the adequacy of their suicide-related skills and training and fewer resources in the community. CONCLUSIONS Recommendations for improving the responsiveness of private practitioners are provided, with an emphasis on enhancing clinical training and increasing the availability and accessibility of mental health resources.
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Champine RB, Shaker AH, Tsitaridis KA, Whitson ML, Kaufman JS. Service-Related Barriers and Facilitators in an Early Childhood System of Care: Comparing the Perspectives of Parents and Providers. Community Ment Health J 2019; 55:942-953. [PMID: 31165963 DOI: 10.1007/s10597-019-00418-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/30/2019] [Indexed: 01/13/2023]
Abstract
Systems of care (SOCs) have the potential to enhance underserved families' access to integrated health and support services. Most scholarship on SOCs has involved school-aged children and adolescents. Thus, research is needed to better understand barriers to, and facilitators of, families' access to services during early childhood. The present study included a community-based participatory approach in understanding services for families of children under age six years with severe emotional and behavioral problems. We analyzed data from two focus groups with caregivers (n = 7) and three focus groups with service providers (n = 22). Our thematic analysis of participants' responses revealed five primary barriers to family service access, including challenges associated with transition planning. In comparison, participants described four primary facilitators of family service access, including providers' adoption of "whole-family" service delivery approaches. Findings indicated areas of convergence and divergence in caregivers' and providers' responses. We discuss limitations and potential implications.
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Affiliation(s)
- Robey B Champine
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, 48503, USA. .,Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, USA. .,Child Health and Development Institute of Connecticut, Farmington, CT, USA.
| | - Andrea H Shaker
- Department of Psychology, University of New Haven, New Haven, CT, USA
| | | | - Melissa L Whitson
- Department of Psychology, University of New Haven, New Haven, CT, USA
| | - Joy S Kaufman
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, USA
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Reaume-Zimmer P, Chandrasena R, Malla A, Joober R, Boksa P, Shah JL, Iyer SN, Lal S. Transforming youth mental health care in a semi-urban and rural region of Canada: A service description of ACCESS Open Minds Chatham-Kent. Early Interv Psychiatry 2019; 13 Suppl 1:48-55. [PMID: 31243909 PMCID: PMC6771628 DOI: 10.1111/eip.12818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
AIM This study describes how mental health services for youth are being transformed within the context of a semi-urban and rural region of Canada (Chatham-Kent, Ontario), based on the framework of ACCESS Open Minds (ACCESS OM), a pan-Canadian youth mental health research and evaluation network. METHODS Transformation has focused on the five key objectives of ACCESS OM, namely early identification, rapid access, appropriate care, continuity of care, and youth and family engagement. A community mapping process was conducted at the beginning of the transformation to help develop a comprehensive inventory of services, identify challenges and optimize partnerships to address the five key objectives. RESULTS The following strategies represent key elements in the transformation: coordination and partnerships between hospital, community and voluntary organizations, as well as different sectors of the community (e.g., Child and Youth Services, Education, Community Safety and Correctional Services, CSCS); working with local champions (e.g., Youth Diversion Officer and the Mental Health and Addictions Nurse in the school sectors); establishing a youth-friendly space in a central part of the community, where services are co-located and operate within an open-concept design; training of ACCESS Clinicians to conduct an initial assessment; engaging youth and family in service-level recruitment, planning, daily operations, and evaluation, including hiring of youth and family peer navigators; and, engaging the community through awareness and educational events. CONCLUSIONS The success of this transformation needs to be measured on various outcome parameters, but it is notable that neighbouring communities are already beginning to implement a similar model.
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Affiliation(s)
- Paula Reaume-Zimmer
- Mental Health and Addiction Services, Bluewater Health and Canadian Mental Health Association Lambton-Kent, Ontario, Canada.,ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ranjith Chandrasena
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Shulich School of Medicine, Western University, London, Ontario, Canada
| | - Ashok Malla
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Ridha Joober
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Patricia Boksa
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jai L Shah
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Srividya N Iyer
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Shalini Lal
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.,Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
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Abuosi AA, Anaba EA. Barriers on access to and use of adolescent health services in Ghana. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-10-2018-0119] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this paper is to explore perceived barriers to accessing and using adolescent health services in Ghana.
Design/methodology/approach
The study was a qualitative study adopting a case study design. In total, 24 adolescents were recruited from four adolescent health facilities in Tema, a suburb of Ghana, using convenient sampling. In-depth interviews with respondents were conducted coupled with the taking of field notes and personal observations. Data collection took place between January and May 2017. Data were transcribed, managed and coded for themes. Thematic analysis was guided by Braun and Clarke’s (2006) Framework.
Findings
The findings of this study revealed that majority of the respondents were females (54 percent) older adolescents (above 15 years (60 percent), students (79 percent)), had junior high school education and stayed with their biological parent(s) (70 percent). Adolescents in this study perceived four main barriers that restrict their access to or use of adolescent health services. The barriers were found at the facility level, provider level, community level and personal level.
Originality/value
The findings of this study provide evidence-based information for planning adolescent health care interventions that would improve adolescents’ access to and use of health services in Ghana.
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Increasing Access to Psychiatric Services in Schools: The Bridge Program. J Psychiatr Pract 2019; 25:227-236. [PMID: 31083038 DOI: 10.1097/pra.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One in 5 youth experience a psychiatric disorder in any given year, but fewer than half of these youth receive mental health services. This lack of service utilization is often attributed to structural and perceptual barriers, and school-based mental health programs have been proposed as a means of addressing these barriers and increasing youths' access to services. While universal prevention programs and targeted treatments may benefit most youth receiving services in schools, collaborations between schools and child psychiatry may benefit youth with the most severe symptoms and the greatest impairment. This article describes the Bridge Program, a school-based psychiatric program funded by a county-wide mental health tax initiative designed to provide psychiatric services in local schools without any out-of-pocket expenses for youth and families within 10 days of referral. Two case reports provide a description of the delivery of psychiatric services through the Bridge Program. Future research is needed to compare the feasibility and effectiveness of different approaches to increasing access to youth psychiatric care.
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Steel A, Munk N, Wardle J, Adams J, Sibbritt D, Lauche R. Generational differences in complementary medicine use in young Australian women: Repeated cross-sectional dataset analysis from the Australian longitudinal study on women’s health. Complement Ther Med 2019; 43:66-72. [DOI: 10.1016/j.ctim.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/14/2019] [Accepted: 01/14/2019] [Indexed: 10/27/2022] Open
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Howard A, Flanagan M, Drouin M, Carpenter M, Chen EM, Duchovic C, Toscos T. Adult experts' perceptions of telemental health for youth: A Delphi study. JAMIA Open 2018; 1:67-74. [PMID: 31984319 PMCID: PMC6951899 DOI: 10.1093/jamiaopen/ooy002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/02/2018] [Accepted: 02/22/2018] [Indexed: 11/26/2022] Open
Abstract
Objectives Our objectives were to measure experts’ opinions and develop consensus via the Delphi process on the barriers, applications, and concerns associated with telemental health (TMH) for youth. Materials and methods We delivered 3 online surveys over 2 months in Summer, 2016–2025 adult experts, including adults who experienced youth depression or suicidality, parents of youth with lived experience, and professionals (ie youth mental health researchers, clinicians/staff, or educators). We used the Delphi method to construct Likert and open-ended questions, developing expert consensus over 3 iterative surveys on the barriers and benefits of TMH for youth. Results Adult experts identified stigma and knowledge barriers to youth mental health care. Although TMH is perceived as beneficial for screening, education, follow-up, and emotional support, no single delivery method (eg websites or instant messaging) was deemed universally beneficial. Discussion Adults are the developers, administrators, and gatekeepers of youth mental health care. Although adult experts see potential for TMH to supplement traditional therapy via familiar technologies, there is no consensus on the technologies by which TMH should be delivered. However, there is consensus that family members and friends provide potential pathways to care; thus, an online TMH toolkit for youth would be beneficial for both caretakers and practitioners. Conclusion Telemental health may not overcome barriers for crisis management but adult experts agreed that TMH had potential benefits for youth. Health care organizations should conduct research and provide training and education to youth caretakers and practitioners on potential barriers and benefits of TMH technologies for youth.
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Affiliation(s)
- Abigail Howard
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA
| | - Mindy Flanagan
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA.,Indiana University Center for Health Services Research, School of Medicine, Indianapolis, Indiana, USA
| | - Michelle Drouin
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA.,Indiana University-Purdue University Fort Wayne, Fort Wayne, Indiana, USA
| | - Maria Carpenter
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA
| | - Elizabeth M Chen
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | | | - Tammy Toscos
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA
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López CM, Qanungo S, Jenkins C, Acierno R. Technology as a Means to Address Disparities in Mental Health Research: A Guide to "Tele-Tailoring" your Research Methods. PROFESSIONAL PSYCHOLOGY-RESEARCH AND PRACTICE 2018; 49:57-64. [PMID: 30034085 PMCID: PMC6052868 DOI: 10.1037/pro0000176] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We must include rural participants in health-related research if we are to address health-related disparities and inequity, particularly in mental health. However, the first step of the research process, in person, witnessed, signed informed consent is often a limiting factor and insurmountable barrier to precisely the type of research (e.g., telehealth) designed to overcome barriers of geographic distance and travel time. Telehealth, or the provision of medical care or services to patients by means of audio/video and procedure-specific technology, addresses some barriers to health created by rurality by making health care professionals more accessible to patients. A logical complement to telehealth is "teleconsent." Teleconsent can be defined as using remote, facial integrated identity verification to allow (a) remote guidance of participants through consent documents, and (b) digital signing by all parties, obviating the need for in person signed consent. The ability to review and sign consent documents via telehealth with synchronous viewing is a novel, innovative means by which to overcome the initial significant barrier to recruitment of rural participants into healthcare research. By leveraging the growing capabilities of telehealth, teletailoring studies can improve the efficiency of research recruitment and facilitate the consent process for under-represented populations in research. Strategies for implementation are clearly relevant to increasing the success of clinical trial recruitment.
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Affiliation(s)
| | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, SC
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, SC
| | - Ron Acierno
- College of Nursing, Medical University of South Carolina, SC
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Delivery of a Therapist-Facilitated Telecare Anxiety Program to Children in Rural Communities: A Pilot Study. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: This pilot study explored the feasibility and preliminary efficacy of a therapist-facilitated telecare cognitive behavioural anxiety program delivered through schools to children within rural communities. Method: Sixteen children aged 9–12 years (82.5% male), with a principal diagnosis of an anxiety disorder, and their mothers participated in the pilot study. The treatment program was an adaption of the Cool Kids Child and Adolescent Anxiety Management Program. Treatment was delivered by clinical psychologists and involved 10 weekly sessions with children via an interactive, real-time videoconferencing online platform at their school. Parents also received 4 phone calls during the treatment program. Outcome measures included clinician-rated diagnostic status and child- and parent-reported symptoms and interference. Results: According to combined parent and child reports, 62.5% of children no longer met diagnostic criteria for their primary anxiety disorder, and 31.25% did not meet diagnostic criteria for any anxiety disorder post-treatment. Results indicated that the severity of anxiety symptoms, functional impact of anxiety symptoms, externalising difficulties, and depressive symptoms in children decreased significantly post-treatment, as reported by both parents and children. Conclusions: A telecare model of therapy could be a feasible and effective way of delivering evidence-based intervention to children in rural communities.
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Bowman S, McKinstry C, McGorry P. Youth mental ill health and secondary school completion in Australia: time to act. Early Interv Psychiatry 2017; 11:277-289. [PMID: 27381567 DOI: 10.1111/eip.12357] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/01/2016] [Indexed: 12/30/2022]
Abstract
AIM This paper reviews the evidence of youth mental ill health and its impact on secondary school educational attainment. METHODS This narrative review presents the current research related to the mental ill health of young people in urban and rural Australia, their educational attainment and the effectiveness of mental health strategies implemented in secondary schools. RESULTS The prevalence of mental ill health is high for Australian young people and the onset of depression, anxiety, substance-use disorders and first episode psychosis (FEP) commonly occurs when the individual is at school. The prevalence is reported to be higher for rural young people and barriers to treatment exist. Current evidence suggests that 40% of young people experiencing depression or anxiety disorders are not completing secondary school. Further evidence shows that over 50% of individuals who experience FEP do not finish secondary school. Current mental health promotion strategies employed in secondary schools have not been shown to reduce rates of depression or anxiety in adolescence nor identify prodromal or acute FEP. These strategies have not led to interventions that assist young people with mental ill health to finish school. CONCLUSIONS Not completing secondary school can limit employment options, lead to severe levels of disadvantage and increased burden on welfare and healthcare systems. All young people, including those in rural areas, have the right to education and should not be disadvantaged in their educational aspirations because they have an emerging or current mental illness.
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Affiliation(s)
- Siann Bowman
- Department of Occupational Therapy, Community and Clinical Allied Health & LaTrobe Rural Health School, College of Science, Health and Engineering, LaTrobe University, Melbourne, Victoria, Australia
| | - Carol McKinstry
- Occupational Therapy, LaTrobe Rural Health School, LaTrobe University, Bendigo, Victoria, Australia
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia
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Caxaj CS, Gill NK. Belonging and Mental Wellbeing Among a Rural Indian-Canadian Diaspora: Navigating Tensions in "Finding a Space of Our Own". QUALITATIVE HEALTH RESEARCH 2017; 27:1119-1132. [PMID: 27179022 DOI: 10.1177/1049732316648129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Belonging is linked to a variety of positive health outcomes. Yet this relationship is not well understood, particularly among rural immigrant diasporas. In this article, we explore the experiences of community belonging and wellbeing among a rural Indian-Canadian diaspora in the Interior of British Columbia, Canada, our central research questions being, "What are the experiences of belonging in this community? How does a sense of belonging (or lack of) shape mental health and wellbeing among local residents?" Using a situational analysis research approach, our findings indicate that local residents must navigate several tensions within an overarching reality of finding a space of our own. Such tensions reveal contradictory experiences of tight-knitedness, context-informed notions of cultural continuity, access/acceptability barriers, particularly in relation to rural agricultural living, and competing expectations of "small town" life. Such tensions can begin to be addressed through creative service provision, collaborative decision making, and diversity-informed program planning.
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Affiliation(s)
- C Susana Caxaj
- 1 University of British Columbia, Kelowna, British Columbia, Canada
| | - Navjot K Gill
- 2 Simon Fraser University, Vancouver, British Columbia, Canada
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Reardon T, Harvey K, Baranowska M, O'Brien D, Smith L, Creswell C. What do parents perceive are the barriers and facilitators to accessing psychological treatment for mental health problems in children and adolescents? A systematic review of qualitative and quantitative studies. Eur Child Adolesc Psychiatry 2017; 26:623-647. [PMID: 28054223 PMCID: PMC5446558 DOI: 10.1007/s00787-016-0930-6] [Citation(s) in RCA: 284] [Impact Index Per Article: 40.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 12/05/2016] [Indexed: 11/21/2022]
Abstract
A minority of children and adolescents with mental health problems access treatment. The reasons for poor rates of treatment access are not well understood. As parents are a key gatekeeper to treatment access, it is important to establish parents' views of barriers/facilitators to accessing treatment. The aims of this study are to synthesise findings from qualitative and quantitative studies that report parents' perceptions of barriers/facilitators to accessing treatment for mental health problems in children/adolescents. A systematic review and narrative synthesis were conducted. Forty-four studies were included in the review and were assessed in detail. Parental perceived barriers/facilitators relating to (1) systemic/structural issues; (2) views and attitudes towards services and treatment; (3) knowledge and understanding of mental health problems and the help-seeking process; and (4) family circumstances were identified. Findings highlight avenues for improving access to child mental health services, including increased provision that is free to service users and flexible to their needs, with opportunities to develop trusting, supportive relationships with professionals. Furthermore, interventions are required to improve parents' identification of mental health problems, reduce stigma for parents, and increase awareness of how to access services.
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Affiliation(s)
- Tessa Reardon
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
| | - Magdalena Baranowska
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Doireann O'Brien
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Lydia Smith
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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Boydell KM, Dew A, Hodgins M, Bundy A, Gallego G, Iljadica A, Lincoln M, Pignatiello A, Teshima J, Willis D. Deliberative Dialogues Between Policy Makers and Researchers in Canada and Australia. JOURNAL OF DISABILITY POLICY STUDIES 2017. [DOI: 10.1177/1044207317694840] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Knowledge translation (KT) and implementation science are growing fields in Canada, Australia, and worldwide. Many audiences are targeted as KT knowledge users—policy makers represent one key knowledge user in the health care field. The need for policy makers to understand research and for researchers to understand policy processes is commonly recognized. There is also increasing interest in health policy that focuses on KT as a framework for understanding the use of evidence and, in particular, describing the influence of research on policy along with concepts of coproduction and user involvement. With relationship building central to successful evidence-informed policy, this article explores deliberative dialogue as a potential approach to enhancing KT. It describes two examples of researcher efforts to cultivate relationships and contacts with policy and decision makers via such dialogues and illustrates the inherent opportunities and challenges of doing so.
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Affiliation(s)
- Katherine M. Boydell
- Black Dog Institute, Randwick, New South Wales, Australia
- University of Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angela Dew
- The University of Sydney, New South Wales, Australia
- University of New South Wales, Sydney, Australia
| | | | - Anita Bundy
- The University of Sydney, New South Wales, Australia
| | | | | | | | - Antonio Pignatiello
- University of Toronto, Ontario, Canada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - John Teshima
- The Hospital for Sick Children, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Newton AS, Rosychuk RJ, Niu X, Radomski AD, McGrath PJ. Emergency Department Use and Postvisit Care for Anxiety and Stress Disorders Among Children: A Population-Based Cohort Study in Alberta, Canada. Pediatr Emerg Care 2016; 32:658-663. [PMID: 26945191 PMCID: PMC5068196 DOI: 10.1097/pec.0000000000000747] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We examined sociodemographic trends in emergency department ED visits and postvisit health care for anxiety and stress disorders. METHODS Emergency department visits (N = 11,289) by children younger than 18 years were extracted from population-based administrative databases from Alberta, Canada (2002-2011). We examined health services use by demographics and socioeconomic proxy (First Nations status, family subsidy type: government, human services program, none). We calculated visit rates and described physician visits after discharge (n = 8075 children). Multivariable survival analyses (with 95% confidence intervals [CIs]) estimate time to first physician visit and ED return. RESULTS During 2002-2011, visit rates increased by age, First Nations, and subsidy status. The largest increase was for children (all ages) from families receiving government subsidy (491.43/100,000, P < 0.001). Thirty days after an index visit, most physician follow-up visits were made by children aged 15 to 17 years (61.0%) and from families receiving no subsidy (66.5%). The median time to physician follow-up for First Nations children was 32 days (95% CI, 27-37) compared with 19 days for children from families receiving government subsidy whose median time was shortest (95% CI, 18-23). Children (all ages) in the government and human services program subsidy groups and those who had First Nations status returned earlier to the ED compared with children in the no subsidy group. CONCLUSIONS Adolescents had high ED use and physician follow-up, whereas First Nations children and those from families receiving subsidy (all ages) had high ED use and low physician follow-up. Efforts to improve disorder identification and treatment among high ED user groups and low physician follow-up user groups are needed.
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Affiliation(s)
- Amanda S. Newton
- From the *Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; †IWK Health Centre; and ‡Departments of Psychiatry, Pediatrics, and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rhonda J. Rosychuk
- From the *Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; †IWK Health Centre; and ‡Departments of Psychiatry, Pediatrics, and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Xiaoqing Niu
- From the *Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; †IWK Health Centre; and ‡Departments of Psychiatry, Pediatrics, and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ashley D. Radomski
- From the *Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; †IWK Health Centre; and ‡Departments of Psychiatry, Pediatrics, and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick J. McGrath
- From the *Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta; †IWK Health Centre; and ‡Departments of Psychiatry, Pediatrics, and Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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43
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Abdool R, Szego M, Buchman D, Justason L, Bean S, Heesters A, Kaufman H, Parke B, Wagner F, Gibson J. Difficult healthcare transitions. Nurs Ethics 2016; 23:770-783. [DOI: 10.1177/0969733015583185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: In Ontario, Canada, patients who lack decision-making capacity and have no family or friends to act as substitute decision-makers currently rely on the Office of the Public Guardian and Trustee to consent to long-term care (nursing home) placement, but they have no legal representative for other placement decisions. Objectives: We highlight the current gap in legislation for difficult transition cases involving unrepresented patients and provide a novel framework for who ought to assist with making these decisions and how these decisions ought to be made. Research design: This paper considers models advanced by Volpe and Steinman with regard to who ought to make placement decisions for unrepresented patients, as well as current ethical models for analyzing how these decisions should be made. Participants and research context: We describe an anonymized healthcare transition case to illustrate the fact that there is no legally recognized decision-maker for placement destinations other than long-term care facilities and to show how this impacts all stakeholders. Ethical considerations: The case provided is an anonymized vignette representing a typical transition case involving an unrepresented patient. Findings: As a result of a gap in provincial legislation, healthcare providers usually determine the appropriate placement destination without a clear framework to guide the process and this can cause significant moral distress. Discussion: We argue for a team decision-making approach in the short term, and a legislative change in the long-term, to respect the patient voice, evaluate benefit and risk, enhance collaboration between healthcare providers and patients, and promote social justice. We believe that our approach, which draws upon the strengths of interprofessional teams, will be of interest to all who are concerned with the welfare and ethical treatment of the patients for whom they care. Conclusions: One of the main strengths of our recommendation is that it provides all members of the healthcare team (including nurses, social workers, therapists, and others) an increased opportunity to advocate on behalf of unrepresented patients.
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Affiliation(s)
- Rosalind Abdool
- Centre for Clinical Ethics, Canada; Hôtel-Dieu Grace Healthcare, Canada; Joint Centre for Bioethics, University of Toronto, Canada; Department of Philosophy, University of Waterloo, Canada
| | - Michael Szego
- Centre for Clinical Ethics, Canada; Department of Family and Community Medicine, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada
| | - Daniel Buchman
- University Health Network, Canada; Joint Centre for Bioethics, University of Toronto, Canada
| | - Leah Justason
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada
| | - Sally Bean
- Sunnybrook Health Sciences Centre, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada
| | - Ann Heesters
- University Health Network, Canada; Joint Centre for Bioethics, University of Toronto, Canada
| | - Hannah Kaufman
- Department of Family and Community Medicine, University of Toronto, Canada
| | - Bob Parke
- Humber River Hospital, Canada; Joint Centre for Bioethics, University of Toronto, Canada
| | - Frank Wagner
- Department of Family and Community Medicine, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada
| | - Jennifer Gibson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada; Joint Centre for Bioethics, University of Toronto, Canada
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Tobon JI, Reid GJ, Goffin RD. Continuity of Care in Children's Mental Health: development of a measure. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:668-86. [PMID: 24078060 DOI: 10.1007/s10488-013-0518-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A new measure, Continuity of Care in Children's Mental Health (C3MH), is presented. The study involved item generation, pre-testing, pilot testing, and validation. The C3MH was administered to 364 parents recruited from 13 children's mental health agencies in Ontario, Canada. The measure includes five scales supported by confirmatory factor analysis. Scale validity was supported through analyses of relationships with established measures of satisfaction, problem severity, and therapeutic alliance, as well as through known-group differences. The results of a pilot youth-report version (N = 57) are presented. The C3MH will be a useful tool for assessing improvements in system integration.
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Affiliation(s)
- Juliana I Tobon
- Department of Psychology, The University of Western Ontario, London, ON, Canada.
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45
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Schraeder KE, Reid GJ. Why wait? The effect of wait-times on subsequent help-seeking among families looking for children's mental health services. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:553-65. [PMID: 25178864 DOI: 10.1007/s10802-014-9928-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Placement on a wait-list may increase families' help-seeking efforts, leading them to contact more than one children's mental health (MH) agency/professional. Two issues were examined in the current study: 1) Does time on a wait-list for families impact the time to contact a new agency for children's MH services? 2) What are the effects of predisposing (e.g., child age), need (e.g., child psychopathology), and enabling/system-level factors (e.g., parent treatment history) on the length of time parents wait before they contact a new agency for help with their child's MH problems? A total of 273 families seeking help for their child (64% boys, M = 10.7 years old, SD = 3.3) were asked about their contact with MH agencies/professionals during the previous year. Survival analyses, modeling time from initial wait-list placement to when a new agency was contacted, were conducted separately for families who did (n = 114), and those who did not (n = 159), receive help prior to contacting a new agency. Almost half of wait-listed families contacted a new agency by the end of the study period. Longer wait-time was associated with a greater likelihood of seeking help at a second agency with 25% of families contacting a new agency within the first month of being wait-listed. Parents with previous treatment experience and families living in areas with more agencies contacted a new agency sooner. Subsequent help-seeking behaviour suggests parents' intolerance for lengthy treatment delays may result in disorganized pathways to care. These findings suggest a highly fragmented service delivery system.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, 363 Windermere Rd, Room 326E, Westminister Hall, N6A 3K7, London, ON, Canada,
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46
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Caxaj CS. A Review of Mental Health Approaches for Rural Communities: Complexities and Opportunities in the Canadian Context. ACTA ACUST UNITED AC 2016. [DOI: 10.7870/cjcmh-2015-023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Three mental health approaches with potential relevance to rural Canada were reviewed: telepsychiatry, integrated mental health models, and community-based approaches. These approaches have been evaluated in relation to their cost-effectiveness, comprehensiveness, client-centredness, cultural appropriateness, acceptability, feasibility and fidelity; criteria that may vary amidst rural contexts. Collaborative approaches to care, technologies fully integrated into local health systems, multi-sectoral capacity-building, and further engagement with informal social support networks may be particularly promising strategies in rural communities. More research is required to determine rural mental health pathways among diverse social groups, and further, to establish the acceptability of novel approaches in mental health.
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Affiliation(s)
- C. Susana Caxaj
- University of British Columbia
- University of British Columbia
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47
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Mulvale GM, Nguyen TD, Miatello AM, Embrett MG, Wakefield PA, Randall GE. Lost in transition or translation? Care philosophies and transitions between child and youth and adult mental health services: a systematic review. J Ment Health 2016; 28:379-388. [DOI: 10.3109/09638237.2015.1124389] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Tram D. Nguyen
- Faculty of Health Sciences, McMaster University, Ontario, Canada
| | | | - Mark G. Embrett
- Faculty of Health Sciences, McMaster University, Ontario, Canada
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48
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Usability evaluation with mental health professionals and young people to develop an Internet-based cognitive-behaviour therapy program for adolescents with anxiety disorders. BMC Pediatr 2015; 15:213. [PMID: 26675420 PMCID: PMC4682240 DOI: 10.1186/s12887-015-0534-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Use of the Internet to deliver cognitive behavioural therapy, a frontline treatment for anxiety disorders, is emerging as an option to increase access to treatment among adolescents with anxiety disorders. This study examined the usability of the Internet-based component of Breathe, a CBT program designed for adolescents with mild to moderate anxiety and impairments. METHODS A mixed-method usability testing design with semi-structured interviews, task completion, and survey by trained usability moderators was undertaken with two interactive cycles to determine the usability (ease of use, efficiency, errors, and user satisfaction) of the user interface and content areas of the program. Purposeful sampling was used to recruit mental health clinicians with expertise in treating adolescent anxiety disorders and young people aged 15 to 24 years involved. Testing involved using Web-conferencing software that allowed remote participation through personal computers. Two testing cycles involved participants completing structured 'think aloud' and 'cognitive walkthrough' tasks within the program. At the end of each cycle participants completed a 15-item global usability evaluation survey and were asked a series of open-ended questions. Descriptive and simple content analyses were used to identify and score usability issues for frequency and severity. RESULTS Five clinicians and four young people (all < 20 years of age) participated. Most participants described their computer skills as 'good' (60% clinicians, 50% young people), and attitudes toward Internet-based health care ranged from negative (75% young people) to positive (60% clinicians, 25% young people). Scores from the global usability evaluation after both testing cycles ranged from 3.5 to 5 out of 5 in strong agreement/support of the program in terms of user performance indicators (i.e., learnability, efficiency and number of errors) and user satisfaction. Participants were able to complete all critical tasks with minimal errors. Errors and issues identified during testing were predominantly around enhancements to the visual design and navigational support. Opinions across usability elements did not differ between young people and clinician participants. CONCLUSIONS A multi-method remote usability approach provided the opportunity to improve the technical interface, therapeutic messaging and user experience of an Internet-based treatment program for adolescent anxiety disorders.
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49
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Skubby D, Bonfine N, Tracy H, Knepp K, Munetz MR. The Help-Seeking Experiences of Parents of Children with a First-Episode of Psychosis. Community Ment Health J 2015; 51:888-96. [PMID: 25876766 DOI: 10.1007/s10597-015-9877-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
The objective was to understand the experiences of parents as they sought psychological and specialized medical services for a loved one having a first episode of psychosis. The research method was qualitative and the data gathering was done through semi-structured interviews. Eleven parents of eight adolescent or young adult children consented to be interviewed. Data from these interviews were coded and sorted. Parents reported that many of their encounters resulted in delays in accessing treatment. These encounters were characterized by misattributions of the child's behavior, poor advice, misdiagnosis, disbelief in the seriousness of the child's condition, and an unwillingness to share information. But parents also reported that encounters with other individuals were characterized by helpful advice, emotional support, and suggestions as to how to access early intervention services. Encounters with many professionals were generally not helpful to parents. These encounters served as roadblocks to accessing proper treatment for their child. More publicity, outreach, and education are recommended in the professional community.
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Affiliation(s)
- David Skubby
- Department of Sociology and Anthropology, Hendrix College, 1600 Washington Ave., Conway, AR, 72032, USA.
| | - Natalie Bonfine
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
| | - Hattie Tracy
- Child Guidance and Family Solutions, 18 North Forge St., Akron, OH, 44304, USA
| | - Kristen Knepp
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
| | - Mark R Munetz
- Department of Psychiatry, Northeast Ohio Medical University, State Route 44, Rootstown, OH, 44272, USA
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50
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Translating Cognitive Behavioral Therapy for Anxious Youth to Rural-Community Settings via Tele-Psychiatry. Community Ment Health J 2015; 51:852-6. [PMID: 25982829 DOI: 10.1007/s10597-015-9882-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
This study aimed to determine the feasibility of translating cognitive behavioral therapy for anxious youth to rural-community settings via tele-psychiatry training. A 20-week group-supervision training program was delivered to ten different groups from different agencies within Northern Ontario. Each group consisted of four to nine clinicians with child therapy background not specific to CBT (n = 78, 51% social workers, 49% other mental health disciplines). Clinicians were each required to treat an anxious youth under supervision. Changes in clinician knowledge and youth internalizing symptoms were measured. Northern Ontario clinicians showed significant gains on a child CBT-related knowledge test (t (1, 52) = -4.6, p < .001). Although youth treated by these clinicians showed a significant decrease in anxiety symptoms, possible response bias and the lack of a comparison group mandate further studies before generalizing our findings. Nevertheless, training local therapists in anxiety-focused CBT for children via a group supervision based tele-psychiatry model appears to be a feasible and well-received approach to knowledge translation to rural settings.
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