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Chiccarelli E, North S, Pasternak RH. Innovative Strategies for Addressing Adolescent Health in Primary Care Through Telehealth. Pediatr Clin North Am 2024; 71:693-706. [PMID: 39003011 DOI: 10.1016/j.pcl.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
With recent gains in telehealth access across health sectors, this editorial explores adolescent-specific health issues where innovative use of virtual care is improving outcomes and access for adolescents. These include contraception, obesity, gender-affirming care, mental health, and eating disorder care. Clinicians caring for adolescents should be aware of advances in this field to maximize opportunities for their patients to receive evidence-based care in a manner that supports health equity and confidentiality concerns while understanding the evolving regulatory landscape of telehealth.
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Affiliation(s)
- Elvira Chiccarelli
- Brooke Army Medical Center, 3100 Schofield Road, Fort Sam Houston, TX 78234, USA.
| | - Steve North
- Center for Rural Health Innovation, 167 Locust Street, Spruce Pine, NC 28777, USA
| | - Ryan H Pasternak
- Louisiana State University School of Medicine, Childrens Mercy Kansas City, 3101 Broadway Boulevard, Kansas City, MO 64111, USA
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Thomas DC, Litherland EF, Masso S, Raymundo G, Keep M. Clinicians' Decision-Making Regarding Telehealth Services: Focus Group Study in Pediatric Allied Health. JMIR Form Res 2024; 8:e46300. [PMID: 38848121 PMCID: PMC11193077 DOI: 10.2196/46300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 01/16/2024] [Accepted: 02/26/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person. OBJECTIVE The aim of this study is to explore clinicians' decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians' perceptions of telehealth utility beyond COVID-19 lockdowns. METHODS We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community-based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling. RESULTS The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: "flexible telehealth use," "telehealth can be superior to in-person therapy," and "fear that in-person services may be replaced." CONCLUSIONS The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience.
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Affiliation(s)
- Donna Claire Thomas
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Eva Frances Litherland
- Integrated and Community Health, Western Sydney Local Health District, Blacktown, Australia
| | - Sarah Masso
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Gianina Raymundo
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Melanie Keep
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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3
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Creswell C, Taylor L, Giles S, Howitt S, Radley L, Whitaker E, Brooks E, Knight F, Raymont V, Hill C, van Santen J, Williams N, Mort S, Harris V, Yu S, Pollard J, Violato M, Waite P, Yu LM. Digitally augmented, parent-led CBT versus treatment as usual for child anxiety problems in child mental health services in England and Northern Ireland: a pragmatic, non-inferiority, clinical effectiveness and cost-effectiveness randomised controlled trial. Lancet Psychiatry 2024; 11:193-209. [PMID: 38335987 DOI: 10.1016/s2215-0366(23)00429-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/11/2023] [Accepted: 12/12/2023] [Indexed: 02/12/2024]
Abstract
BACKGROUND Anxiety problems are common in children, yet few affected children access evidence-based treatment. Digitally augmented psychological therapies bring potential to increase availability of effective help for children with mental health problems. This study aimed to establish whether therapist-supported, digitally augmented, parent-led cognitive behavioural therapy (CBT) could increase the efficiency of treatment without compromising clinical effectiveness and acceptability. METHODS We conducted a pragmatic, unblinded, two-arm, multisite, randomised controlled non-inferiority trial to evaluate the clinical effectiveness and cost-effectiveness of therapist-supported, parent-led CBT using the Online Support and Intervention (OSI) for child anxiety platform compared with treatment as usual for child (aged 5-12 years) anxiety problems in 34 Child and Adolescent Mental Health Services in England and Northern Ireland. We examined acceptability of OSI plus therapist support via qualitative interviews. Participants were randomly assigned (1:1) to OSI plus therapist support or treatment as usual, minimised by child age, gender, service type, and baseline child anxiety interference. Outcomes were assessed at week 14 and week 26 after randomisation. The primary clinical outcome was parent-reported interference caused by child anxiety at week 26 assessment, using the Child Anxiety Impact Scale-parent report (CAIS-P). The primary measure of health economic effect was quality-adjusted life-years (QALYs). Outcome analyses were conducted blind in the intention-to-treat (ITT) population with a standardised non-inferiority margin of 0·33 for clinical analyses. The trial was registered with ISRCTN, 12890382. FINDINGS Between Dec 5, 2020, and Aug 3, 2022, 706 families (706 children and their parents or carers) were referred to the study information. 444 families were enrolled. Parents reported 255 (58%) child participants' gender to be female, 184 (41%) male, three (<1%) other, and one (<1%) preferred not to report their child's gender. 400 (90%) children were White and the mean age was 9·20 years (SD 1·79). 85% of families for whom clinicians provided information in the treatment as usual group received CBT. OSI plus therapist support was non-inferior for parent-reported anxiety interference on the CAIS-P (SMD 0·01, 95% CI -0·15 to 0·17; p<0·0001) and all secondary outcomes. The mean difference in QALYs across trial arms approximated to zero, and OSI plus therapist support was associated with lower costs than treatment as usual. OSI plus therapist support was likely to be cost effective under certain scenarios, but uncertainty was high. OSI plus therapist support acceptability was good. No serious adverse events were reported. INTERPRETATION Digitally augmented intervention brought promising savings without compromising outcomes and as such presents a valuable tool for increasing access to psychological therapies and meeting the demand for treatment of child anxiety problems. FUNDING Department for Health and Social Care and United Kingdom Research and Innovation Research Grant, National Institute for Health and Care (NIHR) Research Policy Research Programme, Oxford and Thames Valley NIHR Applied Research Collaboration, Oxford Health NIHR Biomedical Research Centre.
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Affiliation(s)
- Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Lucy Taylor
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Sophie Giles
- Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - Lucy Radley
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emily Whitaker
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emma Brooks
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Fauzia Knight
- Centre for Psychological Sciences, University of Westminster, London, UK
| | - Vanessa Raymont
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Claire Hill
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - James van Santen
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Nicola Williams
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Sam Mort
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Victoria Harris
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
| | - Shuye Yu
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jack Pollard
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mara Violato
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Polly Waite
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, UK
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Madhanagopal N, Ahmad A, Hu YH, Olango G, Molla M. Mental Health Symptoms and Service Use in Depressed and Anxious Minors at the Onset of COVID-19 in a County Clinic Serving a Predominantly Hispanic Population. Cureus 2024; 16:e55160. [PMID: 38558688 PMCID: PMC10979717 DOI: 10.7759/cureus.55160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE The study's primary aim was to compare the utilization rates of services by minors with depression/anxiety in a county mental health clinic before (from December 1, 2019, to March 15, 2020) and during the COVID-19 pandemic (from March 16 to June 30, 2020). The secondary aim was to study demographics and psychiatric symptomatology. METHODS Service utilization rates were estimated. Univariate and multivariate logistic regression was used to identify significant predictors of worsening psychiatric symptoms, anxiety, and change in the frequency of therapy between the pre-COVID-19 period and the COVID-19 period. RESULTS Service utilization rates increased during the pandemic period. During the pandemic, the presence of mood symptoms, suicidal ideation, and relationship conflicts predicted worsening psychiatric symptoms. In addition, the presence of preexisting sleep problems and physical health issues that continued during COVID-19 exhibited correlations with worsening psychiatric symptoms during COVID-19. COVID-related stressors and physical health issues were associated with anxiety; suicidal ideation predicted a change in the frequency of therapy. CONCLUSIONS Prospective studies to recognize risk factors for worsening mental health in minors with psychiatric illness during a crisis are warranted to identify and allocate services to the high-risk groups.
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Affiliation(s)
- Nandhini Madhanagopal
- Psychiatry, Child and Adolescent Psychiatry, Kern Medical, Kern Behavioral Health & Recovery Services, UCLA-Kern Child & Adolescent Psychiatry Fellowship Program, Bakersfield, USA
| | - Ammar Ahmad
- Psychiatry, Child and Adolescent Psychiatry, Kern Medical, Kern Behavioral Health & Recovery Services, UCLA-Kern Child & Adolescent Psychiatry Fellowship Program, Bakersfield, USA
| | - Yu-Hsi Hu
- Psychiatry, Child and Adolescent Psychiatry, Veterans Administration, Palo Alto, USA
| | - Garth Olango
- Psychiatry, Child and Adolescent Psychiatry, Kern Medical, Kern Behavioral Health & Recovery Services, UCLA-Kern Child & Adolescent Psychiatry Fellowship Program, Bakersfield, USA
| | - Mohammed Molla
- Psychiatry, Child and Adolescent Psychiatry, Kern Medical, Kern Behavioral Health & Recovery Services, UCLA-Kern Child & Adolescent Psychiatry Fellowship Program, Bakersfield, USA
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5
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von Wirth E, Meininger L, Adam J, Woitecki K, Treier AK, Döpfner M. Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists. J Telemed Telecare 2023:1357633X231157103. [PMID: 36883237 PMCID: PMC9996161 DOI: 10.1177/1357633x231157103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/29/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing. METHODS Caregivers (parents) and psychotherapists of n = 228 patients (4-20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1). RESULTS At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists' ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r < .35). CONCLUSION The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639).
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Affiliation(s)
- Elena von Wirth
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lea Meininger
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Adam
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Katrin Woitecki
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne-Katrin Treier
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Henke RM. Knowing Well, Being Well: well-being born of understanding: The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-288. [PMID: 36646664 DOI: 10.1177/08901171221140641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Nadeem E, R Van Meter A. The Impact of the COVID-19 Pandemic on Adolescents: An Opportunity to Build Resilient Systems. Am J Health Promot 2023; 37:274-281. [PMID: 36646661 DOI: 10.1177/08901171221140641d] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The impact of the COVID-19 pandemic on adolescents is significant. Educational progress and mental health, in particular, have been negatively affected. Among youth from vulnerable communities, pre-existing academic and health disparities have been exacerbated. Youth outcomes are often attributed to individual resilience - or lack thereof; in this paper, we describe how failure to adapt and effectively cope at the system level (ie, lack of system resilience) is implicated in the current dual educational and mental crisis. We describe opportunities to make our systems more nimble and better-equipped to support youth moving forward.
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Affiliation(s)
- Erum Nadeem
- Graduate School of Applied and Professional Psychology, Rutgers University, USA
| | - Anna R Van Meter
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, USA
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8
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Henke RM. The COVID-19 Pandemic and Children: Implications for Future Health. Am J Health Promot 2023; 37:263-264. [PMID: 36646663 DOI: 10.1177/08901171221140641a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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9
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Cassity-Caywood W, Griffiths A, Woodward M, Hatfield A. The Benefits and Challenges of Shifting to Telehealth During COVID-19: Qualitative Feedback from Kentucky's Sexual Violence Resource Centers and Children's Advocacy Centers. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2023; 8:87-99. [PMID: 36597503 PMCID: PMC9801142 DOI: 10.1007/s41347-022-00296-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/31/2022]
Abstract
The onset of the COVID-19 pandemic presented novel challenges for service providers addressing mental health issues with a large shift to the utilization of telehealth. While previous research has examined the benefits and challenges of providing mental health and crisis services remotely through telehealth, little research exists examining the use of telehealth in children's advocacy centers (CACs) and sexual violence resource centers (SVRCs). CACs and SVRCs are multi-disciplinary agencies taking a holistic approach to addressing interpersonal violence, making them unique in that they provide a range of direct services beyond mental health counseling (e.g., legal advocacy, medical exams, and prevention education) but all geared toward public health and safety. The current study explored the experiences of direct service providers in Kentucky CACs and SVRCs and their opinions about the most significant challenges and benefits of adapting their practices at the onset of the COVID-19 pandemic. A total of 118 providers participated in the study, and 88 reported using telehealth (defined as communicating with clients via technology such as videoconferencing, phone calls, or email) since the onset of COVID-19. Qualitative data from those 88 respondents regarding the challenges and benefits of using telehealth were collected and coded using a thematic content analysis. 78.6% of the sample indicated that they served primarily rural areas. Benefits noted included increasing treatment access, increasing treatment flexibility, and advancing continuity of care, while challenges included difficulties with technology, client engagement, privacy, and logistical challenges. Responses highlighted that telehealth presented both a number of advantages and difficulties and that more formal guidance for providers at CACs and SVRCs was desired.
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Affiliation(s)
- Whitney Cassity-Caywood
- Department of Community Leadership and Human Services, Murray State University, Murray, KY USA.,Lifeskills Center for Child Welfare Education and Research, Western Kentucky University, Bowling Green, KY USA.,Paducah Regional Campus, Murray State University, 4430 Sunset Ave, Paducah, KY 42001 USA
| | - Austin Griffiths
- The Department of Social Work Program, Western Kentucky University, Bowling Green, KY USA.,Lifeskills Center for Child Welfare Education and Research, Western Kentucky University, Bowling Green, KY USA
| | - Matthew Woodward
- Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY USA.,Lifeskills Center for Child Welfare Education and Research, Western Kentucky University, Bowling Green, KY USA
| | - Alecia Hatfield
- Department of Psychology, Western Kentucky University, Bowling Green, KY USA.,Lifeskills Center for Child Welfare Education and Research, Western Kentucky University, Bowling Green, KY USA
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10
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Fiala-Baumann B, Ploner H, Witzmann D, Jesser A. Säuglings‑, Kinder- und Jugendlichen- (SKJ) Psychotherapien während der Covid-19 Pandemie: Ergebnisse einer Studie unter psychodynamischen Psychotherapeut*innen in Österreich. PSYCHOTHERAPIE FORUM 2022. [PMCID: PMC9746562 DOI: 10.1007/s00729-022-00213-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Zusammenfassung
Fragestellung
Diese explorative Studie untersucht die Situation der Säuglings‑, Kinder- und Jugendlichen- (SKJ) Psychotherapien während der Covid-19 Pandemie in Österreich.
Methodik
23 psychodynamisch arbeitende Psychotherapeut*innen nahmen an einer Online-Umfrage teil, die quantitative und qualitative Daten generierte. Offene Fragen zu subjektiv wahrgenommenen Veränderungen wurden mithilfe der qualitativen Inhaltsanalyse ausgewertet.
Ergebnisse
Insgesamt sank die Anzahl an Psychotherapien insbesondere bei den Säuglings- und Kleinkind-Psychotherapien. Die Zahl der Kinder und Jugendlichen-Psychotherapien nahm zunächst ab, stieg nach dem ersten Lockdown aber an. Große Nachfrage wurde zuletzt vor allem bei Jugendlichenpsychotherapien wahrgenommen. Anpassungsleistungen an sich ändernde Bedingungen und Settings erforderten große Flexibilität der Psychotherapeut*innen, die mit Fortschreiten der Pandemie zunehmend an ihre Belastungsgrenzen kamen. Befragte beobachteten eine Zunahme an Symptomen sowie einen gestiegenen Bedarf an Eltern- und Vernetzungsarbeit mit Institutionen.
Schlussfolgerungen
Tele-Psychotherapie kann vor allem mit jüngeren Kindern Präsenztherapie nicht ersetzen. Ergebnisse deuten auf eine Unterversorgung dieser Zielgruppe hin. Dies, sowie die beobachtete Zunahme an Symptomen bei älteren Kindern und Jugendlichen, ist gesellschaftspolitisch und gesundheitsökonomisch ein großes Thema und erfordert dringend einen weiteren Ausbau der Versorgungsnetzwerke.
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Affiliation(s)
| | | | | | - Andrea Jesser
- Wissenschaftliche Arbeitsgruppe, D.O.T. – Die offene Tür, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, Dr. Karl-Dorrek-Straße 30, 3500 Krems, Österreich
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Pirutinsky S, Rosmarin DH. A comparative study of mental health diagnoses, symptoms, treatment, and medication use among Orthodox Jews. Transcult Psychiatry 2022; 59:756-766. [PMID: 35018874 DOI: 10.1177/13634615211068607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Historical clinical reports and media narratives suggest that Orthodox Jews are reticent to seek treatment for mental illness, present only with serious concerns, and hesitate to comply with treatment in general and psychopharmacology in particular. On the other hand, recent developments, and some limited research, suggest that Orthodox Jews may be likely to seek and comply with treatment. The current study compared the diagnostic, symptomatic, and treatment characteristics of 191 Orthodox Jews and 154 control patients all presenting to a large private mental health clinic with offices throughout greater New York. Results indicated that the groups were largely demographically similar, and that their diagnoses did not significantly differ. Orthodox Jews initially presented with lower levels of symptoms, terminated with similar symptom levels, attended a similar number of sessions, and were equally likely to use psychopharmacological interventions of similar types, compared to controls. This was equally true of ultra-Orthodox and modern Orthodox Jews. Clinicians providing mental health services to Orthodox Jews should be aware of these findings, which contrast with existing clinical and popular stereotypes. Further, excessive efforts to protect Orthodox Jewish patients against stigma may be unnecessary and counterproductive.
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Affiliation(s)
| | - David H Rosmarin
- Department of Psychiatry, 1811Harvard Medical School.,Spirituality & Mental Health Program, McLean Hospital
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12
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Taylor L, Giles S, Howitt S, Ryan Z, Brooks E, Radley L, Thomson A, Whitaker E, Knight F, Hill C, Violato M, Waite P, Raymont V, Yu LM, Harris V, Williams N, Creswell C. A randomised controlled trial to compare clinical and cost-effectiveness of an online parent-led treatment for child anxiety problems with usual care in the context of COVID-19 delivered in Child and Adolescent Mental Health Services in the UK (Co-CAT): a study protocol for a randomised controlled trial. Trials 2022; 23:942. [PMID: 36384704 PMCID: PMC9667839 DOI: 10.1186/s13063-022-06833-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the context of COVID-19, NHS Child and Adolescent Mental Health Services (CAMHS) and other children's mental health services have faced major challenges in providing psychological treatments that (i) work when delivered remotely and (ii) can be delivered efficiently to manage increases in referrals as social distancing measures have been relaxed. Anxiety problems are a common reason for referral to CAMHS, children with pre-existing anxiety problems are particularly vulnerable in the context of COVID-19, and there were concerns about increases in childhood anxiety as schools reopened. The proposed research will evaluate the clinical and cost-effectiveness of a brief online parent-led cognitive behavioural treatment (CBT) delivered by the OSI (Online Support and Intervention for child anxiety) platform with remote support from a CAMHS therapist compared to 'COVID-19 treatment as usual' (C-TAU) in CAMHS and other children's mental health services throughout the COVID-19 pandemic. METHODS We will conduct a two-arm, multi-site, randomised controlled non-inferiority trial to evaluate the clinical and cost-effectiveness of OSI with therapist support compared to CAMHS and other child mental health services 'COVID-19 treatment as usual' (C-TAU) during the COVID-19 outbreak and to explore parent and therapists' experiences. DISCUSSION If non-inferiority is shown, the research will provide (1) a solution for efficient psychological treatment for child anxiety disorders while social distancing (for the COVID-19 context and future pandemics); (2) an efficient means of treatment delivery as 'normal service' resumes to enable CAMHS to cope with the anticipated increase in referrals; and (3) a demonstration of rapid, high-quality evaluation and application of online interventions within NHS CAMHS to drive forward much-needed further digital innovation and evaluation in CAMHS settings. The primary beneficiaries will be children with anxiety disorders and their families, NHS CAMHS teams, and commissioners who will access a potentially effective, cost-effective, and efficient treatment for child anxiety problems. TRIAL REGISTRATION ISRCTN ISRCTN12890382 . Registered prospectively on 23 October 2020.
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Affiliation(s)
- Lucy Taylor
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Sophie Giles
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Sophie Howitt
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Zoe Ryan
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emma Brooks
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Lucy Radley
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Abigail Thomson
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Emily Whitaker
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Fauzia Knight
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Claire Hill
- grid.9435.b0000 0004 0457 9566School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Mara Violato
- grid.4991.50000 0004 1936 8948Health Economics Research Centre, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Polly Waite
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | - Vanessa Raymont
- grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Ly-Mee Yu
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Victoria Harris
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Williams
- grid.4991.50000 0004 1936 8948Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Cathy Creswell
- grid.4991.50000 0004 1936 8948Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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13
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Carretier E, Bastide M, Lachal J, Moro MR. Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents. Eur Child Adolesc Psychiatry 2022; 32:963-973. [PMID: 36370315 PMCID: PMC9652600 DOI: 10.1007/s00787-022-02108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic catalysed an abrupt explosion in the use telepsychiatry for the delivery of mental health services. We aimed to explore the experience of telemedicine use during this period among adolescent outpatients and inpatients and their parents. This qualitative study took place in a French adolescent medicine and psychiatry department during the first lockdown. Data collection by purposive sampling continued until we reached theoretical sufficiency. The interviews were analysed by applying Interpretative Phenomenological Analysis which is based on an iterative, inductive process. It included 20 participants: 10 adolescents and 10 parents. The analysis showed three themes: (1) facilitators of a switch from face-to-face to tele-consultation: (a) the context of health emergency, (b) the integration of parents in the treatment, (c) the choice between telephone or video consultation; (2) distance from the therapist's gaze and its consequences: (a) an obstacle to decrypting clinical nonverbal communication, (b) effectiveness depends on the severity of the adolescent's symptoms, (c) and on the previous quality of the therapeutic relationship; (3) awareness of the value of the face-to-face therapeutic space. In the post-COVID era, practitioners would benefit from combining both approaches, face-to-face and remote, based on the quality of the therapeutic alliance, the pathology, the parents' availability for in-person participation, and the patient's age. Future quantitative research will also be necessary to establish the extent to which the experiences described by the participants in this study reflect those of a broader population.
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Affiliation(s)
- Emilie Carretier
- Paris Cité University, PCPP, 92100, Boulogne-Billancourt, France. .,Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807, Villejuif, France.
| | | | - Jonathan Lachal
- Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France ,CHU de Clermont-Ferrand, Service de Psychiatrie de l’Enfant et de l’Adolescent, 63000 Clermont-Ferrand, France ,Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Marie Rose Moro
- Paris Cité University, PCPP, 92100 Boulogne-Billancourt, France ,Paris-Saclay University, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France ,APHP, Cochin Hospital, Maison de Solenn, 75014 Paris, France
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14
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Chavira DA, Ponting C, Ramos G. The impact of COVID-19 on child and adolescent mental health and treatment considerations. Behav Res Ther 2022; 157:104169. [PMID: 35970084 PMCID: PMC9339162 DOI: 10.1016/j.brat.2022.104169] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/14/2022] [Accepted: 07/22/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Denise A. Chavira
- University of California Los Angeles, Department of Psychology, USA,Corresponding author. 1285 Franz Hall, PO Box 951563, Los Angeles, CA 90095, USA
| | - Carolyn Ponting
- University of California Los Angeles, Department of Psychology, USA,University of California San Francisco, Department of Psychiatry and Biobehavioral Sciences, USA
| | - Giovanni Ramos
- University of California Los Angeles, Department of Psychology, USA
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15
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Zangani C, Ostinelli EG, Smith KA, Hong JSW, Macdonald O, Reen G, Reid K, Vincent C, Syed Sheriff R, Harrison PJ, Hawton K, Pitman A, Bale R, Fazel S, Geddes JR, Cipriani A. Impact of the COVID-19 Pandemic on the Global Delivery of Mental Health Services and Telemental Health: Systematic Review. JMIR Ment Health 2022; 9:e38600. [PMID: 35994310 PMCID: PMC9400843 DOI: 10.2196/38600] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/05/2022] [Accepted: 07/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic required mental health services around the world to adapt quickly to the new restrictions and regulations put in place to reduce the risk of transmission. As face-to-face contact became difficult, virtual methods were implemented to continue to safely provide mental health care. However, it is unclear to what extent service provision transitioned to telemental health worldwide. OBJECTIVE We aimed to systematically review the global research literature on how mental health service provision adapted during the first year of the pandemic. METHODS We searched systematically for quantitative papers focusing on the impact of the COVID-19 pandemic on mental health services published until April 13, 2021, in the PubMed, Embase, medRxiv, and bioXriv electronic bibliographic databases, using the COVID-19 Open Access Project online platform. The screening process and data extraction were independently completed by at least two authors, and any disagreement was resolved by discussion with a senior member of the team. The findings were summarized narratively in the context of each country's COVID-19 Stringency Index, which reflects the stringency of a government's response to COVID-19 restrictions at a specific time. RESULTS Of the identified 24,339 records, 101 papers were included after the screening process. Reports on general services (n=72) showed that several countries' face-to-face services reduced their activities at the start of the pandemic, with reductions in the total number of delivered visits and with some services forced to close. In contrast, telemental health use rapidly increased in many countries across the world at the beginning of the pandemic (n=55), with almost complete virtualization of general and specialistic care services by the end of the first year. Considering the reported COVID-19 Stringency Index values, the increased use of virtual means seems to correspond to periods when the Stringency Index values were at their highest in several countries. However, due to specific care requirements, telemental health could not be used in certain subgroups of patients, such as those on clozapine or depot treatments and those who continued to need face-to-face visits. CONCLUSIONS During the pandemic, mental health services had to adapt quickly in the short term, implementing or increasing the use of telemental health services across the globe. Limited access to digital means, poor digital skills, and patients' preferences and individual needs may have contributed to differences in implementing and accessing telemental health services during the pandemic. In the long term, a blended approach, combining in-person and virtual modalities, that takes into consideration the needs, preferences, and digital skills of patients may better support the future development of mental health services. It will be required to improve confidence with digital device use, training, and experience in all modalities for both clinicians and service users.
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Affiliation(s)
- Caroline Zangani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | - Katharine A Smith
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - James S W Hong
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Orla Macdonald
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Gurpreet Reen
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Katherine Reid
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | | | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Keith Hawton
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, United Kingdom
| | - Rob Bale
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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16
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Lee CM, Lutz J, Khau A, Lin B, Phillip N, Ackerman S, Steinbuchel P, Mangurian C. Pediatric Primary Care Perspectives of Mental Health Services Delivery during the COVID-19 Pandemic. CHILDREN 2022; 9:children9081167. [PMID: 36010056 PMCID: PMC9406881 DOI: 10.3390/children9081167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022]
Abstract
Due to a national shortage of child and adolescent psychiatrists, pediatric primary care providers (PCPs) are often responsible for the screening, evaluation, and treatment of mental health disorders. COVID-19 pandemic stay-at-home orders decreased access to mental health care and increased behavioral and emotional difficulties in children and adolescents. Despite increased demand upon clinicians, little is known about mental health care delivery in the pediatric primary care setting during the pandemic. This focus group study explored the experiences of pediatric PCPs and clinical staff delivering mental health care during the pandemic. Transcripts from nine focus groups with San Francisco Bay Area primary care practices between April and August 2020 were analyzed using a thematic analysis approach. Providers expressed challenges at the patient-, provider-, and system-levels. Many providers reported increased patient mental health symptomatology during the pandemic, which was often intertwined with patients’ social determinants of health. Clinicians discussed the burden of the pandemic their own wellness, and how the rapid shift to telehealth primary care and mental health services seemed to hinder the availability and effectiveness of many resources. The findings from this study can inform the creation of new supports for PCPs and clinical staff providing mental health care.
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Affiliation(s)
- Chuan Mei Lee
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA;
- Clinical Excellence Research Center, School of Medicine, Stanford University, 453 Quarry Road, Palo Alto, CA 94304, USA
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
- Correspondence: ; Tel.: +1-415-476-7000 or +1-415-502-6361
| | - Jessica Lutz
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Allyson Khau
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Brendon Lin
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Nathan Phillip
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Sara Ackerman
- Department of Social and Behavioral Sciences, University of California San Francisco, 490 Illinois St., Floor 12, Box 0612, San Francisco, CA 94143, USA;
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., 2nd Floor, San Francisco, CA 94158, USA
| | - Petra Steinbuchel
- Benioff Children’s Hospitals Child and Adolescent Psychiatry Portal, University of California San Francisco, 5100 Martin Luther King Jr. Way, Oakland, CA 94609, USA; (J.L.); (A.K.); (B.L.); (N.P.); (P.S.)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA 94143, USA;
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., 2nd Floor, San Francisco, CA 94158, USA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, 2789 25th St., San Francisco, CA 94110, USA
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., San Francisco, CA 94158, USA
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17
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AlRasheed R, Woodard GS, Nguyen J, Daniels A, Park N, Berliner L, Dorsey S. Transitioning to Telehealth for COVID-19 and Beyond: Perspectives of Community Mental Health Clinicians. J Behav Health Serv Res 2022; 49:524-530. [PMID: 35538275 PMCID: PMC9090117 DOI: 10.1007/s11414-022-09799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/11/2022]
Abstract
In response to COVID-19, mental health clinics transitioned to telehealth to maintain psychotherapy delivery. Community mental health (CMH) settings, which are often under-resourced, likely experienced many barriers. This study examined CMH clinicians’ experiences transitioning to telehealth. Data came from a state-funded initiative training CMH clinicians in cognitive behavioral therapy. Participants (N = 197) completed pre-training and post-consultation surveys which included questions about their experiences with telehealth. Most clinicians found telehealth beneficial and effective. Clinicians strongly endorsed wanting telehealth as an option even after in-person services resume. CMH clinicians rated “engaging younger children” as the most significant barrier to telehealth. Despite some telehealth barriers, clinicians generally viewed telehealth favorably and prefer having it as a long-term option. Future work should continue to understand when telehealth may be advantageous and for whom in order to improve the accessibility and quality of behavioral health services.
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Affiliation(s)
- Rashed AlRasheed
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA.
| | - Grace S Woodard
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Julie Nguyen
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Alayna Daniels
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Niya Park
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, 401 Broadway, Suite 2027, Seattle, WA, 98122, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, 119A Guthrie Hall, Box 351525, Seattle, WA, 98105, USA
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Sharma MS, De Maio M, Young K, Santopietro J. Transformation of Outpatient Psychiatry. Psychiatr Clin North Am 2022; 45:57-69. [PMID: 35219442 DOI: 10.1016/j.psc.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Provision of psychiatric services during the pandemic required flexibility, innovation, and collaboration. Going forward, telepsychiatry will offer accessible and effective treatment options. Increased collaboration with multidisciplinary providers, a critical component of effective treatment during the pandemic, should augment future treatment relationships. Large practice organizations continue to develop and disseminate best practices, and providers and institutions must continuously adapt and improve services. An increased focus on the utility of novel and innovative technology's role in psychiatry has emerged during the pandemic, and although openness to innovation will be critical, as will adherence to use of scientifically validated tools and procedures.
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Affiliation(s)
- Manu S Sharma
- Yale School of Medicine, 1450 Chapel Street, New Haven, CT-06511, USA.
| | - Mara De Maio
- Child and Adolescent Services, Institute of Living, 200 Retreat Avenue, Terry Building 2nd floor, Hartford, CT 06106, USA
| | - Kevin Young
- Psychology Training, Institute of Living, 200 Retreat Avenue, Terry Building 2nd floor, Hartford, CT 06106, USA; Psychiatry, University of Connecticut School of Medicine
| | - John Santopietro
- Yale School of Medicine, 1450 Chapel Street, New Haven, CT-06511, USA; University of Connecticut School of Medicine, Farmington, CT 06032, USA; Hartford HealthCare; Behavioral Health Network, Hartford, CT, USA
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19
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Hurtubise K. Telehealth: Moving It Forward as an Option to Enhance Family-Centered Pediatric Rehabilitation Services. A Commentary on "'Another Tool in Your Toolkit': Pediatric Occupational and Physical Therapists' Perspectives of Initiating Telehealth during the COVID-19 Pandemic". Phys Occup Ther Pediatr 2022; 42:482-489. [PMID: 35949140 DOI: 10.1080/01942638.2022.2106769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Karen Hurtubise
- CanChild Center for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, Canada.,Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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20
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Van Meter A, Agrawal N. LovesCompany: evaluating the safety and feasibility of a mental health-focused online community for adolescents. J Child Adolesc Ment Health 2022; 34:83-100. [PMID: 38504652 DOI: 10.2989/17280583.2023.2283030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Background: Adolescents are at risk for mental health (MH) disorders but are unlikely to seek services and may be reluctant to talk about their MH. An anonymous, online MH-focused community could help reduce suffering. However, online forums can also promote negative behaviours such as cyberbullying. This study aimed to evaluate the safety and feasibility of an online community - LovesCompany - to improve MH outcomes for adolescents.Methods: American adolescents (14-17 years) were recruited through social media. Eligible participants were randomised to LovesCompany or a placebo MH resource site. Outcomes were assessed every other week for six months, and at twelve months. Multilevel models assessed group differences in depression, anxiety, and suicidal ideation. A subgroup of participants participated in qualitative interviews.Results: Participants (N = 202) were mostly female (70%), White non-Hispanic (69%), and cisgender (80%). There were no instances of inappropriate behaviour such as bullying or posting explicit content. Symptoms for both groups improved over time. Participants appreciated hearing others' experiences and valued the opportunity to offer support.Conclusion: Although adolescents are often resistant to MH treatment, they appear to be interested in anonymous, online, MH-focused conversation, and can benefit from giving and seeking support. Finding a balance between an appealing user experience, ethical considerations, and resource needs is challenging.
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Affiliation(s)
- Anna Van Meter
- Department of Child and Adolescent Psychiatry, Grossman School of Medicine, New York University Langone Health, New York, USA
- Feinstein Institutes for Medical Research, Institute for Behavioral Science, Manhasset, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Uniondale, USA
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, USA
| | - Neha Agrawal
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, USA
- Community West Treatment Center, Los Angeles, USA
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21
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Svynarenko R, Beebe LH, Lindley LC. Identifying Patterns of Pediatric Mental and Behavioral Health at End of Life: A National Study. J Hosp Palliat Nurs 2021; 23:571-578. [PMID: 34483331 PMCID: PMC8556350 DOI: 10.1097/njh.0000000000000800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Children, who enroll in hospice, have complex mental and behavioral health (MHBH) problems. There is limited literature on patterns of these problems among children at their end of life. Using the national database of 6195 children enrolled in hospice between January 1, 2011, and December 31, 2013, and latent class analysis, this study identified 4 distinctive classes of children. Neurodevelopment and anxiety class (26.5% of the sample) had 41.3% of children of 15 years or older, who had an average of 1.4 MHBH comorbidities and took 17 medications; 29.1% had physical health comorbidities, and 23% were dependent on technology. In the Behavior and Neurodevelopment class (20%), 53.1% of the children were between ages 6 and 14 years, who had an average of 2 MHBH comorbidities and took 17 medications. In the Physiology class (43.4%), 65.5% of children were younger than 5 years, had 1 MHBH comorbidity, and took 19 medications. In the Mood, Behaviors, and Anxiety class (10.2%), more than 90% of children were older than 6 years, had 4 MHBH comorbidities, and took 30 medications. In the latter 3 classes, approximately half of the children either had physical health comorbidities or were technology dependent. These findings highlight the importance of end-of-life care that accounts for the likely presence of complicated patterns of MHBH conditions.
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22
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The Impact of the Covid-19-Related Transition to Telehealth on Visit Adherence in Mental Health Care: An Interrupted Time Series Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:453-462. [PMID: 34716823 PMCID: PMC8556819 DOI: 10.1007/s10488-021-01175-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/18/2022]
Abstract
Covid-19 has led to an unprecedented shift to telemental health (TMH) in mental healthcare. This study examines the impact of this transition on visit adherence for mental health services in an integrated behavioral health department. Monthly visit data for 12,245 patients from January, 2019 to January, 2021 was extracted from the electronic medical record. Interrupted time series (ITS) analysis examined the impact of the Covid-19 transition to TMH on immediate level and trend changes in the percentage of cancelled visits and no shows in the 10 months following the transition. ITS also compared changes across the three largest services types: adult, pediatric, and substance use. Following the TMH-transition, completed visits increased by 10% amounting to an additional 3644 visits. In April, 2020, immediately following the TMH-transition, no shows increased by 1.4%, (95% CI 0.1, 2.7, p < 0.05) and cancellations fell by 13.5% (95% CI − 17.9, − 9.0, p < 0.001). Across the 10-month post-TMH period, 18.2% of visits were cancelled, compared to 28.3% across the 14-month pre-TMH period. The proportion of no-shows remained the same. The pattern was similar for pediatric and adult sub-clinics, but no significant changes in cancellations or no shows were observed in the substance use sub-clinic. TMH during the Covid-19 pandemic is associated with improved visit adherence over time and may be a promising model for improving the efficiency of mental health care delivery once it is safe to resume in person care.
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23
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Addressing Barriers to Primary Care Screening and Referral to Prevention for Youth Risky Health Behaviors: Evidence Regarding Potential Cost-Savings and Provider Concerns. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 23:212-223. [PMID: 34714504 PMCID: PMC8554188 DOI: 10.1007/s11121-021-01321-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
Despite growing evidence and support for co-locating behavioral services in primary care to prevent risky health behaviors, implementation of these services has been limited due to a lack of reimbursement for services and negative perceptions among providers. We investigated potential to overcome these barriers based on new developments in healthcare funding and screening and referral to prevention (SRP) in primary care based on the Consolidated Framework for Implementation Research (CFIR), which could guide future SRP implementation strategies. To investigate the economic need for healthcare-based SRP, we quantified hospital charges to healthcare payors for services arising from adolescent risky behaviors (e.g., substance use, risky sex). Annual North Carolina (NC) hospital charges for these services exceeded $327 M (2019 dollars), suggesting high potential for cost savings if SRP can curb hospital services associated with risky behaviors. To investigate provider barriers and facilitators, we surveyed 151 NC pediatricians and 230 NC family therapists about their attitudes regarding a recently developed well-child visit SRP with family-based prevention. Both sets of professionals reported widespread need for and interest in the SRP but cited barriers of lack of reimbursement, training, and referrals to/from each other. Physicians, but not family therapists, reported concerns with poor patient or parent compliance. Many barriers could be resolved by co-locating family therapists in pediatric clinics to conduct well-child SRP. Our results support further research to develop business models for payor-funded SRP and CFIR-guided research to develop implementation strategies for primary care SRP to prevent adolescent risky health behaviors.
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24
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Palinkas LA, De Leon J, Salinas E, Chu S, Hunter K, Marshall TM, Tadehara E, Strnad CM, Purtle J, Horwitz SM, McKay MM, Hoagwood KE. Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189622. [PMID: 34574547 PMCID: PMC8467758 DOI: 10.3390/ijerph18189622] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 11/16/2022]
Abstract
Background: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure—Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.
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Affiliation(s)
- Lawrence A. Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA; (J.D.L.); (E.S.); (S.C.)
- Correspondence: ; Tel.: +1-858-922-7265; Fax: +1-213-740-0789
| | - Jessenia De Leon
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA; (J.D.L.); (E.S.); (S.C.)
| | - Erika Salinas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA; (J.D.L.); (E.S.); (S.C.)
| | - Sonali Chu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA; (J.D.L.); (E.S.); (S.C.)
| | - Katharine Hunter
- Office of Child and Family Services, Virginia Department of Behavioral Health and Developmental Services, Richmond, VA 23218, USA;
| | - Timothy M. Marshall
- Office of Community Mental Health, Connecticut Department of Children and Families, Hartford, CT 06103, USA;
| | - Eric Tadehara
- Utah Department of Human Services, Substance Abuse and Mental Health, Salt Lake City, UT 84116, USA;
| | - Christopher M. Strnad
- Office of Children’s Behavioral Health, Department of Children, Youth and Families, Providence, RI 02903, USA;
| | - Jonathan Purtle
- Department of Health Management & Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA 19104, USA;
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY 10016, USA; (S.M.H.); (K.E.H.)
| | - Mary M. McKay
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, USA;
| | - Kimberly E. Hoagwood
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY 10016, USA; (S.M.H.); (K.E.H.)
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25
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Cunningham NR, Ely SL, Barber Garcia BN, Bowden J. Addressing Pediatric Mental Health Using Telehealth During Coronavirus Disease-2019 and Beyond: A Narrative Review. Acad Pediatr 2021; 21:1108-1117. [PMID: 34118499 PMCID: PMC8413840 DOI: 10.1016/j.acap.2021.06.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/11/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023]
Abstract
The pediatrician serves as a frontline provider addressing patients' medical and mental health needs, yet coronavirus disease-2019 (COVID-19) is reshaping the way physicians deliver care. Pediatricians are increasingly faced with the challenge of delivering care, including mental health care, remotely. Given the rapidly evolving literature, we performed a narrative review of the use of telehealth for mental health care for pediatric populations during the COVID-19 pandemic. Areas of focus included 1) pediatric primary care settings, 2) special pediatric populations (eg, eating disorders, autism), 3) access and engagement in telehealth care, and 4) training opportunities available for mental health providers. Themes that emerged across studies included the importance of meeting patients' needs (eg, access to technological resources) to optimize success in using telehealth tools and challenges around provider access to support tools for use during telehealth. Thus, we provided a summary of evidence-based tools (including COVID-19 specific resources) for improving the remote delivery of mental health care by pediatricians. We also reviewed future directions including trials currently underway to enhance understanding of future telehealth applications for pediatric mental health care.
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Affiliation(s)
- Natoshia R. Cunningham
- Department of Family Medicine, Michigan State University (NR Cunningham and SL Ely), Grand Rapids, Mich,Address correspondence to Natoshia R. Cunningham, PhD, Department of Family Medicine, Michigan State University, 15 Michigan St NE, Grand Rapids, MI 49503
| | - Samantha L. Ely
- Department of Family Medicine, Michigan State University (NR Cunningham and SL Ely), Grand Rapids, Mich
| | - Brittany N. Barber Garcia
- College of Human Medicine, Michigan State University (BNB Garcia and J Bowden), Grand Rapids, Mich,Spectrum Health, Helen DeVos Children's Hospital (BN Barber Garcia and J Bowden), Grand Rapids, Mich
| | - Jennifer Bowden
- College of Human Medicine, Michigan State University (BNB Garcia and J Bowden), Grand Rapids, Mich,Spectrum Health, Helen DeVos Children's Hospital (BN Barber Garcia and J Bowden), Grand Rapids, Mich
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