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Ashcroft R, Donnelly C, Sheffield P, Lam S, Kemp C, Adamson K, Brown JB. A qualitative examination of the experiences and perspectives of interprofessional primary health care teams in the distribution of the COVID-19 vaccination in Ontario, Canada. PLoS One 2024; 19:e0304616. [PMID: 38857248 PMCID: PMC11164373 DOI: 10.1371/journal.pone.0304616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 05/15/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Primary health care (PHC) teams contributed to all phases of the COVID-19 vaccination distribution. However, there has been criticism for not fully utilizing the expertise and infrastructure of PHC teams for vaccination distribution. Our study sought to understand the role PHC teams had in the distribution of the COVID-19 vaccine in Ontario, Canada. The key objective informing this study was to explore the experiences and perspectives of interprofessional PHC teams in the distribution of COVID-19 vaccination across Ontario. METHODS A qualitative approach was used for this study, which involved 39 participants from the six health regions of the province. Eight focus groups were conducted with a range of interprofessional healthcare providers, administrators, and staff working in PHC teams across Ontario. The sample reflected a diverse range of clinical, administrative, and leadership roles in PHC. Focus groups were audio-recorded and transcribed, while transcriptions were then analyzed using thematic analysis. RESULTS We identified the following four themes in the data: i) PHC teams know their patients; ii) mobilizing team capacity for vaccination, iii) intersectoral collaborations, and iv) operational challenges. CONCLUSIONS PHC teams were an instrumental component in supporting COVID-19 vaccinations in Ontario. The involvement of PHC in future vaccination efforts is key but requires additional resourcing and inclusion of PHC in decision-making. This will ensure provider well-being and maintain collaborations established during COVID-19 vaccination.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Donnelly
- Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Connor Kemp
- Frontenac, Lennox, and Addington Ontario Health Team, Kingston, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Ashcroft R, Menear M, Dahrouge S, Silveira J, Emode M, Booton J, Bahniwal R, Sheffield P, McKenzie K. Nurturing an organizational context that supports team-based primary mental health care: A grounded theory study. PLoS One 2024; 19:e0301796. [PMID: 38687719 PMCID: PMC11060570 DOI: 10.1371/journal.pone.0301796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The expansion of the Patient-Centred Medical Home model presents a valuable opportunity to enhance the integration of team-based mental health services in primary care settings, thereby meeting the growing demand for such services. Understanding the organizational context of a Patient-Centred Medical Home is crucial for identifying the facilitators and barriers to integrating mental health care within primary care. The main objective of this paper is to present the findings related to the following research question: "What organizational features shape Family Health Teams' capacity to provide mental health services for depression and anxiety across Ontario, Canada?" METHODS Adopting a constructivist grounded theory approach, we conducted interviews with various mental health care providers, and administrators within Ontario's Family Health Teams, in addition to engaging provincial policy informants and community stakeholders. Data analysis involved a team-based approach, including code comparison and labelling, with a dedicated data analysis subcommittee convening monthly to explore coded concepts influencing contextual factors. RESULTS From the 96 interviews conducted, involving 82 participants, key insights emerged on the organizational contextual features considered vital in facilitating team-based mental health care in primary care settings. Five prominent themes were identified: i) mental health explicit in the organizational vision, ii) leadership driving mental health care, iii) developing a mature and stable team, iv) adequate physical space that facilitates team interaction, and v) electronic medical records to facilitate team communication. CONCLUSIONS This study underscores the often-neglected organizational elements that influence primary care teams' capacity to deliver quality mental health care services. It highlights the significance of strong leadership complemented by effective communication and collaboration within teams to enhance their ability to provide mental health care. Strengthening relationships within primary care teams lies at the core of effective healthcare delivery and should be leveraged to improve the integration of mental health care.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Menear
- Faculty of Medicine, Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Simone Dahrouge
- Faculty of Medicine, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jose Silveira
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Monica Emode
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jocelyn Booton
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Kwame McKenzie
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Wellesley Institute, Toronto, Ontario, Canada
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Geary O, Grealish A, Bright AM. The effectiveness of mother-led infant massage on symptoms of maternal postnatal depression: A systematic review. PLoS One 2023; 18:e0294156. [PMID: 38091329 PMCID: PMC10718423 DOI: 10.1371/journal.pone.0294156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/25/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Postnatal depression is a significant public health issue which may escalate and lead to adverse outcomes for women, infants, their family and the wider society. The aim of this review was to examine the effectiveness and experiences of mother-led infant massage on symptoms of maternal postnatal depression and to synthesise these findings to inform policy, practice and further research. METHODS A systematic search of five academic databases was conducted: CINAHL, MEDLINE, EMBASE, PsycINFO and Allied and Complementary Medicine Database in February 2023 with no date or geographic limiters set owing to the paucity of research on this subject area. Quality appraisal was undertaken using the Joanna Briggs Institute quality appraisal tools and all included RCT's were assessed separately using the Cochrane Risk of Bias Tool. Narrative synthesis was used to analyse the data. FINDINGS A total of (n = 323) studies were returned of which (n = 8) met the inclusion criteria for the review. This review identified a total sampling of (n = 521) women with maternal postnatal depression. The results are presented under three themes: 1) the effectiveness of mother-led infant massage on symptoms of postnatal depression; 2) women's experiences of mother-led infant massage; and 3) the effects of mother-led infant massage on the mother-infant relationship. DISCUSSION The review highlights women who used infant massage displayed a reduction in symptoms of postnatal depression, improved mother-infant interactions and improved self-efficacy in addition to benefits for infants. Public Health Nurse/Community Midwife-led infant massage may help to relieve such symptoms and empower women.
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Affiliation(s)
- Orla Geary
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Annmarie Grealish
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Ann-Marie Bright
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
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Kourgiantakis T, Markoulakis R, Lee E, Hussain A, Lau C, Ashcroft R, Goldstein AL, Kodeeswaran S, Williams CC, Levitt A. Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers. Int J Ment Health Syst 2023; 17:4. [PMID: 36918893 PMCID: PMC10011786 DOI: 10.1186/s13033-023-00572-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/31/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers. METHODS This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data. RESULTS The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do." CONCLUSION Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | - Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Carrie Lau
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Kourgiantakis T, Markoulakis R, Hussain A, Lee E, Ashcroft R, Williams C, Lau C, Goldstein AL, Kodeeswaran S, Levitt A. Navigating inequities in the delivery of youth mental health care during the COVID-19 pandemic: perspectives of youth, families, and service providers. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:806-816. [PMID: 35852728 PMCID: PMC9663755 DOI: 10.17269/s41997-022-00670-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 06/28/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16-24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers. METHODS Using a descriptive qualitative research design and a university-community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data. RESULTS The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic. CONCLUSION At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health services.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 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
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Charmaine Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Carrie Lau
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Abby L. Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON Canada
| | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON Canada ,Faculty of Medicine, University of Toronto, Toronto, ON Canada
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The Feasibility of a Primary Care Based Navigation Service to Support Access to Health and Social Resources: The Access to Resources in the Community (ARC) Model. Int J Integr Care 2022; 22:13. [PMID: 36474646 PMCID: PMC9695153 DOI: 10.5334/ijic.6500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/28/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION We established a patient centric navigation model embedded in primary care (PC) to support access to the broad range of health and social resources; the Access to Resources in the Community (ARC) model. METHODS We evaluated the feasibility of ARC using the rapid cycle evaluations of the intervention processes, patient and PC provider surveys, and navigator log data. PC providers enrolled were asked to refer patients in whom they identified a health and/or social need to the ARC navigator. RESULTS Participants: 26 family physicians in four practices, and 82 of the 131 patients they referred. ARC was easily integrated in PC practices and was especially valued in the non-interprofessional practices. Patient overall satisfaction was very high (89%). Sixty patients completed the post-intervention surveys, and 33 reported accessing one or more service(s). CONCLUSION The ARC Model is an innovative approach to reach and support a broad range of patients access needed resources. The Model is feasible and acceptable to PC providers and patients, and has demonstrated potential for improving patients' access to health and social resources. This study has informed a pragmatic randomized controlled trial to evaluate the ARC navigation to an existing web and telephone navigation service (Ontario 211).
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Ashcroft R, Donnelly C, Gill S, Dancey M, Lam S, Grill AK, Mehta K. The Delivery of Patient Care in Ontario's Family Health Teams during the First Wave of the COVID-19 Pandemic. Healthc Policy 2021; 17:72-89. [PMID: 34895411 PMCID: PMC8665725 DOI: 10.12927/hcpol.2021.26656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The objective of this paper was to identify continuations and changes in care delivery methods in primary care teams during the COVID-19 pandemic. DESIGN The study used a cross-sectional, web-based survey comprising close-ended and open-ended questions. SETTING The setting comprised family health teams (FHTs) across Ontario, Canada. PARTICIPANTS The participants included executive directors of FHTs or designates of their choosing. SURVEY Descriptive statistics were derived from responses to close-ended questions, and responses to open-ended questions were coded using thematic analysis. RESULTS With 93 participants, the response rate was 48%. Participants reported the continuation of in-person care, the implementation of virtual care across FHTs and collaboration within these teams and their communities.
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Affiliation(s)
- Rachelle Ashcroft
- Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
| | - Catherine Donnelly
- Associate Professor, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Sandeep Gill
- Quality and Knowledge Translation Manager, Association of Family Health Teams of Ontario, Toronto, ON
| | - Maya Dancey
- Research Intern, Telfer School of Management, University of Ottawa, Ottawa, ON
| | - Simon Lam
- Research Associate, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
| | - Allan K Grill
- Associate Professor, Department of Family & Community Medicine, University of Toronto, Toronto, ON; Lead Physician, Markham Family Health Team, Chief, Department of Family Medicine, Markham Stouffville Hospital, Markham, ON
| | - Kavita Mehta
- Chief Executive Officer, Association of Family Health Teams of Ontario, Toronto, ON
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