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Coronado-Montoya S, Abdel-Baki A, Crockford D, Côté J, Dubreucq S, Dyachenko A, Fischer B, Lecomte T, L’Heureux S, Ouellet-Plamondon C, Roy MA, Tibbo P, Villeneuve M, Jutras-Aswad D. Preferences of Young Adults With Psychosis for Cannabis-Focused Harm Reduction Interventions: A Cross-Sectional Study: Préférences des jeunes adultes souffrant de psychose pour les interventions de réduction des méfaits axées sur le cannabis : une étude transversale. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:524-535. [PMID: 38571478 PMCID: PMC11168346 DOI: 10.1177/07067437241242395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Cannabis use is common in people with early-phase psychosis (EP) and is associated with worse treatment outcomes. Few targeted interventions for cannabis use behaviour in this population exist, most focusing on abstinence, none focusing on harm reduction. Many people with EP will not seek treatment for their cannabis use with current therapeutic options. Understanding preferences for cannabis-focused harm reduction interventions may be key to improving outcomes. This study aimed to determine preferences of young adults with EP who use cannabis for cannabis-focused harm reduction interventions. METHODS Eighty-nine young adults across Canada with EP interested in reducing cannabis-related harms were recruited. An online questionnaire combining conventional survey methodology and two unique discrete choice experiments (DCEs) was administered. One DCE focused on attributes of core harm reduction interventions (DCE 1) and the second on attributes of boosters (DCE 2). We analysed these using mixed ranked-ordered logistic regression models. Preference questions using conventional survey methodology were analysed using summary statistics. RESULTS Preferred characteristics for cannabis-focused harm reduction interventions (DCE 1) were: shorter sessions (60 min vs. 10 min, odds ratio (OR): 0.72; P < 0.001); less frequent sessions (daily vs. monthly, OR: 0.68; P < 0.001); shorter interventions (3 months vs. 1 month, OR: 0.80; P < 0.01); technology-based interventions (vs. in-person, OR: 1.17; P < 0.05). Preferences for post-intervention boosters (DCE 2) included opting into boosters (vs. opting out, OR: 3.53; P < 0.001) and having shorter boosters (3 months vs. 1 month, OR: 0.79; P < 0.01). Nearly half of the participants preferred to reduce cannabis use as a principal intervention goal (vs. using in less harmful ways or avoiding risky situations). CONCLUSIONS Further research is required to see if technology-based harm reduction interventions for cannabis featuring these preferences translate into greater engagement and improved outcomes in EP patients.
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Affiliation(s)
- Stephanie Coronado-Montoya
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Department of Psychiatry, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - David Crockford
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - José Côté
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Faculty of Nursing, Université de Montréal, Montréal, Canada
| | - Simon Dubreucq
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Alina Dyachenko
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Addiction and Mental Health, Simon Fraser University, Vancouver, Canada
- Research & Graduate Studies Division, University of the Fraser Valley, Abbotsford, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- School of Population Health, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Tania Lecomte
- Department of Psychology, University of Montréal, Montréal, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
| | - Sophie L’Heureux
- Clinique Notre-Dame des Victoires, Institut Universitaire en Santé Mentale, Centre Intégré Universitaire de Soins et Services Sociaux de la Capitale Nationale, Québec, Canada
- Department of Psychiatry and Neurosciences, Laval University, Québec, Canada
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Department of Psychiatry, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Laval University, Québec, Canada
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Québec, Québec, Canada
- Centre de Recherche CERVO, Québec, Canada
| | - Philip Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Marie Villeneuve
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montréal, Canada
- Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- Department of Psychiatry, Centre Hospitalier de l’Université de Montréal, Montréal, Canada
- University Institute on Addictions, Montréal, Canada
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Chavarria V, Rubio-Valera M, Doménech Abella J, Baladón LH, Mateu I, Arias de la Torre J, Alvarós JC, Peña-Salazar C, Dima AL, Serrano-Blanco A. Patient Satisfaction and Willingness to Continue with Telemental Health Care During and After the Early Period of SARS-CoV-2 Pandemic: A User Survey. Telemed J E Health 2024; 30:e1935-e1943. [PMID: 38597958 DOI: 10.1089/tmj.2023.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Objective: The SARS-CoV-2 pandemic and related lockdown periods generated an increase in the use of virtual care for mental health (MH). This study aimed to assess patient satisfaction with Telemental Health services (TMH) during first lockdown and factors related to their willingness to continue using this service. Methods: We conducted a cross-sectional survey of 364 MH outpatients from 9 centers in the Barcelona region (Spain), who received TMH between April 20 and May 22, 2020. We assessed sociodemographic and clinical characteristics, prior experience, and familiarity with technologies and satisfaction with TMH. Willingness to receive TMH after the lockdown was measured separately for telephone and videoconferencing. We performed descriptive statistics and bivariate and multivariate regression models to predict TMH willingness. Results: From 450 patients contacted, 364 were interviewed. Satisfaction with TMH was high (mean 9.24, standard deviation 0.07); 2.47% preferred only TMH visits after lockdown, 23.08% preferred mostly TMH visits, 50.82% accepted some TMH visits, and 23.63% would prefer in-person consultations. Female patients and those having received TMH during lockdown showed higher odds of willingness to receive TMH in the future, while patients unfamiliar with technologies showed lower odds. Concerning TMH through telephone, willingness was more likely in patients living with more persons. Videoconferencing willingness was more likely for people living with depression. Conclusions: TMH was well accepted during the first lockdown and patients were willing to maintain it after lockdown. Low familiarity with new technologies is an important barrier to TMH willingness, which needs to be addressed for appropriate implementation going forward.
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Affiliation(s)
- Victor Chavarria
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, Madrid, Spain
| | - Maria Rubio-Valera
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Joan Doménech Abella
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Luisa Higuera Baladón
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud, Madrid, Spain
| | - Isabel Mateu
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Jorge Arias de la Torre
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Care in Long Term Conditions Research Division, King's College London, London, United Kingdom
- Institute of Biomedicina, University of Leon, Leon, Spain
| | | | - Carlos Peña-Salazar
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Alexandra L Dima
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Antoni Serrano-Blanco
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
- Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
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3
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AshaRani PV, Tan YWB, Samari E, Wang P, Cetty L, Satghare P, Verma SK, Tang C, Subramaniam M. The relationship between therapeutic alliance, frequency of consultation and uptake of telemedicine among patients seeking treatment for early psychosis: A moderated mediation model. Digit Health 2024; 10:20552076241247194. [PMID: 38698830 PMCID: PMC11064748 DOI: 10.1177/20552076241247194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/05/2024] Open
Abstract
Background Telehealth services ensure the delivery of healthcare services to a wider range of consumers through online platforms. Nonetheless, the acceptance and uptake of telehealth remain elusive. This study aims to understand the (a) uptake and (b) acceptability of telemedicine, (c) if therapeutic alliance mediates the relationship between the frequency of consultations with clinicians and the uptake of telemedicine in patients with early psychosis, and (d) role of education in moderating the relationship between therapeutic alliance and the uptake of telemedicine for their mental healthcare. Methods A convenience sample of outpatients (n = 109) seeking treatment for early psychosis and their care providers (n = 106) were recruited from a tertiary psychiatric care centre. Sociodemographic and clinical characteristics, therapeutic alliance (Working Alliance Inventory), and telemedicine use were captured through self-administered surveys. The moderated mediation analysis was performed using PROCESS macro 3.4.1 with therapeutic alliance and level of education as the mediating and moderating factors, respectively. Results The acceptance of telemedicine was high (possibly will use: 47.7%; definitely will use: 26.6%) whilst the uptake was low (11%). Therapeutic alliance mediated the relationship between the frequency of consultation and the uptake of telemedicine (β: 0.326; CI: 0.042, 0.637). This effect was moderated by the level of education (β: -0.058; p < 0.05). Conclusion Therapeutic alliance mediates the relationship between the frequency of consultations and the uptake of telemedicine services with the level of education moderating this mediation. Focusing on the patients with lower education to improve their telemedicine knowledge and therapeutic alliance might increase the uptake.
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Affiliation(s)
- PV AshaRani
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Ellaisha Samari
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Pratika Satghare
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Swapna K Verma
- Department of Psychosis, Duke-NUS Medical School, Singapore, Singapore
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Charmaine Tang
- Early Psychosis Intervention Programme, Department of Psychosis, Institute of Mental Health, Singapore, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Ricklan SJ, Sohler N, Ezie CEC, Avalone L, Dinsell V, Lewis C, Fattal O, Balan S, McQuistion H, Pastore F, Sarcevic N, Swift R, Espejo G, Lorenz C. Impact of Telemedicine on Utilization of Psychiatric Resources in New York City during the COVID-19 Pandemic. Community Ment Health J 2024; 60:115-123. [PMID: 38105337 DOI: 10.1007/s10597-023-01210-1] [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] [Received: 05/17/2023] [Accepted: 11/04/2023] [Indexed: 12/19/2023]
Abstract
This study sought to evaluate the impact of telepsychiatry during the COVID-19 pandemic among patients discharged from psychiatric inpatient units in the New York City Health and Hospitals Corporation system. We compared patients discharged to telepsychiatry (April 2020, n = 739) and in-person follow-up (May 2019, n = 527); we collected number, timing and attendance for follow-up appointments and number and timing of emergency room (ER) visits and readmissions. We used logistic regression to evaluate the odds of having these encounters and Kaplan-Meier analyses to compare time to these encounters. Patients discharged in 2020 were more likely to have a follow-up (29.4 vs. 19.9%, p < 0.001) and an ER visit or readmission (40.5 vs. 28.7%, p < 0.001). Kaplan-Meier analyses showed shorter time to first follow-up (chi-square = 14.69, d.f.=1, p < 0.0001, follow-ups = 322) and ER visit or readmission (chi-square = 19.57, d.f.=1, p < 0.0001, ER visits or admissions = 450) in the 2020 cohort. In multivariable analyses, patients discharged in 2020 were more likely to have a follow-up visit (adjusted OR 1.85, 95% confidence interval 1.40, 2.45, p < 0.0001). We found an increase in psychiatric service utilization during the pandemic, with an increase in and shorter time until outpatient visits and ER visits or readmissions. Although increased use of psychiatric services during the height of the COVID-19 pandemic is encouraging, it also points to the depth of the crisis among vulnerable populations; this pattern warrants further exploration and intervention.
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Affiliation(s)
- Sarah J Ricklan
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA.
| | - Nancy Sohler
- CUNY School of Medicine, Harris Hall, 160 Convent Avenue, New York, 10031, NY, USA
| | - C E Chiemeka Ezie
- NYU Grossman School of Medicine, 550 First Ave, New York, NY, 10016, USA
| | - Lynsey Avalone
- NYC Health and Hospitals, 125 Worth Street, New York, NY, 10013, USA
| | - Victoria Dinsell
- NYU Grossman School of Medicine, 462 1st Avenue, New York, NY, 10016, USA
| | - Crystal Lewis
- NYU Grossman School of Medicine, One Park Ave, New York, NY, 10016, USA
| | - Omar Fattal
- NYC Health and Hospitals, 125 Worth Street, Office 423, New York, NY, 10013, USA
| | - Sabish Balan
- Harlem Hospital, 506 Lenox Avenue, New York, NY, 10037, USA
| | - Hunter McQuistion
- NYU Grossman School of Medicine, One Park Ave, 8th Floor, New York, NY, 10016, USA
| | - Frank Pastore
- North Central Bronx Hospital, 3424 Kossuth Avenue, New York, NY, 10467, USA
| | - Nermica Sarcevic
- Jacobi Hospital, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Ronnie Swift
- NY Health and Hospitals/Metropolitan, 1901 First Avenue, New York, NY, 10029, USA
| | - Gemma Espejo
- Montefiore Medical Center, 111 East 210th St, New York, NY, 10467, USA
| | - Carina Lorenz
- NYC Health and Hospitals-Bellevue, 462 1st Avenue, New York, NY, 10016, USA
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5
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Coronado-Montoya S, Abdel-Baki A, Côté J, Crockford D, Dubreucq S, Fischer B, Lachance-Touchette P, Lecomte T, L'Heureux S, Ouellet-Plamondon C, Roy MA, Tatar O, Tibbo P, Villeneuve M, Wittevrongel A, Jutras-Aswad D. Evaluation of a Cannabis Harm Reduction Intervention for People With First-Episode Psychosis: Protocol for a Pilot Multicentric Randomized Trial. JMIR Res Protoc 2023; 12:e53094. [PMID: 38109196 PMCID: PMC10758938 DOI: 10.2196/53094] [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: 09/25/2023] [Revised: 10/27/2023] [Accepted: 11/24/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Cannabis use is highly prevalent in young people with first-episode psychosis (FEP). Most report cannabis use and are often diagnosed with a cannabis use disorder upon admission to specialized services for psychosis. Cannabis use in this population is associated with worse clinical and psychosocial outcomes, rendering it an important clinical target. Despite this, few cannabis-specific interventions have been developed for FEP and empirically evaluated through randomized controlled trials. Most evaluated interventions have targeted cannabis abstinence, with limited efficacy, but none have centered on harm reduction outcomes for people with FEP who use cannabis. Early intervention services (EIS), the standard of care for FEP, have not successfully addressed problematic cannabis use in people with FEP either. Clinical trials are needed to explore the potential of harm reduction strategies, although these should be preceded by robust pilot studies to establish optimal design and approaches. OBJECTIVE Recognizing the need for harm reduction strategies for individuals with FEP who use cannabis and based on research on patients' preferences supporting harm reduction interventions, we developed a mobile app-based cannabis harm reduction intervention for this population. This intervention is called Cannabis Harm-reducing Application to Manage Practices Safely (CHAMPS). Here, we describe the protocol for a multicenter, 2-arm, parallel group, randomized pilot trial evaluating the acceptability of CHAMPS for people with FEP who use cannabis and the feasibility of conducting a full-scale trial in this population using CHAMPS. The impact on key clinical outcomes will also be explored. METHODS This pilot trial aims to recruit 100 young people with FEP using cannabis from 6 Canadian EIS clinics. Participants will be randomized in a 1:1 ratio to CHAMPS+EIS or EIS-only. CHAMPS acceptability will be assessed using completion rates for the intervention arm. Trial feasibility will be assessed using a retention rate for randomized participants. Secondary outcomes will explore tendencies of change in the use of protective behavioral strategies and in motivation to change strategies. Exploratory outcomes include cannabis use-related problems, other substance use, the severity of dependence, psychotic symptoms, and health care service use. RESULTS Recruitment began in December 2021. Data collection and analysis are expected to be completed in early 2024. Study results describing CHAMPS acceptability and trial feasibility will then be submitted for publication in a peer-reviewed journal. CONCLUSIONS CHAMPS uniquely combines evidence-based approaches, patient perspectives, and mobile health technology to support harm reduction in people with FEP who use cannabis. Attaining adequate acceptability and feasibility through this trial may justify further exploration of harm reduction tools, particularly within the context of conducting a larger-scale randomized controlled trial. This pilot trial has the potential to advance knowledge for researchers and clinicians regarding a feasible and user-acceptable research design in the cannabis and early psychosis fields. TRIAL REGISTRATION ClinicalTrials.gov NCT04968275, https://clinicaltrials.gov/ct2/show/NCT04968275. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53094.
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Affiliation(s)
- Stephanie Coronado-Montoya
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - José Côté
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - David Crockford
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Simon Dubreucq
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Benedikt Fischer
- Centre for Applied Research in Addiction and Mental Health, Simon Fraser University, Vancouver, BC, Canada
- Research & Graduate Studies Division, University of the Fraser Valley, Abbotsford, BC, Canada
- Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
- School of Population Health, University of Auckland, Auckland, New Zealand
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Tania Lecomte
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Sophie L'Heureux
- Clinique Notre-Dame des Victoires, Institut Universitaire en Santé Mentale, Centre Intégré Universitaire de Soins et Services Sociaux de la Capitale Nationale, Québec, QC, Canada
- Department of Psychiatry and Neurosciences, Laval University, Québec, QC, Canada
| | - Clairélaine Ouellet-Plamondon
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marc-André Roy
- Department of Psychiatry and Neurosciences, Laval University, Québec, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
- Centre de Recherche CERVO, Québec, QC, Canada
| | - Ovidiu Tatar
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Phillip Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Marie Villeneuve
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Anne Wittevrongel
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
- Department of Psychiatry, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- University Institute on Addictions, Montreal, QC, Canada
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6
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Lal S, Abdel-Baki A, Peredo R. Clinician perspectives on providing telepsychiatry services to young adults with first-episode psychosis during COVID-19. Early Interv Psychiatry 2023; 17:1189-1198. [PMID: 37057704 DOI: 10.1111/eip.13416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Telepsychiatry has the potential to facilitate access to mental health services for young people with first-episode of psychosis (FEP); however, limited attention has been given regarding the perceptions of mental health providers in this regard. OBJECTIVE To assess service providers' perceptions on the use of telepsychiatry and changes over time. METHODS Longitudinal survey (conducted at two time points) of 26 service providers, including physicians, nurses, social workers, occupational therapists, and peer support workers, recruited from a specialized program for FEP providing telepsychiatry services through REACTS (videoconferencing platform). RESULTS Responses during the initial and the follow-up survey were similar. Most participants used REACTS nine times or more, with more than half reporting that sessions lasted more than 30 min. Over time, there was a trend towards higher frequency of use and lower duration of sessions. The majority perceived REACTS as safe and easy to use and indicated they would recommend REACTS to colleagues. Although participants reported some issues related to set-up and initial use, internet accessibility, and sound and image, most of these concerns decreased during follow-up. Participants appreciated the usability and utility of REACTS, and reported several benefits of telepsychiatry, including facilitating client engagement, assessment and continuity. CONCLUSIONS Service providers expressed positive perceptions regarding the use of telepsychiatry. Despite analysis being limited to a small sample, this study raises awareness of telepsychiatry's value and feasibility for offering services to young populations with FEP and the importance of conducting research on clinician perspectives in this regard.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | - Amal Abdel-Baki
- Youth Mental Health Service, Centre Hospitalier Université de Montréal (CHUM), Montreal, QC, Canada
- Axe Neurosciences, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montreal, QC, Canada
| | - Rossana Peredo
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
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Reliford A, Zhang E, Lanina O, Williams SZ, Sanichar N, Khan S, Dapkins I, Frankle WG. Patient and Clinician Satisfaction with the Early Implementation of Telemental Health Services in an Urban Behavioral Health Clinic During the COVID-19 Pandemic. Telemed J E Health 2023; 29:1713-1722. [PMID: 36912813 DOI: 10.1089/tmj.2022.0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Objective: The COVID-19 pandemic served as an impetus for the rapid expansion of telehealth. In this study, we examined the experience of rapid transition to telemental health (TMH) within The Family Health Centers at NYU Langone, a large, urban, Federally Qualified Health Center, in the 3 months after the onset of the COVID-19 pandemic. Methods: We administered surveys to clinicians and patients who utilized TMH between March 16, 2020 and July 16, 2020. Patients were sent a web-based survey via email or received a phone survey (for those without email) with four languages choices: English, Spanish, Traditional Chinese, or Simplified Chinese. Results: The majority (79%) of clinicians (n = 83) rated the experience of TMH as "excellent" or "good," and felt that they could establish and maintain the patient relationship through TMH. Four thousand seven hundred seventy-two survey invitations were sent out to patients, and 654 (13.7%) responded. Ninety percent reported that they were satisfied with the service they received and rated TMH as better or the same as in-person care (81.6%) with a high mean satisfaction score (4.5 out of 5). Patients were more likely to rate TMH as better or the same as in-person care relative to the clinicians. Conclusions: These results are consistent with several recent studies that have explored patient satisfaction with TMH during the COVID-19 pandemic and demonstrate that both clinicians and patients experienced a high degree of satisfaction with mental health care delivered virtually compared with face-to-face encounters.
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Affiliation(s)
- Aaron Reliford
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Emily Zhang
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
| | - Olga Lanina
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
| | - Sharifa Z Williams
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Navin Sanichar
- Center for Research on Cultural and Structural Equity in Behavioral Health, Division of Social Solutions and Services Research, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York, USA
| | - Shabana Khan
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York, USA
| | - Isaac Dapkins
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - W Gordon Frankle
- Department of Psychiatry, and NYU Grossman School of Medicine, New York, New York, USA
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8
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Eisner E, Berry N, Bucci S. Digital tools to support mental health: a survey study in psychosis. BMC Psychiatry 2023; 23:726. [PMID: 37803367 PMCID: PMC10559432 DOI: 10.1186/s12888-023-05114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/16/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation. METHODS A survey was administered to a self-selecting sample in-person (n = 157) or online (n = 58), with questions examining: i) ownership and usage rates of digital devices among people with psychosis; ii) interest in using technology to engage with mental health services; and iii) facilitators of and barriers to using digital tools in a mental healthcare context. RESULTS Device ownership: Virtually all participants owned a mobile phone (95%) or smartphone (90%), with Android phones slightly more prevalent than iPhones. Only a minority owned a fitness tracker (15%) or smartwatch (13%). Device ownership was significantly lower in unemployed people and those without secondary education. Device cost and paranoid ideation were barriers to ownership. Technology and mental health services: Most participants (88%) said they would willingly try a mental health app. Symptom monitoring apps were most popular, then appointment reminders and medication reminders. Half the sample would prefer an app alongside face-to-face support; the other half preferred remote support or no other mental health support. Facilitators: Participants thought using a mental health app could increase their understanding of psychosis generally, and of their own symptoms. They valued the flexibility of digital tools in enabling access to support anywhere, anytime. Barriers: Prominent barriers to using mental health apps were forgetting, lack of motivation, security concerns, and concerns it would replace face-to-face care. Overall participants reported no substantial effects of technology on their mental health, although a quarter said using a phone worsened paranoid ideation. A third used technology more when psychotic symptoms were higher, whereas a third used it less. Around half used technology more when experiencing low mood. CONCLUSIONS Our findings suggest rapidly increasing device ownership among people with psychosis, mirroring patterns in the general population. Smartphones appear appropriate for delivering internet-enabled support for psychosis. However, for a sub-group of people with psychosis, the sometimes complex interaction between technology and mental health may act as a barrier to engagement, alongside more prosaic factors such as forgetting.
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Affiliation(s)
- Emily Eisner
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
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9
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Sheriff R, Hong JSW, Henshall C, D'Agostino A, Tomassi S, Stein HC, Cerveri G, Cibra C, Bonora S, Giordano B, Smith T, Phiri P, Asher C, Elliot K, Zangani C, Ede R, Saad F, Smith KA, Cipriani A. Evaluation of telepsychiatry during the COVID-19 pandemic across service users, carers and clinicians: an international mixed-methods study. BMJ MENTAL HEALTH 2023; 26:e300646. [PMID: 37567731 PMCID: PMC10577786 DOI: 10.1136/bmjment-2022-300646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 06/14/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Worldwide uptake of telepsychiatry accelerated during the COVID-19 pandemic. OBJECTIVE To conduct an evaluation of the opinions, preferences and attitudes to telepsychiatry from service users, carers and clinicians in order to understand how telepsychiatry can be best used in the peri/post-COVID-19 era. METHODS This mixed-methods, multicentre, international study of telepsychiatry was set in two sites in England and two in Italy. Survey questionnaires and focus group topic guides were co-produced for each participant group (service users, carers and clinicians). FINDINGS In the UK, 906 service users, 117 carers and 483 clinicians, and in Italy, 164 service users, 56 carers and 72 clinicians completed the surveys. In all, 17 service users/carers and 14 clinicians participated in focus groups. Overall, telepsychiatry was seen as convenient in follow-ups with a specific purpose such as medication reviews; however, it was perceived as less effective for establishing a therapeutic relationship or for assessing acutely disturbed mental states. In contrast to clinicians, most service users and carers indicated that telepsychiatry had not improved during the COVID-19 pandemic. Most service users and carers reported that the choice of appointment modality was most often determined by the service or clinician. CONCLUSION AND RELEVANCE There were circumstances in which telepsychiatry was seen as more suitable than others and clear differences in clinician, carer and service user perspectives on telepsychiatry. CLINICAL IMPLICATIONS All stakeholders should be actively engaged in determining a hybrid model of care according to clinical features and service user and carer preferences. Clinicians should be engaged in training programmes on telepsychiatry.
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Affiliation(s)
- Rebecca Sheriff
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - James S W Hong
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Catherine Henshall
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
- Oxford Institute of Nursing, Midwifery and Allied Health Research (OxINMAHR), Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Armando D'Agostino
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Simona Tomassi
- Psychiatric Unit 1, Azienda ULSS 9 Scaligera, Verona, Italy
| | | | | | - Chiara Cibra
- Department of Psychiatry and Addiction, ASST Lodi, Lodi, Italy
| | - Stefano Bonora
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Barbara Giordano
- Department of Mental Health and Addiction, ASST Santi Paolo e Carlo, Milan, Italy
| | - Tanya Smith
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Peter Phiri
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
- School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Carolyn Asher
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Kathryn Elliot
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, UK
| | - Caroline Zangani
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Roger Ede
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Fathi Saad
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Katharine Alison Smith
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, Oxford University, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Oxford Precision Psychiatry Lab, Oxford Health Biomedical Research Centre, Oxford, UK
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10
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Tatar O, Abdel-Baki A, Dyachenko A, Bakouni H, Bahremand A, Tibbo PG, Crockford D, Roy MA, Copeland J, Fischer B, Lecomte T, Côté J, Ouellet-Plamondon C, L'Heureux S, Villeneuve M, Jutras-Aswad D. Evaluating preferences for online psychological interventions to decrease cannabis use in young adults with psychosis: An observational study. Psychiatry Res 2023; 326:115276. [PMID: 37301021 DOI: 10.1016/j.psychres.2023.115276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
Innovative technology-based solutions have the potential to improve access to clinically proven interventions for cannabis use disorder (CUD) in individuals with first episode psychosis (FEP). High patient engagement with app-based interventions is critical for achieving optimal outcomes. 104 individuals 18 to 35 years old with FEP and CUD from three Canadian provinces completed an electronic survey to evaluate preferences for online psychological intervention intensity, participation autonomy, feedback related to cannabis use, and technology platforms and app functionalities. The development of the questionnaire was informed by a qualitative study that included patients and clinicians. We used Best-Worst Scaling (BWS) and item ranking methodologies to measure preferences. Conditional logistic regression models for BWS data revealed high preferences for moderate intervention intensity (e.g., modules with a length of 15 min) and treatment autonomy that included preferences for using technology-based interventions and receiving feedback related to cannabis use once a week. Luce regression models for rank items revealed high preferences for smartphone-based apps, video intervention components, and having access to synchronous communications with clinicians and gamification elements. Results informed the development of iCanChange (iCC), a smartphone-based intervention for the treatment of CUD in individuals with FEP that is undergoing clinical testing.
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Affiliation(s)
- Ovidiu Tatar
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Amal Abdel-Baki
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada
| | - Alina Dyachenko
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada
| | - Hamzah Bakouni
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Arash Bahremand
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Philip G Tibbo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; Nova Scotia Early Psychosis Program, Halifax, NS, Canada
| | - David Crockford
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Marc-André Roy
- Clinique Notre-Dame des Victoires, Institut Universitaire en Santé Mentale, Centre Intégré Universitaire de Soins et Services Sociaux de la Capitale Nationale, Québec, QC, Canada; Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Jan Copeland
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Queensland, Australia
| | - Benedikt Fischer
- Schools of Population Health and Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Montreal, QC, Canada; Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | - José Côté
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Clairélaine Ouellet-Plamondon
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada
| | - Sophie L'Heureux
- Clinique Notre-Dame des Victoires, Institut Universitaire en Santé Mentale, Centre Intégré Universitaire de Soins et Services Sociaux de la Capitale Nationale, Québec, QC, Canada; Department of Psychiatry and Neurosciences, Faculty of Medicine, Laval University, Québec, QC, Canada
| | - Marie Villeneuve
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Didier Jutras-Aswad
- Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Department of Psychiatry, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, QC, Canada; Institut universitaire sur les dépendances, Montreal, QC, Canada.
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11
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Drissi N, Ouhbi S, Serhani MA, Marques G, de la Torre Díez I. Connected Mental Health Solutions: Global Attitudes, Preferences, and Concerns. Telemed J E Health 2023; 29:315-330. [PMID: 35730979 DOI: 10.1089/tmj.2022.0036] [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: 11/12/2022] Open
Abstract
Background: Connected mental health (CMH) presents several technology-based solutions, which can help overcome many mental care delivery barriers. However, attitudes toward the use of CMH are diverse and differ from a cohort to another. Objective: The purpose of this study is to investigate the global attitudes toward CMH use and assess the use of technology for mental care. Methods: This study presents a synthesis of literature available in Scopus, Science Direct, and PubMed digital libraries, investigating attitudes toward CMH in different cohorts from different countries, based on a systematic review of relevant publications. This study also analyzes technology use patterns of the cohorts investigated, the reported preferred criteria that should be considered in CMH, and issues and concerns regarding CMH use. Results: One hundred and one publications were selected and analyzed. These publications were originated from different countries, with the majority (n = 23) being conducted in Australia. These studies reported positive attitudes of investigated cohorts toward CMH use and high technology use and ownership. Several preferred criteria were reported, mainly revolving around providing blended care functionalities, educational content, and mental health professionals (MHPs) support. Whereas concerns and issues related to CMH use addressed technical problems related to access to technology and to CMH solutions, the digital divide, lack of knowledge and use of CMH, and general reservations to use CMH. Concerns related to institutional and work barriers were also identified. Conclusions: Attitudes toward CMH show promising results from users and MHP views. However, factors such as providing blended care options and considering technical concerns should be taken into consideration for the successful adoption of CMH.
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Affiliation(s)
- Nidal Drissi
- Department of Information Systems and Security and CIT, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sofia Ouhbi
- Department of Computer Science and Software Engineering, CIT, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohamed Adel Serhani
- Department of Information Systems and Security and CIT, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Gonçalo Marques
- Polytechnic of Coimbra, School of Technology and Management of Oliveira do Hospital (ESTGOH), Coimbra, Portugal
| | - Isabel de la Torre Díez
- Department of Signal Theory and Communications and Telematics Engineering, University of Valladolid, Valladolid, Spain
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12
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Polillo A, Voineskos AN, Foussias G, Kidd SA, Bromley S, Soklaridis S, Wang W, Stergiopoulos V, Kozloff N. Disengagement from early psychosis intervention services: an observational study informed by a survey of patient and family perspectives. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:94. [PMID: 36369306 PMCID: PMC9651118 DOI: 10.1038/s41537-022-00300-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
Approximately one-third of patients with early psychosis disengage from services before the end of treatment. We sought to understand patient and family perspectives on early psychosis intervention (EPI) service engagement and use these findings to elucidate factors associated with early disengagement, defined as dropout from EPI in the first 9 months. Patients aged 16-29 referred to a large EPI program between July 2018-February 2020 and their family members were invited to complete a survey exploring facilitators and barriers to service engagement. A prospective chart review was conducted for 225 patients consecutively enrolled in the same EPI program, receiving the NAVIGATE model of coordinated specialty care, between July 2018-May 2019. We conducted a survival analysis, generating Kaplan-Meier curves depicting time to disengagement and Cox proportional hazards models to determine rate of disengagement controlling for demographic, clinical, and program factors. The survey was completed by 167 patients and 79 family members. The top endorsed engagement facilitator was related to the therapeutic relationship in both patients (36.5%) and families (43.0%). The top endorsed barrier to engagement was medication side effects in both patients (28.7%) and families (39.2%). In Cox proportional hazards models, medication nonadherence (HR = 2.37, 95% CI = 1.17-4.80) and use of individual psychotherapy (HR = .460, 95% CI = 0.220-0.962) were associated with early disengagement, but some of the health equity factors expected to affect engagement were not. Findings suggest that delivery of standardized treatment may buffer the effects of health disparities on service disengagement in early psychosis.
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Affiliation(s)
- Alexia Polillo
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Foussias
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sarah Bromley
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sophie Soklaridis
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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13
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Somaiya J, Thompson A, O'Donoghue B, Brown E. Delivery of an online psychosocial recovery program during COVID-19: A survey of young people attending a youth mental health service. Early Interv Psychiatry 2022; 16:1259-1266. [PMID: 35132766 PMCID: PMC9111580 DOI: 10.1111/eip.13280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 01/16/2023]
Abstract
AIMS The COVID-19 pandemic forced the rapid move of mental health services to being delivered online. This included the delivery of a psychosocial recovery program (PRP) delivered in youth mental health services in Melbourne, Australia which consists of groups that address functional recovery. At the time, there was limited evidence about how this switch in service provision would be received by service users or what impact the pandemic was having on their mental health. METHODS Young people engaged with the PRP between March and May 2020 were sent a link to complete an online survey that was co-developed by young people and clinicians. Attendance data at groups were extracted as a proximal measure of feasibility and acceptability. RESULTS A total of 44 young people undertook the survey with the domains of wellbeing most impacted by lockdown being work/study, motivation and social connection. Groups provided online were generally well attended during lockdown, particularly those that had a focus on therapeutic content. Young people indicated little preference for continuing to attend groups run purely online when restrictions eased, with many expressing a preference for these to be offered face-to-face or in a combined format. CONCLUSIONS These findings suggest that implementation of online psychosocial groups during periods of lockdown is both feasible and acceptable. Whilst young people found accessing groups online to be of benefit at the time, they felt that continued substitution of face-to-face groups would not necessarily be preferable and clinical services should consider these preferences in their long-term service delivery.
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Affiliation(s)
- Janaki Somaiya
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Thompson
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Warwick Medical School, University of Warwick, UK
| | - Brian O'Donoghue
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ellie Brown
- Orygen, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
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14
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Randall LA, Raisin C, Waters F, Williams C, Shymko G, Davis D. Implementing telepsychiatry in an early psychosis service during COVID-19: Experiences of young people and clinicians and changes in service utilization. Early Interv Psychiatry 2022; 17:470-477. [PMID: 35943177 PMCID: PMC9538557 DOI: 10.1111/eip.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/28/2022] [Accepted: 07/05/2022] [Indexed: 11/28/2022]
Abstract
AIM In response to the COVID-19 pandemic, our early psychosis program rapidly transitioned to telepsychiatry. This study examined the change in health service utilization and experiences of young people and clinicians in response to the implementation of telepsychiatry. METHODS Mixed methodology and triangulation of evidence drawn from health service databases and survey data. Using a retrospective observational design, health service data from pre- (Time 1) and post-(Time 2) telepsychiatry periods were compared. Surveys were also conducted with representation from clinicians and young people. RESULTS The number of appointments increased between Time 1 and 2, although this was accompanied by a near-doubling in missed appointments (8% to 13%). Young people had mixed views about telepsychiatry. While convenience was a frequently cited benefit, clients reported technological issues, isolation and lack of human connection. A preference for face-to-face appointments was linked to younger age and anxiety when using telepsychiatry. Clinicians reported improved workplace satisfaction and efficiency but noted some limitations in the use of telepsychiatry including difficulty interviewing and managing unwell clients remotely and called for greater skill development. CONCLUSIONS The introduction of telepsychiatry in response to COVID-19 was associated with an increase in service activity; however, there was an increase missed appointments by young people. Although clinicians and clients reported positive experiences, telepsychiatry was not completely endorsed as a replacement for face-to-face interactions.
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Affiliation(s)
- Leigh-Anne Randall
- Black Swan Health Ltd, Headspace Early Psychosis, Osborne Park, Western Australia, Australia
| | - Cara Raisin
- Black Swan Health Ltd, Headspace Early Psychosis, Osborne Park, Western Australia, Australia.,Child & Youth Adolescent Mental Health Service (CYMHS), Alfred Health, Melbourne, Victoria, Australia
| | - Flavie Waters
- Black Swan Health Ltd, Headspace Early Psychosis, Osborne Park, Western Australia, Australia.,Clinical Research Centre, North Metropolitan Mental Health Service, Graylands Perth, Western Australia, Australia.,School of Psychological Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Chelsey Williams
- Black Swan Health Ltd, Headspace Early Psychosis, Osborne Park, Western Australia, Australia
| | - Gordon Shymko
- Black Swan Health Ltd, Headspace Early Psychosis, Osborne Park, Western Australia, Australia.,School of Psychological Sciences, The University of Western Australia, Perth, Western Australia, Australia.,South Metropolitan Health Service, Peel and Rockingham Kwinana (PaRK) Mental Health Service, Rockingham, Western Australia, Australia
| | - Deepak Davis
- Black Swan Health Ltd, Headspace Early Psychosis, Osborne Park, Western Australia, Australia.,Clinical Research Centre, North Metropolitan Mental Health Service, Graylands Perth, Western Australia, Australia.,School of Psychological Sciences, The University of Western Australia, Perth, Western Australia, Australia
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15
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Pires de Oliveira Padilha P, Bertulies-Esposito B, L'Heureux S, Olivier D, Lal S, Abdel-Baki A. COVID-19 pandemic's effects and telehealth in Early Psychosis Services of Quebec, Canada: Will changes last? Early Interv Psychiatry 2022; 16:862-867. [PMID: 34626091 PMCID: PMC8653188 DOI: 10.1111/eip.13227] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 09/06/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022]
Abstract
AIM To explore the impacts of the COVID-19 pandemic first wave in Quebec, Canada on practices in early intervention services (EIS) for first-episode psychosis, including reorganization of clinical and administrative practices and teleconsultation use. METHODS Adopting a cross-sectional descriptive study design, a 41 questions online survey was sent to the team leaders of all the 33 Quebec EIS, of which 100% responded. Data were collected from 18 May to 4 June 2020 and analysed using descriptive statistics and content analysis. Programmes were categorized as urban/non-urban and results were compared between these. RESULTS All 33 existing Quebec EIS (16 urban and 17 non-urban) completed the survey. Among them, 85% did not experience redeployment of EIS team staff and 58% reported stable frequency of patient interactions, either in-person or through telemedicine. During the studied period, 64% of programmes reported that all professionals used teleconsultation at least occasionally. However, 73% of programmes, mostly in non-urban areas, reported some limitations regarding clinicians' degree of ease with teleconferencing platforms and half of EIS could not access technical support to use them. The majority of EIS (94%) expressed interest to participate in a training program about the use of technologies for teleconsultations. Many smaller clinics reported interest in offering multiregional/multiclinics group teletherapy, therefore merging their pool of patients and clinical staff workforce. CONCLUSIONS Further studies are warranted to improve access to and use of technology-mediated treatment, which seems to be a promising alternative to provide high-quality mental healthcare during the COVID-19 pandemic and beyond.
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Affiliation(s)
| | - Bastian Bertulies-Esposito
- CHUM Research Centre, Axe Neurosciences, Montreal, Quebec, Canada.,Department of Psychiatry and addictology, University of Montreal, Montreal, Quebec, Canada.,Department of Psychiatry, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Sophie L'Heureux
- Department of Psychiatry and Neurosciences, Laval University, Quebec City, Quebec, Canada.,Clinique Notre-Dame des Victoires, IUSMQ, Quebec City, Quebec, Canada
| | - David Olivier
- Department of Psychiatry and addictology, University of Montreal, Montreal, Quebec, Canada.,Program Oxy-Jeunes, CIUSSS MCQ, Shawinigan, Quebec, Canada
| | - Shalini Lal
- School of Rehabilitation, University of Montreal, Montreal, Quebec, Canada.,Youth Mental Health and Technology Lab, CHUM Research Centre, Montreal, Quebec, Canada.,PEPP Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada
| | - Amal Abdel-Baki
- CHUM Research Centre, Axe Neurosciences, Montreal, Quebec, Canada.,Department of Psychiatry and addictology, University of Montreal, Montreal, Quebec, Canada.,Youth Mental Health Service, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
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16
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Lal S, Abdel-Baki A, Lee H. Telepsychiatry services during COVID-19: A cross-sectional survey on the experiences and perspectives of young adults with first-episode psychosis. Early Interv Psychiatry 2022; 17:368-377. [PMID: 35731034 PMCID: PMC9350121 DOI: 10.1111/eip.13332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/21/2022] [Accepted: 05/29/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Limited evidence exists on the implementation of telepsychiatry within the context of early intervention services for psychosis, the need for which has become even more relevant during the COVID-19 pandemic. To address this gap, we investigated the experiences and perspectives of young adults recovering from a first-episode psychosis (FEP) following their use of telepsychiatry services (i.e. use of video conferencing technology to deliver mental health services to patients in real time). METHODS A cross-sectional online survey study was implemented between November 19th , 2020 and March 9th , 2021 with young adults recruited from a specialized program for FEP located in an urban Canadian setting. Data were analysed using descriptive statistics, exploratory (Fisher's exact test), and content analysis. RESULTS Among 51 participants (mean age = 26.0, SD = 4.7; 56.9% female), the majority were satisfied with the service (91%, 46/51), perceived that the platform was easy to use (90%, 46/51) and felt secure in terms of confidentiality (82%, 42/51). Satisfaction was related to perceptions regarding ease of use, image quality, and employment/studying status. Several partially or totally agreed that the presence of a third party was essential to login during the first few sessions (35%, 18/51), and some needed technical support (24%, 12/51) throughout the sessions. CONCLUSIONS This study shows that telepsychiatry is feasible and acceptable to implement for patients in the early phase of psychosis recovery. It also highlights the importance of making technical support available, especially in the first few times of using the service, and addressing patient concerns regarding confidentiality, even when using secured health technologies.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Quebec, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, Quebec, Canada.,Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montréal, Quebec, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Amal Abdel-Baki
- Department of Psychiatry, Centre Hospitalier Université de Montréal (CHUM), Montreal, Quebec, Canada.,Axe Neurosciences, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.,Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Hajin Lee
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, Quebec, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, Quebec, Canada
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17
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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18
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Rosic T, Lubert S, Samaan Z. Virtual psychiatric care fast-tracked: reflections inspired by the COVID-19 pandemic. BJPsych Bull 2022; 46:33-36. [PMID: 32799956 PMCID: PMC7492577 DOI: 10.1192/bjb.2020.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For many patients and healthcare providers, the move to virtual psychiatric care has been fast-tracked by the COVID-19 pandemic. In this article, we consider a patient perspective and a provider perspective on the transition to virtual psychiatric care and its strengths and limitations, as well as a call for much-needed future research.
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Affiliation(s)
- Tea Rosic
- McMaster University,Hamilton, Ontario, Canada
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19
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Abstract
AIMS AND METHOD This review aims to clarify the evidence on the effectiveness of telepsychiatry following the COVID-19 pandemic. We conducted a literature review of three databases (Cochrane Library, PubMed and PsycINFO), using the terms virtual consultation/telepsychiatry/video consultation AND psychiatry/mental illness. RESULTS We identified 325 eligible papers and conducted a thematic analysis resulting in five themes: patient and clinical satisfaction, diagnostic reliability, outcomes, technology and professional guidance. The most significant factors linked to effectiveness of telepsychiatry were patient and clinician satisfaction and adequate technology to facilitate examination of the patient. CLINICAL IMPLICATIONS The consistent diagnostic reliability, satisfactory clinical outcomes and patient satisfaction linked to telepsychiatry favour its continued use once the pandemic ends. The main barrier is reluctance among clinicians and lack of professional guidance. We recommend education on the uses of telepsychiatry among clinicians, and the provision of professional guidance for its use from medical bodies and organisations.
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20
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Tempelaar W, Barwick M, Crawford A, Voineskos A, Addington D, Addington J, Alexander T, Baluyut C, Bromley S, Durbin J, Foussias G, Ford C, de Freitas L, Jindani S, Kirvan A, Kurdyak P, Pauly K, Polillo A, Roby R, Sockalingam S, Sosnowski A, Villanueva V, Wang W, Kozloff N. Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery: Protocol for a Pragmatic Mixed Methods Implementation and Evaluation Study. JMIR Res Protoc 2021; 10:e34591. [PMID: 34806990 PMCID: PMC8653974 DOI: 10.2196/34591] [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] [Received: 10/31/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention adaptations or to support the effectiveness and satisfaction with virtual EPI services. OBJECTIVE This study aims to explore the adaptations required to deliver NAVIGATE, a model of coordinated specialty care used in EPI, in a virtual format. This study will evaluate implementation of the NAVIGATE model delivered virtually by describing the nature of the adaptations to the intervention, assessing fidelity to the EPI model and the satisfaction of clients, family members, and care providers. We will investigate barriers and facilitators to virtual NAVIGATE implementation, service engagement, and health equity impacts of this work. METHODS The Centre for Addiction and Mental Health (Toronto, Ontario, Canada) transitioned to delivering NAVIGATE virtually early in the COVID-19 pandemic. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions will be used to describe the adaptations required to deliver NAVIGATE virtually. Fidelity to the EPI model will be measured using the First Episode Psychosis Services Fidelity Scale and fidelity to NAVIGATE will be assessed by investigating adherence to its core components. Implementation facilitators and barriers will be explored using semistructured interviews with providers informed by the Consolidated Framework for Implementation Research. Satisfaction with virtually delivered NAVIGATE will be assessed with virtual client and provider experience surveys and qualitative interviews with clients, family members, and providers. Service engagement data will be collected through review of medical records, and potential impacts of virtually delivered NAVIGATE on different population groups will be assessed with the Health Equity Impact Assessment. RESULTS Virtual clinical delivery of NAVIGATE started in March 2020 with additional adaptations and data collection is ongoing. Data will be analyzed using descriptive statistics and survival analysis for quantitative data. Qualitative data will be analyzed using thematic content analysis. Integration of qualitative and quantitative data will occur at the data collection, interpretation, and reporting levels following a convergent design. CONCLUSIONS This study will provide information regarding the type of intervention adaptations required for virtual delivery of NAVIGATE for youth with early psychosis, ensuring access to high-quality care for this population during the pandemic and beyond by guiding future implementation in similar contexts. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34591.
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Affiliation(s)
- Wanda Tempelaar
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Melanie Barwick
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Allison Crawford
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Donald Addington
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jean Addington
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Crystal Baluyut
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Bromley
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janet Durbin
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - George Foussias
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Catherine Ford
- Mental Health Addiction, Ontario Ministry of Health, Toronto, ON, Canada
| | - Lauren de Freitas
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Seharish Jindani
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anne Kirvan
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paul Kurdyak
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Kirstin Pauly
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexia Polillo
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rachel Roby
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexandra Sosnowski
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- College of Public Health, University of South Florida, Tampa, FL, United States
| | - Nicole Kozloff
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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21
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Lal S, Gleeson JF, D'Alfonso S, Etienne G, Joober R, Lepage M, Lee H, Alvarez-Jimenez M. A Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Specialized Services for First-Episode Psychosis: Protocol for a Pilot Pre-Post, Mixed Methods Study of Horyzons-Canada (Phase 2). JMIR Res Protoc 2021; 10:e28141. [PMID: 34879000 PMCID: PMC8693205 DOI: 10.2196/28141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/18/2021] [Accepted: 09/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Psychotic disorders are among the most disabling of all mental disorders. The first-episode psychosis (FEP) often occurs during adolescence or young adulthood. Young people experiencing FEP often face multiple barriers in accessing a comprehensive range of psychosocial services, which have predominantly been delivered in person. New models of service delivery that are accessible, sustainable, and engaging are needed to support recovery in youth diagnosed with FEP. OBJECTIVE In this paper, we describe a protocol to implement and evaluate the acceptability, safety, and potential efficacy of an online psychosocial therapeutic intervention designed to sustain recovery and prevent relapses in young adults diagnosed with FEP. This intervention was originally developed and tested in Australia and has been adapted for implementation and evaluation in Canada and is called Horyzons-Canada (HoryzonsCa). METHODS This cohort study is implemented in a single-center and applies a pre-post mixed methods (qualitative-quantitative convergent) design. The study involves recruiting 20 participants from a specialized early intervention program for psychosis located in Montreal, Canada and providing them with access to the HoryzonsCa intervention for 8 weeks. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews. RESULTS This study received funding from the Brain and Behavior Research Foundation (United States), the Quebec Health Research Funding Agency (Canada), and the Canada Research Chairs Program. The study was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal on April 11, 2018 (#IUSMD 17-54). Data were collected from August 16, 2018, to April 29, 2019, and a final sample of 20 individuals participated in the baseline and follow-up interviews, among which 9 participated in the focus groups. Data analysis and reporting are in process. The results of the study will be submitted for publication in 2021. CONCLUSIONS This study will provide preliminary evidence on the acceptability, safety, and potential efficacy of using a digital health innovation adapted for the Canadian context to deliver specialized mental health services to youth diagnosed with FEP. TRIAL REGISTRATION ISRCTN Registry ISRCTN43182105; https://www.isrctn.com/ISRCTN43182105. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/28141.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - John F Gleeson
- Healthy Brain and Mind Research Centre and School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Australia
| | - Simon D'Alfonso
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Geraldine Etienne
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Hajin Lee
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada
- Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
- Orygen, Parkville, Australia
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22
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Abstract
BACKGROUND Digital phenotyping is the use of data from smartphones and wearables collected in situ for capturing a digital expression of human behaviors. Digital phenotyping techniques can be used to analyze both passively (e.g., sensor) and actively (e.g., survey) collected data. Machine learning offers a possible predictive bridge between digital phenotyping and future clinical state. This review examines passive digital phenotyping across the schizophrenia spectrum and bipolar disorders, with a focus on machine-learning studies. METHODS A systematic review of passive digital phenotyping literature was conducted using keywords related to severe mental illnesses, data-collection devices (e.g., smartphones, wearables, actigraphy devices), and streams of data collected. Searches of five databases initially yielded 3312 unique publications. Fifty-one studies were selected for inclusion, with 16 using machine-learning techniques. RESULTS All studies differed in features used, data pre-processing, analytical techniques, algorithms tested, and performance metrics reported. Across all studies, the data streams and other study factors reported also varied widely. Machine-learning studies focused on random forest, support vector, and neural net approaches, and almost exclusively on bipolar disorder. DISCUSSION Many machine-learning techniques have been applied to passively collected digital phenotyping data in schizophrenia and bipolar disorder. Larger studies, and with improved data quality, are needed, as is further research on the application of machine learning to passive digital phenotyping data in early diagnosis and treatment of psychosis. In order to achieve greater comparability of studies, common data elements are identified for inclusion in future studies.
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23
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mHealth for Young Adults with Early Psychosis: User Preferences and Their Relationship to Attitudes About Treatment-Seeking. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2021; 6:667-676. [PMID: 34604506 PMCID: PMC8476976 DOI: 10.1007/s41347-021-00223-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/12/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022]
Abstract
A long duration of untreated psychosis reduces benefits of early intervention for early psychosis. Digital technologies have potential to encourage help-seeking and reduce barriers to care. Because of high rates of smartphone ownership, mobile health (mHealth) interventions may be particularly well-suited to increase access. There is a lack of available information on the specific features that may be most appealing to young adults with early psychosis. The present study remotely recruited 77 young adults with psychosis and surveyed their interest in mHealth features, delivery modalities, and attitudes toward treatment. Overall, respondents reported high utilization of digital health and high interest in psychosis-specific mHealth. They expressed the highest interest (ordered by mean score by item) in information about medications and side effects (n = 69, 89.6% reporting being “interested” or “very interested”), managing stress and improving mood (n = 67, 89.3%) and symptoms of psychosis (n = 66, 88%), as well as in tracking changes in symptoms (n = 70, 90.9%), and goals (n = 66, 86.9%). They also reported high interest in content being delivered as text (n = 69, 89.6%) and also in communicating directly with providers. Respondents were less interested in social features, and those with most negative attitudes toward help-seeking had particularly low interest in features related to disclosing symptoms to others. These results suggest mHealth may have potential to engage individuals with early psychosis, and that the most effective strategies may be those that are most straightforward, including direct psychoeducational information.
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24
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Patel SR, Bello I, Cabassa LJ, Nossel IR, Wall MM, Montague E, Rahim R, Mathai CM, Dixon LB. Adapting coordinated specialty care in the post-COVID-19 era: study protocol for an integrative mixed-methods study. Implement Sci Commun 2021; 2:72. [PMID: 34225817 PMCID: PMC8256216 DOI: 10.1186/s43058-021-00178-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coordinated Specialty Care (CSC) programs provide evidence-based services for young people with a recent onset of a psychotic disorder. OnTrackNY is a nationally recognized model of CSC treatment in New York state. In 2019, OnTrackNY was awarded a hub within the Early Psychosis Intervention Network (EPINET) to advance its learning health care system (LHS). The OnTrackNY network is comprised of 23 CSC teams across New York state. OnTrack Central, an intermediary organization, provides training and implementation support to OnTrackNY teams. OnTrack Central coordinates a centralized data collection protocol for quality improvement and evaluation of program fidelity and a mechanism to support practice based-research. OnTrackNY sites' breadth coupled with OnTrack Central oversight provides an opportunity to examine the impacts of the COVID-19 crisis in New York State, and supplementary funding was awarded to the OnTrackNY EPINET hub in 2021 for that purpose. METHODS This project will examine the implications of modifications to service delivery within the OnTrackNY LHS during and after the COVID-19 crisis. We will use the Framework for Reporting Adaptations and Modification-Enhanced (FRAME) to classify systematically, code, and analyze modifications to CSC services and ascertain their impact. We will utilize integrative mixed methods. Qualitative interviews with multi-level stakeholders (program participants, families, providers, team leaders, agency leaders, trainers (OnTrack Central), and decision-makers at the state and local levels) will be used to understand the process of making decisions, information about modifications to CSC services, and their impact. Analysis of OnTrackNY program data will facilitate examining trends in team staffing and functioning, and participant service utilization and outcomes. Study findings will be summarized in a CSC Model Adaptation Guide, which will identify modifications as fidelity consistent or not, and their impact on service utilization and care outcomes. DISCUSSION A CSC Model Adaptation Guide will inform CSC programs, and the state and local mental health authorities to which they are accountable, regarding modifications to CSC services and the impact of these changes on care process, and participant service utilization and outcomes. The guide will also inform the development of tailored technical assistance that CSC programs may need within OnTrackNY, the EPINET network, and CSC programs nationally. TRIAL REGISTRATION NCT04021719 , July 16th, 2019.
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Affiliation(s)
- Sapana R Patel
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA.
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA.
| | - Iruma Bello
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work at Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Ilana R Nossel
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA
| | - Melanie M Wall
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, 10032, USA
| | - Elaina Montague
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
| | - Reanne Rahim
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
| | - Chacku M Mathai
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
| | - Lisa B Dixon
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 100, New York, NY, 10032, USA
- Columbia University Vagelos College of Physicians and Surgeons, 630 W 168th St, New York, NY, 10032, USA
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25
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Wood HJ, Gannon JM, Chengappa KNR, Sarpal DK. Group teletherapy for first-episode psychosis: Piloting its integration with coordinated specialty care during the COVID-19 pandemic. Psychol Psychother 2021; 94:382-389. [PMID: 33078496 DOI: 10.1111/papt.12310] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/26/2020] [Indexed: 12/15/2022]
Abstract
Digital health has emerged in recent years as a tool to optimize care delivery and promote treatment adherence among individuals with first-episode psychosis (FEP). Recent mandates for social distancing and sheltering in place due to the COVID-19 pandemic have catapulted efforts to provide ongoing coordinated specialty care (CSC) on virtual platforms. While prior evidence provides support for the general implementation of virtual individual therapy, there is limited guidance and evidence for the adoption of group teletherapy. Here we describe our efforts to implement group teletherapy for two small cohorts of individuals with FEP receiving care in a coordinated specialty care clinic using methods adopted from Acceptance and Commitment Therapy. We observed high adherence with group visits as well as client satisfaction across groups. Based on our results, we have taken efforts to implement virtual group therapy more permanently in our clinic. Our experience provides guidance and a model for integration of virtual group therapy within CSC. PRACTITIONER POINTS: In-person group therapy can be adapted as an online treatment modality for individuals with first-episode psychosis (FEP). Group teletherapy is both accessible and satisfactory to individuals with FEP. Group teletherapy has potential as a more standard and widespread treatment modality within coordinated specialty care for FEP.
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Affiliation(s)
- Helen J Wood
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Jessica M Gannon
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
| | - K N Roy Chengappa
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
| | - Deepak K Sarpal
- Comprehensive Recovery Services, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania, USA.,Department of Psychiatry, University of Pittsburgh, Pennsylvania, USA
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Tse J, LaStella D, Chow E, Kingman E, Pearlman S, Valeri L, Wang H, Dixon LB. Telehealth Acceptability and Feasibility Among People Served in a Community Behavioral Health System During the COVID-19 Pandemic. Psychiatr Serv 2021; 72:654-660. [PMID: 33957769 PMCID: PMC11184975 DOI: 10.1176/appi.ps.202000623] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors examined the acceptability and feasibility of telehealth services shortly after their rapid introduction into a community behavioral health agency as part of the response to the COVID-19 pandemic. METHODS Individuals receiving services during May 8-18, 2020, from behavioral health programs that had introduced telehealth in March 2020, were invited to participate in a survey regarding their perceptions of the telehealth services. Ordinal logistic regressions were used to test for differences in survey responses in three ways: between program types, between the 2020 sample and a 2018 sample, and between individuals reported by staff to be distressed or not distressed by the COVID-19 pandemic. RESULTS Of 1,482 survey respondents, >80% reported that their ability to connect to staff, receive support, and get an appointment was at least as great as before the pandemic. Among 80% of respondents indicating interest in continuing remote services after the pandemic ended, 83% preferred a mix of remote and face-to-face services. From February 2020 to April 2020, total service utilization remained stable for treatment, outreach, and housing programs. In addition, mental health-related hospital utilization did not increase. CONCLUSIONS The findings of this study suggest that telehealth, including telephone-based services, is an acceptable and even preferred service delivery mode for clients with severe mental illness. Continued investigation into the optimal dosing of face-to-face versus remote services in various settings is needed to inform service practice during and after the COVID-19 pandemic.
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Affiliation(s)
- Jeanie Tse
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Drew LaStella
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Elisa Chow
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Emily Kingman
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Shoshannah Pearlman
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Linda Valeri
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Hao Wang
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
| | - Lisa B Dixon
- Institute for Community Living, New York City (Tse, LaStella, Chow, Kingman, Pearlman, Wang); New York University School of Medicine, New York City (Tse); New York University Silver School of Social Work, New York City (Chow); Department of Biostatistics, Columbia University Mailman School of Public Health, New York City (Valeri); New York State Psychiatric Institute, New York City (Dixon); Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon). Benjamin G. Druss, M.D., M.P.H., served as decision editor on the manuscript
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Lal S, Siafa L, Lee H, Adair CE. Priority Given to Technology in Government-Based Mental Health and Addictions Vision and Strategy Documents: Systematic Policy Review. J Med Internet Res 2021; 23:e25547. [PMID: 33949955 PMCID: PMC8135019 DOI: 10.2196/25547] [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] [Received: 11/10/2020] [Revised: 03/01/2021] [Accepted: 04/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background The use of information and communication technologies (ICTs) to deliver mental health and addictions (MHA) services is a global priority, especially considering the urgent shift towards virtual delivery of care in response to the COVID-19 pandemic. It is important to monitor the evolving role of technology in MHA services. Given that MHA policy documents represent the highest level of priorities for a government’s vision and strategy for mental health care, one starting point is to measure the frequency with which technology is mentioned and the terms used to describe its use in MHA policy documents (before, during, and after COVID-19). Yet, to our knowledge, no such review of the extent to which ICTs are referred to in Canadian MHA policy documents exists to date. Objective The objective of this systematic policy review was to examine the extent to which technology is addressed in Canadian government–based MHA policy documents prior to the COVID-19 pandemic to establish a baseline for documenting change. Methods We reviewed 22 government-based MHA policy documents, published between 2011 and 2019 by 13 Canadian provinces and territories. We conducted content analysis to synthesize the policy priorities addressed in these documents into key themes, and then systematically searched for and tabulated the use of 39 technology-related keywords (in English and French) to describe and compare jurisdictions. Results Technology was addressed in every document, however, to a varying degree. Of the 39 searched keywords, we identified 22 categories of keywords pertaining to the use of technology to deliver MHA services and information. The 6 most common categories were tele (n=16/22), phone (n=12/22), tech (n=11/22), online (n=10/22), line (n=10/22), and web (n=10/22), with n being the number of policy documents in which the category was mentioned out of 22 documents. The use of terms referring to advanced technologies, such as virtual (n=6/22) and app (n= 4/22), were less frequent. Additionally, policy documents from some provinces and territories (eg, Alberta and Newfoundland and Labrador) mentioned a diverse range of ICTs, whereas others described only 1 form of ICT. Conclusions This review indicates that technology has been given limited strategic attention in Canadian MHA policy. Policy makers may have limited knowledge on the evidence and potential of using technology in this field, highlighting the value for knowledge translation and collaborative initiatives among policy makers and researchers. The development of a pan-Canadian framework for action addressing the integration and coordination of technology in mental health services can also guide initiatives in this field. Our findings provide a prepandemic baseline and replicable methods to monitor how the use of technology-supported services and innovations emerge relative to other priorities in MHA policy during and after the COVID-19 pandemic.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada.,Prevention and Early Intervention Program for Psychosis and ACCESS Open Minds, Douglas Mental Health University Institute, Montréal, QC, Canada
| | - Lyna Siafa
- Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada.,Department of Medicine, McGill University, Montréal, QC, Canada
| | - Hajin Lee
- School of Rehabilitation, Faculty of Medicine, University of Montréal, Montréal, QC, Canada.,Youth Mental Health and Technology Lab, Health Innovation and Evaluation Hub, University of Montréal Hospital Research Centre, Montréal, QC, Canada
| | - Carol E Adair
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Patel S, Bello I, Cabassa LJ, Nossel IR, Wall MM, Montague E, Rahim R, Mathai CM, Dixon LB. Adapting Coordinated Specialty Care in the Post-COVID-19 Era: Study Protocol for an Integrative Mixed-methods Study. RESEARCH SQUARE 2021:rs.3.rs-452200. [PMID: 34013257 PMCID: PMC8132251 DOI: 10.21203/rs.3.rs-452200/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background : Coordinated Specialty Care (CSC) programs provide evidence-based services for young people with a recent onset of a psychotic disorder. OnTrackNY is a nationally recognized model of CSC treatment in New York state. In 2019, OnTrackNY was awarded a hub within the Early Psychosis Intervention Network (EPINET) to advance its learning health care system (LHS). The OnTrackNY network is comprised of 23 CSC teams across New York state. OnTrack Central, an intermediary organization, provides training and implementation support to OnTrackNY teams. OnTrack Central coordinates a centralized data collection protocol for quality improvement and evaluation of program fidelity and a mechanism to support practice based-research. OnTrackNY sites’ breadth coupled with OnTrack Central oversight provides an opportunity to examine the impacts of the COVID-19 crisis in New York State. Methods : This project will examine the implications of modifications to service delivery within the OnTrackNY LHS during and after the COVID-19 crisis. We will use the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to classify systematically, code, and analyze modifications to CSC services and ascertain their impact. We will utilize integrative mixed methods. Qualitative interviews with multi-level stakeholders (program participants, families, providers, team leaders, agency leaders, trainers (OnTrack Central), and decision-makers at the state and local levels) will be used to understand the process making decisions, information about modifications to CSC services, and their impact. Analysis of OnTrackNY program data will facilitate examining trends in team staffing and functioning, and participant service utilization and outcomes. Study findings will be summarized in a CSC Model Adaptation Guide , which will identify modifications as fidelity consistent or not, and their impact on service utilization and care outcomes. Discussion : A CSC Model Adaptation Guide will inform CSC programs, and the state and local mental health authorities to which they are accountable, regarding modifications to CSC services and the impact of these changes on care process, and participant service utilization and outcomes. The guide will also inform the development of tailored technical assistance that CSC programs may need within OnTrackNY, the EPINET network, and CSC programs nationally. Trial Registration : NCT04021719, July 16 th , 2019.
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Affiliation(s)
- Sapana Patel
- Columbia University and the New York State Psychiatric Institute
| | | | | | - Ilana R Nossel
- Columbia Presbyterian Medical Center: Columbia University Irving Medical Center
| | | | | | | | | | - Lisa B Dixon
- Columbia Presbyterian Medical Center: Columbia University Irving Medical Center
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Bertulies-Esposito B, Abdel-Baki A, Conus P, Krebs MO. L’union fait la force : initier un mouvement francophone national et international pour l’implantation de l’intervention précoce. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088189ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ouellet-Plamondon C, Abdel-Baki A, Jutras-Aswad D. Premier épisode psychotique et trouble de l’usage de substance concomitants : revue narrative des meilleures pratiques et pistes d’approches adaptées pour l’évaluation et le suivi. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088186ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bertulies-Esposito B, Sicotte R, Iyer SN, Delfosse C, Girard N, Nolin M, Villeneuve M, Conus P, Abdel-Baki A. Détection et intervention précoce pour la psychose : pourquoi et comment ? SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088178ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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32
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Thibaudeau E, Raucher-Chéné D, Lecardeur L, Cellard C, Lepage M, Lecomte T. Les interventions psychosociales destinées aux personnes composant avec un premier épisode psychotique : une revue narrative et critique. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088184ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ghosh A, Verma M, Lal S. A Review of Models and Efficacy of Telepsychiatry for Inpatient Service Delivery: Proposing a Model for Indian Settings. Indian J Psychol Med 2020; 42:34S-40S. [PMID: 33354061 PMCID: PMC7736746 DOI: 10.1177/0253717620958168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The use of telepsychiatry (TP) for inpatient service delivery is still an emerging field and there is limited literature on its practice and evidence. This review was conducted with the objectives of (a) exploring the models of TP for inpatient service delivery, (b) qualitative synthesis of the efficacy of TP in inpatient settings, and (c) proposing a best-fit model of TP-based inpatient care for Indian settings. METHODS An electronic database search was conducted on July 22, 2020, in PubMed, Directory of Open Access Journals, and Google Scholar for relevant articles. Seventeen articles were included in the review. RESULTS The review revealed three models for TP-based inpatient care; direct care model, teleconsultation model, and the collaborative care model. Preliminary evidence suggests that TP is cost-effective and reliable, and that patients and service providers are highly satisfied with this approach. Evidence gaps were seen for some diagnostic categories such as psychosis and for extremes of age groups. Based on the existing models, we propose an Indian model for implementing TP in inpatient settings. CONCLUSION Promising initial results and the evidence gaps highlight the need for further research in this area.
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Affiliation(s)
- Abhishek Ghosh
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meha Verma
- Dept. of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shalini Lal
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada.,Youth Mental Health and Technology Lab, University of Montreal Hospital Research Centre, Montreal, QC, Canada.,PEPP Montreal and ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, QC, Canada
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Ramkisson R, Dave S, Abraham S, Pillai A, Moir R, Matheiken S, Bamrah JS. Remote psychiatric consultations – top tips for clinical practitioners. PROGRESS IN NEUROLOGY AND PSYCHIATRY 2020. [DOI: 10.1002/pnp.674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Roshelle Ramkisson
- Dr Ramkisson is Consultant Psychiatrist, Training Programme Director Core Psychiatry, Associate Director of Medical Education, NICE Fellow, at Pennine Care NHS Foundation Trust
| | - Subodh Dave
- Dr Dave is Associate Dean and Consultant Psychiatrist at the Royal Derby Hospital
| | - Seri Abraham
- Dr Abraham is Consultant Psychiatrist at Pennine Care NHS Foundation Trust
| | - Anil Pillai
- Dr Pillai is Consultant Old Age Psychiatrist and Training Programme Director, Old Age Psychiatry HEE (Yorkshire and Humber) at Bradford District Care Foundation Trust
| | - Rachel Moir
- Dr Moir is CT1 Psychiatry Trainee at Royal Oldham Hospital
| | - Shevonne Matheiken
- Dr Matheiken is ST4 Old Age Psychiatry, East London NHS Foundation Trust
| | - J S Bamrah
- Prof JS Bamrah is Consultant Psychiatrist at North Manchester General Hospital
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Abstract
Youth mental health is a rapidly developing field with a focus on prevention, early identification, treatment innovation and service development. In this perspective piece, we discuss the effects of COVID-19 on young people’s mental health. The psychosocial effects of COVID-19 disproportionately affect young people. Both immediate and longer-term factors through which young people are affected include social isolation, changes to the delivery of therapeutic services and almost complete loss of all structured occupations (school, work and training) within this population group. Longer-term mechanisms include the effects of the predicted recession on young people’s mental health. Opportunities within this crisis exist for service providers to scale up telehealth and digital services that may benefit service provision for young people’s mental health in the future.
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DeLuca JS, Andorko ND, Chibani D, Jay SY, Rakhshan Rouhakhtar PJ, Petti E, Klaunig MJ, Thompson EC, Millman ZB, Connors KM, Akouri-Shan L, Fitzgerald J, Redman SL, Roemer C, Bridgwater MA, DeVylder JE, King CA, Pitts SC, Reinblatt SP, Wehring HJ, Bussell KL, Solomon N, Edwards SM, Reeves GM, Buchanan RW, Schiffman J. Telepsychotherapy with Youth at Clinical High Risk for Psychosis: Clinical Issues and Best Practices during the COVID-19 Pandemic. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2020; 30:304-331. [PMID: 34305369 PMCID: PMC8297958 DOI: 10.1037/int0000211] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Early detection and prevention of psychosis has become an international priority. Much of this work has focused on youth presenting with attenuated symptoms of psychosis-those at Clinical High Risk for psychosis (CHR)-given their elevated probability of developing the full disorder in subsequent years. Individuals at CHR may be prone to exacerbated psychological distress during the COVID-19 pandemic and its subsequent physical isolation measures, due to heightened stress sensitivity and comorbid mental health problems. Telepsychotherapy holds promise for reaching this population, especially during the current COVID-19 outbreak. However, there are limited evidence-based guidelines or interventions for use of telepsychotherapy with this population. In this paper, we review common clinical issues for individuals at CHR and how they might be exacerbated by the COVID-19 pandemic; best practices for treatment and adaptations for telepsychotherapy for individuals at CHR; and highlight real clinical issues that we are currently experiencing in a United States-based specialized CHR clinic as we conduct telepsychotherapy via videoconferencing. We conclude with questions for those in the field to contemplate, as well as potential challenges and benefits in using telepsychotherapy with individuals at CHR and their families.
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Affiliation(s)
- Joseph S. DeLuca
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Nicole D. Andorko
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Doha Chibani
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Samantha Y. Jay
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | | | - Emily Petti
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Mallory J. Klaunig
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Elizabeth C. Thompson
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI
| | | | - Kathleen M. Connors
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - LeeAnn Akouri-Shan
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - John Fitzgerald
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Samantha L. Redman
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Caroline Roemer
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | | | | | - Cheryl A. King
- University of Michigan, Departments of Psychiatry and Psychology, Ann Arbor, MI
| | - Steven C. Pitts
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
| | - Shauna P. Reinblatt
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | | | - Natalee Solomon
- Maryland Department of Health, Behavioral Health Administration, Transition-Aged Youth and Young Adult Services, Baltimore, MD
| | - Sarah M. Edwards
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Gloria M. Reeves
- University of Maryland School of Medicine, Department of Psychiatry, Division of Child and Adolescent Psychiatry, Baltimore, MD
| | - Robert W. Buchanan
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, MD
| | - Jason Schiffman
- University of Maryland, Baltimore County, Department of Psychology, Baltimore, MD
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