Collaborative Treatment Planning Research Articles

Shared Decision-Making with Latinx Caregivers During Community Implemented Evidence-Based Practices: Determinants and Associations with Alliance

ABSTRACT Objective The current observational study examined shared decision-making (SDM) with caregivers of Latinx youth within the delivery of multiple evidence-based practices (EBPs) in community mental health services. The aims of the study were to (1) Identify therapist and client factors associated with increased SDM within EBP sessions and (2) Examine the association between SDM and therapeutic alliance between community therapists and Latinx caregivers. Method The Observing Patient Involvement in Decision-Making (OPTION) instrument measured SDM in 210 audio-recorded therapy sessions with 62 community therapists (91.94% female; 69.35% Latinx) and 109 Latinx caregivers (91.43% female) of youth who were an average age of 8.26 years (SD = 3.59). We used the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale to measure the caregiver-therapist alliance observationally. Multilevel linear regressions were conducted to examine research questions. Results Greater SDM was observed within sessions where therapists targeted conduct problems versus trauma (B = −8.79, 95% CI[−14.09, −3.49], p = .001). There was a trend that SDM was higher in English-language sessions compared to Spanish. We found that the global measurement of SDM (B = .04, 95% CI[.01, .08], p = .03) and the OPTION item Integrate Preferences (B = .69, 95% CI[.07, 1.32], p = .03) were positively associated with alliance. Conclusions SDM may help foster Latinx caregiver engagement within EBP delivery. Provider training in SDM may be warranted with consideration of the specific clinical contexts (e.g., by presenting problem) that are appropriate for collaborative treatment planning. More research is needed to further establish the benefits of SDM in youth psychotherapy.

An Investigative Analysis of the Role of Multidisciplinary Teams in Cancer Management: Assessing Advantages and Obstacles

Background: Multidisciplinary team (MDT) meetings are vital for improving patient outcomes and treatment plans, yet their effectiveness remains uncertain. Existing research demonstrates that collaborative treatment plans in cancer care lead to better results than those made by individual practitioners. The impact of MDT meetings on patients' management outcomes is significant. Aim: To evaluate the distribution, characteristics, and diagnoses of cancer patients. Additionally, it seeks to assess the influence of MDT meetings on clinical decision-making and the subsequent impact on patient outcomes. Subjects and methods: A descriptive investigation analyzed a cohort of 150 cancer patients receiving care at Benghazi Medical Center from January to June 2022. Diagnoses were established through comprehensive clinical evaluations, laboratory assessments, radiographic imaging, and histopathological examinations. Medical interventions were determined collaboratively by a multidisciplinary team of healthcare professionals, leveraging their specialized expertise for optimal patient management. Results: The study found that individuals aged 41–60 comprised the largest proportion of cancer patients (49.3%). Females accounted for the majority (62%) of cases, and most participants were from Benghazi (69.3%). Gastrointestinal tract (GIT) cancers were the most prevalent (58.7%), followed by breast tumors in women (14.7%) and pancreatic tumors (6%). Treatment decisions, tailored to individual patient needs, were made collaboratively by the multidisciplinary team. Chemotherapy, radiotherapy, or a combination was chosen for 47.3% of cases, while surgical resection was appropriate for 30.7% of cases. The study's findings support the hypothesis that MDT meetings contribute to effective and up-to-date management guidelines. Neglecting discussions about cancer patients poses significant risks that can no longer be ignored. MDT meetings mitigate these risks and ensure comprehensive medical decisions. Conclusion: The study observed that chemotherapy and surgical resection were frequently selected as treatment options. It emphasized the importance of Multidisciplinary Team (MDT) meetings in guiding clinical decision-making. However, further feedback regarding the optimal format of MDT meetings is required. Establishing standardized MDT protocols is imperative for enhancing patient management outcomes.

Collaborative treatment planning.

Collaborative treatment planning.

Organ-preserving treatment as the most important option in the treatment of primary penile cancer

The treatment of patients with penile cancer presents a significant challenge for therapists and patients alike. In this context, the focus must not only be on surgical techniques but rather on patient education and collaborative treatment planning. Consistent information about potential organ preservation and its consequences is essential. Following clinical examination and histological confirmation of the diagnosis, an organ-preserving and stage-adapted surgical procedure should be used in almost all cases. Intraoperatively, the aim should be to achieve tumour-free surgical margins through rapid pathological examination. Psycho-oncological support should be offered to all patients. Centralisation of treatment appears highly desirable for Germany, considering the excellent outcomes observed in English and Dutch centres. Until this has been achieved, following the valuable experience of the "Second Opinion Network for Testicular Tumours", the Second Opinion platform "eKonsil Urologie" (https://www.ekonsil.org) can be used as a reference.

Wheelchair Skills, Capacity and Performance of Manual Wheelchair Users with Spinal Cord Injury in a Selected Rehabilitation Centre of Bangladesh

Introduction: There is growing recognition that Occupational Therapist has a significant role along with other professional in wheelchair skills training. In rehabilitation center, wheelchair skills are provided as a part of community re-integration process of people with spinal cord injury. However, individual capacity, confidence, performance in wheelchair skills should be prioritized in collaborative treatment plan to ensure occupational functioning of people with spinal cord injury in the community. Objectives: The objectives are to find out the level of wheelchair skills capacity, confidence, and performance of persons with SCI and determine correlation among capacity, confidence and performance. Methodology: This cross-sectional descriptive study was carried out in the community among purposively selected ninety manual wheelchair users using the WST-Q version 4.3. Non-parametric test was used to determine correlation among wheelchair skills capacity, confidence and performance. Result: The median (inter-quartile range) values for WST-Q capacity, WST-Q confidence, and WST-Q performance were 74.26% (57.02%-78.78%), 75.75% (66.66%-80.01%), and 72.00% (54.54%-76.47%). The total WST-Q capacity scores correlated significantly with the total WST-Q confidence scores (r=.955; p<.000) and total WST-Q performance scores (r=.888; p<.000). Success rates were <70% for12 of the 34 individual skills on the WST-Q. Conclusion: Wheelchair skills training enhance confidence and participation among people with spinal cord injury. Occupational therapist should focus on improving participation in occupational functioning at community level.

Motivation in Aphasia Treatment: Self-Determination Theory Applied to the FOURC Model.

Although the importance of motivation to successful rehabilitation is frequently acknowledged in the aphasia literature, little evidence-based guidance has been provided on how to support it. The purpose of this tutorial is to introduce a well-validated theory of motivation, self-determination theory (SDT); explain its role as the foundation for the FOURC model of collaborative goal setting and treatment planning; and explain how it may be applied during rehabilitation to support the motivation of people with aphasia. We provide an overview of SDT, explore the link between motivation and psychological wellness, and discuss how psychological needs are addressed in SDT and the FOURC model. Concrete examples from aphasia therapy are used to illustrate main concepts. SDT offers tangible guidance for supporting motivation and wellness. SDT-based practices support positive forms of motivation, which is one of the targets of FOURC. An understanding of SDT's theoretical foundation will help clinicians maximize the impact of collaborative goal setting and aphasia therapy more generally.

Measurement-based care in Veterans Health Administration mental health residential treatment.

In 2016, the Veterans Health Administration (VHA) launched the Measurement-Based Care (MBC) in Mental Health Initiative to support the use of patient-reported outcome measures (PROMs) across mental health services to increase veteran engagement and promote collaborative treatment planning. The present study reported on the administrations of PROMs across all residential stays within the VHA's Mental Health Residential Rehabilitation Treatment Programs between October 1, 2018, and September 30, 2019 (N = 29,111). We subsequently explored a subsample of veterans attending substance use residential treatment during the same period who completed the Brief Addiction Monitor-Revised (BAM-R; Cacciola et al., 2013) at admission and discharge (n = 2,886) to determine the feasibility of using MBC data for program evaluation. The rate of residential stays with at least one PROM was 84.49%. We also identified moderate to large treatment effects on the BAM-R from admission to discharge (Robust Cohen's d = .76-1.60). There is frequent use of PROMs in VHA mental health residential treatment programs with exploratory analyses demonstrating significant improvements for veterans in substance use disorder residential treatment. Considerations for the appropriate use of PROMs in the context of MBC are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Establishing and developing a paediatric psychodermatology service and our experience of a new paediatric psychodermatology clinic during the Covid 19 pandemic.

Children and young people (CYP) with skin and hair conditions are at an increased risk of mental health problems and vice versa. Current child and adolescent mental health services are already stretched and in our experience, this unique combination of symptoms and signs requires a multi‐disciplinary approach. We report our experience of establishing a paediatric psychodermatology clinic where, at each appointment, CYP are seen by a consultant dermatologist and a clinical psychologist initially jointly and then individually to ensure all viewpoints are heard and a collaborative treatment plan can be agreed. The clinic was established one month prior to the national lockdown during the COVID‐19 pandemic and the face‐to‐face model was converted to a virtual format. CYP are now seen either face to face or virtually according to CYP/parent/carer preference and this hybrid model increases accessibility and has reduced DNA rates. Referrals were received from primary, secondary and tertiary care settings. Thirty –six new patients were seen and followed‐up over a 2 year period, age range 3–17 years old. The majority of patients presented with compulsive hair pulling (trichotillomania) and medically unexplained signs (dermatitis artefacta); other problems seen were eczema, skin picking and acne. Half of the patients required additional psychology sessions. Seventy‐six percent of patients have been discharged, almost half back to the care of their general practitioner. We use pre‐ and post‐clinic questionnaires and share these and feedback from CYP/families who have found this clinic model helpful and effective.

Integrated community health service model (ICHSM): A new hope for primary care in hilly outreach areas of Uttarakhand, India.

Comprehensive primary health care has been a subject of concern for millennia, and the Indian government has undertaken a variety of initiatives, including the National Health Mission, Ayushman Bharat, and Health and Wellness Centers, to mention a few. Despite this, there are significant challenges in providing equitable access to primary health care, particularly for persons who live in rural and hilly areas. The major goal of this model is to develop a comprehensive community-based participatory strategy for galvanizing the community toward improved health-care access and realizing the impact of community empowerment. A thorough literature search was conducted to identify the articles that provide a snapshot of primary hea lth-care services situation in mountainous regions of India. Based on the gaps identified in health-care delivery, we proposed a unique approach built on the principle of "to the community, for the community, and by the community." This paper provides the description of the model, its importance, as well as effectiveness of its implementation in a hard-to-reach region. The model recommends developing a community taskforce within the community to educate the masses about their primary health-care needs, thus reducing emergency department visits and hospital admissions, and also assist the primary care or family physician in preparing a collaborative treatment plan for their patients in early stages of diseases.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

Forming a Doctor-Patient Alliance During COVID-19 to Enhance Treatment Outcomes for Obsessive-Compulsive Disorder.

The impact of COVID-19 on first responders' resilience and attachment

ABSTRACT COVID-19 continues to have a deleterious impact on vulnerable populations in our society, and unfortunately, first responders are often overlooked in this conversation. To address that gap, we retrospectively compared routinely collected baseline assessment data from 69 treatment-seeking first responders who presented for treatment before COVID-19 to data collected from 75 similar first responders at the same agency during the pandemic. Data assessments gauged first responders’ attachment avoidance, attachment anxiety, resilience, depression, generalized anxiety, PTSD, and suicidality. Findings indicate that the strength of correlations between resilience, depression, generalized anxiety, and PTSD increased for these responders during the COVID-19 pandemic. They further highlight the role that attachment anxiety plays for first responder ability to cope during the pandemic. Practitioners can use these findings to create a conversation early in the treatment process and guide a collaborative treatment plan.

Evaluation of team communication in an interprofessional inpatient transition of care simulation

BackgroundInterprofessional education (IPE) provides unique opportunities for students to better understand their roles, roles of other healthcare professionals, and prepare for teamwork for patient benefit. Interprofessional team education is recognized as a key element in the 2016 ACPE standards. ObjectiveAssess student self-perceived competence in four IPEC domains after an inpatient simulation activity. MethodsPre/post-test design used the Interprofessional Education Collaborative Competency Survey. The activity included medical, nursing, social work, and pharmacy students working in healthcare teams to develop collaborative treatment plans for simulated patients with altered mental status. ResultsNinety-seven health profession students completed the activity, while 49 second-year (P2) student pharmacists participated in the study. All completed a pre-test and 47/49 (96%) completed a post-test. At pre-test, students ranked themselves highest in abilities to respect patient privacy (100% strongly agree) and acting with honesty and integrity in relationships (100% strongly agree). They reported lower ability in describing team development process. At post-test, significant increases were seen in managing ethical dilemmas (p < .002) and respect (p = .49), though decreases were seen in using appropriate or respectful language (p < .02). ConclusionSignificant differences in student perceptions of ethics and communication were observed after participation in a transition of care inpatient IPE simulation.

Socially conscious surgical care must prioritize older adults

TopicA commentary on social justice issues in geriatric surgery Future directionsRecognizing social determinants of health and racism as a contributing mechanism for inequities in the care of older adult surgical patients Knowledge gapsIdentifying the role of the surgeon in achieving health equity for older adults PurposeIncrease recognition of opportunities for antiracist care in everyday surgical practice, including shared decision-making and palliative care State of the artPatient treatment goals documented in their own words. Social needs screening in older adult surgical patients Technology gapsPlatform for clear documentation of surgical treatments offered and patient treatment goals, social determinants of health and social risk factors, and collaborative treatment and discharge plans discussed across multidisciplinary, elder-friendly teams

The "Gum-Gut" Axis in Inflammatory Bowel Diseases: A Hypothesis-Driven Review of Associations and Advances.

In modern medicine, the oral cavity has often been viewed as a passive conduit to the upper airways and gastrointestinal tract; however, its connection to the rest of the body has been increasingly explored over the last 40 years. For several diseases, the periodontium and gingiva are at the center of this oral-systemic link. Over 50 systemic conditions have been specifically associated with gingival and periodontal inflammation, including inflammatory bowel diseases (IBD), which have recently been elevated from simple “associations” to elegant, mechanistic investigations. IBD and periodontitis have been reported to impact each other’s progression via a bidirectional relationship whereby chronic oral or intestinal inflammation can impact the other; however, the precise mechanisms for how this occurs remain unclear. Classically, the etiology of gingival inflammation (gingivitis) is oral microbial dysbiosis in the subgingival crevice that can lead to destructive periodontal disease (periodontitis); however, the current understanding of gingival involvement in IBD is that it may represent a separate disease entity from classical gingivitis, arising from mechanisms related to systemic inflammatory activation of niche-resident immune cells. Synthesizing available evidence, we hypothesize that once established, IBD can be driven by microbiomial and inflammatory changes originating specifically from the gingival niche through saliva, thereby worsening IBD outcomes and thus perpetuating a vicious cycle. In this review, we introduce the concept of the “gum–gut axis” as a framework for examining this reciprocal relationship between the periodontium and the gastrointestinal tract. To support and explore this gum–gut axis, we 1) provide a narrative review of historical studies reporting gingival and periodontal manifestations in IBD, 2) describe the current understanding and advances for the gum–gut axis, and 3) underscore the importance of collaborative treatment and research plans between oral and GI practitioners to benefit this patient population.

The Content Validity and Clinical Utility of the Kindergarten Readiness Inventory (K-READI): A Screening Tool of School Readiness for Children on the Autism Spectrum

ABSTRACT There is currently a gap in available assessments for evaluating school readiness in children with Autism Spectrum Disorder (ASD). The Kindergarten Readiness Inventory (K-READI) is a non-standardized screener for basic kindergarten readiness skills of children with autism. The K-READI includes five subscales to assess overall school readiness, which include: (1) school activities of daily living, (2) school-related activities, (3) basic school concepts, (4) social participation, and (5) school behavior. The K-READI is proposed as a screener for collaborative treatment planning and further evaluation. The purpose of this study was to determine the content validity and clinical utility of the K-READI. To determine the content validity of the K-READI, the researchers recruited seven participants who were identified as pediatric occupational therapy practitioners or autism experts to review the K-READI. Item level content validity index (I-CVI) and scale level validity (S-CVI) were calculated, as well as modified kappa indices to reduce probability of chance agreement. The K-READI was then revised based on feedback from the content experts. To determine clinical utility of the K-READI, the researchers recruited 16 pediatric occupational therapists to assess the clinical usage of the revised version of the tool. Responses were thematized and analyzed as collective case studies. The content experts agreed that 17 of the 19 items in the K-READI are essential items to screen for kindergarten readiness. Two of the scale items (Cleans Up and Eye Contact) were removed from the K-READI. The other 17 items and scales were also revised and refined for clarity based on feedback. Modified kappa indices showed excellent level of agreement between raters supporting validity of the I-CVI and S-CVI findings. Clinician reviewers found that the K-READI is a potentially useful tool in practice. Four themes emerged from the analysis of clinical utility responses: The K-READI is (1) a thorough assessment of school readiness skills, (2) generally easy to use, (3) may have potential challenges in administration in different settings, and (4) assesses real life school occupations as a reflection of ecological validity. The K-READI shows initial content validity and potential usefulness in clinical practice. Future research directions include the need to establish construct validity and test reliability of the tool.

An evaluation of a simulation and video-based training program to address adverse childhood experiences.

Adverse Childhood Experiences (ACEs) are multiple sources of maltreatment and household dysfunction with tremendous impact on health. A trauma-informed (TI) approach is preferred when working with patients with ACEs. The Professional ACEs-Informed Training for Health© (PATH©) educational program and simulation experience using standardized patients (SP) was developed to help healthcare professionals address ACEs with adults. PATH© is a 3-4 hour curriculum comprised of lecture and discussion, video-based demonstration, simulation experience, and debriefing. It was first developed for primary care (PC) residents in family medicine and internal medicine, and subsequently modified for occupational therapy (OT) and physical therapy (PT) students. This study evaluates a preliminary dataset focusing on PATH© skills of PC residents and OT and PT students during simulation. Recordings of 53 learner-SP encounters from 15 OT and PT students and 38 PC residents were coded using standardized behavioral codes. A subset of ten recordings of PC residents who participated in simulations in the first and fourth year of the training program allowed for evaluation of training outcomes over time. Results showed that medical residents and OT and PT students demonstrated skills during SP encounters congruent with TI training on addressing ACEs with adults, particularly in explaining ACEs, demonstrating empathy, collaborative treatment planning, and stigma reduction. PC residents showed both positive and negative changes in PATH©-specific skills from year 1 to 4 of the training program. This study supports the PATH© model and simulation-based training in preparing clinicians to address ACEs with adults and provides insight into further curriculum improvement.

Measurement-based care implementation in a Veterans Affairs primary care-mental health integration program.

Measurement-based care (MBC) in behavioral health is the systematic use of validated measurement tools to guide clinical decision making and collaborative treatment planning. Although benefits of MBC for clinicians and patients have been supported by research, it appears to be underutilized in clinical settings. This study examined the effectiveness of a MBC implementation plan informed by the theory of planned behavior in a large, integrated primary care program at a Veterans Affairs hospital over 18 months. Multiple methods, including self-report clinician data and aggregated clinic data, were used to examine change in clinician MBC-related behaviors over time. Results demonstrated both an increase in symptom measures administered per clinical encounter and per individual patient treated. Additionally, the ratio of individuals receiving at least one symptom rating measure to total number of patients treated decreased over time, demonstrating increased use of MBC by integrated primary care clinicians. Survey data demonstrated upward trends in administering measures at initial assessment and at treatment termination, and clinician attitudes toward MBC were generally positive. Results corroborate the theory of planned behavior as a model in which to guide systematic MBC implementation. MBC implementation challenges and recommendations are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Narrative Psychiatry and Family Therapy: Promoting Resilience and Collaboration with Persons with Intense Mental and Emotional Experiences at Risk of Causing Violence

Narrative psychiatry identifies meaning‐making as a primal force in our lives and guides family therapists and psychiatrists in cultivating narratives of resilience that support safety and wellbeing when working with families in which a member is dealing with intense mental and emotional experiences and may be at risk of causing violence. These contexts are fraught with implications about power, control, identity, and ethical responsibilities of care for those consulting with us and for the wider community. Offering benefits distinct from pathology‐focused psychiatric practice, narrative psychiatry applies the practices of narrative therapy in psychiatric contexts, focusing on strengths and meaning and honouring how values, intentions, and commitments compel and constrain our actions. Illustrated by case conversations, this paper describes five key practices of narrative psychiatry, including emotional attunement, understanding the person without the problem, externalising problems, creating narratives of resilience, and collaborative treatment planning. It shows how narrative psychiatry facilitates risk reduction through helping a person identify values and narratives that support non‐violence and strengthening abilities, relationships and resources that help them stay true to this commitment. Practical ways that family therapists and psychiatrists can use conversations about resources, including medicines, to deconstruct damaging discourses and generate narratives of resilience are described. Discussion is offered about how narrative psychiatry can support clinicians in ethically negotiating clinical dilemmas in which the preferences of the person or family are in conflict with the clinician's ethical and legal duty to protect life.

The Safing Center: A specialty clinic for treatment and prevention of IPV with veterans.

Intimate partner violence (IPV) has been identified as a significant public health problem that impacts millions of men and women in communities across the United States. The authors describe how one Veterans Affairs Medical Center (VAMC) utilizes a contemporary integrative approach (i.e., contextual IPV framework) in a specialty mental health clinic focused on treatment and prevention of IPV. This framework values psychosocial rehabilitation and a veteran-centered approach in IPV-related treatment, reduces stigma and shame connected with use and/or experience of IPV while simultaneously holding individuals accountable for their behavior, and creates a therapeutic context that allows for comprehensive assessment, systemic conceptualization, and collaborative treatment planning. The authors provide an overview of the clinic and present three clinical cases to illustrate how the contextual IPV framework is utilized in this setting. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Diagnosis and Treatment of Genitourinary Syndrome of Menopause

Genitourinary syndrome of menopause (GSM), formerly referred to as vulvovaginal atrophy or atrophic vaginitis, is a common chronic condition that requires a collaborative treatment plan between a health care provider and a woman to relieve symptoms and improve quality of life. Many women are not aware that symptoms can be controlled with treatment. Current treatment options approved for GSM include vaginal moisturizers, lubricants, and hormones. For women with GSM symptoms that are unresponsive to nonhormonal therapy, low-dose vaginal estrogen therapy is the preferred pharmacologic treatment. Clinicians should be trained to routinely ask appropriate questions during the history to elicit sufficient information to assess for GSM. Physical examination findings may further confirm suspicion of GSM.