Indirect Consultation Research Articles

US State and Territorial Indigenous Consultation Laws: A Potential Strategy to Improve the Social Determinants of Health.

The United Nations (UN) has articulated the right to self-determination as a human right for Indigenous people; however, US states and territories have been slow to operationalize this aspect of the UN Declaration on the Rights of Indigenous Peoples. Indigenous consultation laws require all federal executive agencies to consult with tribal nations before implementing policies that have a "tribal implication," and these form the cornerstone of US efforts to implement the UN Declaration on the Rights of Indigenous Peoples. Despite these federal efforts, less is known about the degree to which state and territorial laws require consultation with Indigenous communities. We reviewed all Indigenous consultation laws identified through a search of 50 US states, the District of Columbia, and 5 territories to provide a holistic picture of how jurisdictions have regulated Indigenous consultation efforts. Of the 56 states, 49 (87.5%) had at least 1 Indigenous consultation law; the remaining 7 jurisdictions had none. States engaged in Indigenous consultation in various ways, generally falling into 1 of 3 categories: (1) centralized consultation facilitated through an agency or department, (2) indirect consultation through a designated commission, and (3) fragmented Indigenous consultation through discrete laws. Important gaps were identified, including the lack of a definition for Indigenous consultation, the absence of an appeal process, and the need to train state officials on existing policies. The results provide a baseline on the degree to which US states and territories consult with Indigenous communities and can be used to identify gaps in US compliance with UN human rights mandates.

Measurement of the Consultation Duration in Otorhinolaryngology Outpatient Clinics: Comparison between a University Hospital and a City Hospital

Abstract Materials and Methods The length of consultation per patient was measured by direct observation at the ear–nose–throat outpatient clinics of one university hospital and one city hospital. The consultation time was measured as follows. Direct consultation time: time spent on history-taking and physical examination of the patients. Indirect consultation time: time spent in charting, preparing treatment/prescription orders, medical, and writing referral letters. Results The total consultation time length was significantly longer at the university hospital than that at the city hospital, both for the first consultation and the follow-up consultation. For first visits, the ratio of the indirect consultation time to the total consultation time was 49.2% at the university hospital and 24.2% at the city hospital. As for follow-up visits, the indirect/total consultation time ratio was 37.8% at the university hospital 24.2% at the city hospital. Conclusion Assistance of a medical secretary would be desirable, especially for first consultations at the university hospital, in view of the long indirect consultation times.

We Need to Find Right Balance Between Telehealth, In-Person Care

We Need to Find Right Balance Between Telehealth, In-Person Care

Mental health services for children in care: investigation to elicit outcomes of direct and indirect interventions.

The aim of this study was to compare the efficacy of direct therapy and indirect consultation for treating mental health difficulties among looked after children (LAC), and also to identify any demographic or clinical predictor variables for outcomes in this cohort. A retrospective evaluation of mental health outcomes for 104 LAC was conducted. All children received network consultation in combination with or without direct therapeutic work. Outcomes were compared between the groups with and without direct therapeutic intervention. Those receiving both treatments displayed significantly greater Strengths and Difficulties Questionnaire (SDQ)-rated improvements than those receiving just consultation. Nonetheless, improvements in scores for the latter group were significant relative to baseline. Treatment duration, younger age at referral and start SDQ were all correlated with positive outcomes, while number of address changes predicted higher start SDQ scores. Despite the retrospective design of this study, its results can be considered as preliminary findings to guide treatment decisions in LAC.

İKİLİ HUKUK SİSTEMİNE KARŞI BİR İTİRAZ: "SISTERS IN ISLAM"IN YASAL HİZMETLERİ ÖRNEĞİ

Founded in Malaysia in 1987, SIS (Sisters in Islam) is an Islamic Feminist group which aims at struggling against gender inequality in various fields. When the term “Islamic Feminism” started to be used in the world, some Malaysian women came together to combat with women’s legal issues and established this organization to present an alternative way for a new law reform on family. The members and the founders of the group realized that centering only Islamic law would not be adequate for combatting with gender inequality. Because the main reason for the secondary position of women is the misinterpretation of the Islamic sources, not Islam itself. Based on this awareness and in parallel with Islamic feminist approach, the members began to make re-reading studies of the Islamic sources. On the other side, some activities to tackle gender inequality in other fields were carried upon. This research aims not to assert an authentic classification to the legal services of SIS which already exists in the literature; but to serve a new typology on the functions of SIS’ legal services in a different point of view and which one of those fields SIS works on. Within this context, during this qualitative research in which content analysis is used as the design of the study, the data were collected through document analysis. As for the technique for data analysis, three phases of qualitative data analysis strategies, that is, description, analysis and interpretation were employed to the gathered data. As the findings and conclusion of the study, the functions of the legal services of SIS can be divided into five categories such as Direct Consultation Services, Indirect Consultation Services, Andragogic and Pedagogic services, Financial services and Suggesting proposals to the government.

2.45 MARCHING 99484-WARD INTO A FINANCIALLY SUSTAINABLE MODEL OF INTEGRATED CARE

AACAP and AAP recognize that integrating mental health (MH) services into pediatric primary care is a potential solution to improving access to MH treatment. Several RCTs and a recent review support the efficacy of these models compared with usual care, but many models rely on grant funding and little is published about sustainable models. Although one study notes that there may be system-level cost savings with integrated care over time, another study notes that integrated MH clinicians most often do not cover the cost of their own salaries with billing revenue. We present billing data from July 2018 through May 2019 after integrating a child psychiatrist one half-day per week for both direct and indirect consultations into a pediatric resident continuity clinic and compare the use of traditional psychiatry billing with the use of the new CPT 99484 code for general MH integration services.

Patient engagement in the development of best practices for transitions from hospital to home: a scoping review

ObjectivesTo explore the extent of patient engagement in the development of best practice reports related to transitions from hospital to home.DesignScoping review.Data sourcesElectronic databases (MEDLINE, EMBASE, CINAHL, Scopus, Trip Database,...

Taxation and Citizen Voice in School District Parcel Tax Elections

Local taxation produces consequential resource inequalities among public school districts, but little is known about how policy design affects taxpayers’ willingness to pay for schooling. We show that voters are more likely to approve local school taxes if the policy is written to require citizen–state consultation on how the funds are spent. In a sample of 236 California school district elections, the promise of indirect consultation with a citizen advisory board was associated with a 3.7 percentage-point greater share of voters and a probability of passage that was 31 percentage points greater, whereas direct consultation with voters was associated with a 5.7 percentage-point greater share of voters and a probability of passage that was 32 percentage points greater, relative to a proposed tax increase with no consultation. These results provide evidence that citizens may trade increased taxation for increased voice even within an established democracy.

Ornitologia, ornitomancja. Sokołowski i (inne) ptaki Jerzego Ficowskiego

Ornithology, ornithomancy. Sokołowski and (other) birds of Jerzy Ficowski The starting point for my article was Jerzy Ficowski’s poem Do autora “Ptaków ziem polskich”. The poem, found in the poet’s penultimate volume – Zawczas z poniewczasem (2004) is commemorating Jan Sokołowski (1899–1982). He was a prominent ornithologist, one of the contemporary forerunners of the field, a pioneer of bird protection in Poland, and, above all, a visionary who in his work exhibited an innovatively personal approach to animals. The language he used was commonly regarded as anthropomorphic, since he attributed animals with emotions. In the article, I deal with poetic traces of both deliberate and accidental relations between Ficowski’s work and the ornithological work of Sokołowki. At the same time I attempt at a reconstruction of the advice that the author of Pantarei gained from the so to speak indirect consultations with the scholar. This allowed him to set the birds free in terms of cultural code of symbolic meaning. By referring to fairly numerous poems of Ficowski in which animals are present as main characters I prove that in both his and Sokołowski’s representation they are in fact quite similar. This, naturally, is done in different registers, however they both paid special attention to both ornithological faithfulness and what is beyond the reach of science, i.e. attempting to reflect the inner life of birds.Key words: animal studies; ornithology; Polish poetry;

Telepsychiatry and Health Technologies: A Guide for Mental Health Professionals

Back to table of contents Previous article Next article Book ForumFull AccessTelepsychiatry and Health Technologies: A Guide for Mental Health ProfessionalsFrank W. Brown, M.D., M.B.A.Frank W. BrownSearch for more papers by this author, M.D., M.B.A.Published Online:1 Nov 2017https://doi.org/10.1176/appi.ajp.2017.17040418AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail edited by Peter Yellowlees, M.B.B.S., M.D., and Jay H. Shore, M.D., M.P.H. Washington, D.C., American Psychiatric Association Publishing, 2018, 400 pp., $69.00 (paperback).There remains a shortage of psychiatrists and other mental health professionals in many service areas of the United States and around the world. Telepsychiatry and other health technologies have provided a means of addressing some of these shortages. The use of these technologies is expected to increase over the next decade, allowing for greater mental health care of more diverse populations.Peter Yellowlees and Jay Shore have edited Telepsychiatry and Health Technologies: A Guide for Mental Health Professionals. This book has been written to be both a core resource for the training of mental health professionals and a reference for those already trained in the use of health technologies. The editors have an aim that this book will eventually be a clinical textbook for the field. The editors note in the preface that the “book focuses on the doctor-patient relationship, and is a practical description of how psychiatrists and other mental health professionals may leverage expanding digital technologies and processes currently available, and that are increasingly being used in clinical practice, for the assessment and treatment of patients with psychiatric disorders.” The book provides practical guidance and advice on the optimal use of telepsychiatry and other health technologies.The book has 10 chapters, with each providing major learning objectives or findings and a brief summary. One major advantage of this book is that each chapter has section headings posed as questions; each section provides a detailed answer to the question, with references. The editors have organized the chapters and section headings to provide a comprehensive review that is well written by very knowledgeable authorities in the field.The book has three major sections, with the first section having four chapters related to current status, the evidence base for telepsychiatry, business development related to health technologies, and models of care. The second section has four chapters related to the core elements of a clinical practice using these technologies. The major areas covered in the second section include communication and media skills, data collection from nonpatient interview sources, clinical documentation, and indirect consultations and hybrid care. The final section of the book has two chapters devoted to patient population management and competencies, skills, and quality of care. Throughout the book, the editors have used numerous clinical case studies that illustrate major themes of the sections; these are illustrative of actual clinical situations using health technologies and will be a valuable resource for practicing clinicians.While all chapters in the book are relevant to the discussion of advancing health technologies, there are several major themes that transcend various chapters. First is that current psychiatric practice tends to be inefficient and that there is a need to leverage technology as part of change management; in the future, the traditional in-person patient session may not be considered the optimal practice standard. Second is that advancing health technologies need to consider emerging technologies beyond simple audiovisual conferencing to include, for example, social networking, virtual reality treatments, and artificial intelligence. Finally, the psychiatrist-patient relationship will center more on the elements of treatment planning, with technology providing the opportunity for hybrid care models in the future.The editors have provided in one source a comprehensive text covering all major areas of telepsychiatry, including emerging technologies. Although the field of telepsychiatry is rapidly changing, the editors have provided clinicians with a resource book that will answer nearly all questions related to the practice of clinical telepsychiatry. As such, this book is highly recommended, especially for those considering expanding clinical practice beyond the traditional in-person session. The book is ideally suited for mental health trainees and practicing clinicians in all mental health fields.Dr. Brown is Chief Quality Officer, Emory University Hospital, and Vice-Chair and Associate Professor, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta.The author reports no financial relationships with commercial interests. FiguresReferencesCited byDetailsCited byCognitive Processing Therapy for Posttraumatic Stress Disorder via Telehealth: Practical Considerations During the COVID‐19 Pandemic11 June 2020 | Journal of Traumatic Stress, Vol. 33, No. 4 Volume 174Issue 11 November 01, 2017Pages 1126-1126 Metrics KeywordsOther Psychological IssuesAdministrationHealth ITPDF download History Accepted 1 April 2017 Published online 1 November 2017 Published in print 1 November 2017

Psychiatric consultation in the collaborative care model: The “bipolar sieve” effect

Around the world, psychiatrists are in exceptionally short supply. The majority of mental health treatment is delivered in primary care. In the United States, the Collaborative Care Model (CCM) addresses the shortfall of psychiatrists by providing indirect consultation in primary care. A Cochrane meta-analysis affirms the efficacy this model for depression and anxiety. However, our experience with the CCM suggests that most patients referred for consultation have problems far more complex than simple depression and anxiety. Based on preliminary data, we offer five linked hypotheses: (1) in an efficient collaborative care process, the majority of mental illnesses can be handled by providers who are less expensive and more plentiful than psychiatrists. (2) A majority of the remaining cases will be bipolar disorder variations. Differentiating these from PTSD, the most common alternative or comorbid diagnosis, is challenging and often requires a psychiatrist’s input. (3) Psychiatric consultants can teach their primary care colleagues that bipolar diagnoses are estimations based on rigorously assessed probabilities, and that cases fall on a spectrum from unipolar to bipolar. (4) All providers must recognize that when bipolarity is missed, antidepressant prescription often follows. Antidepressants can induce bipolar mixed states, with extreme anxiety and potentially dangerous impulsivity and suicidality. (5) Psychiatrists can help develop clinical approaches in primary care that identify bipolarity and differentiate it from (or establish comorbidity with) PTSD; and psychiatrists can facilitate appropriate treatment, including bipolar-specific psychotherapies as well as use of mood stabilizers.

Training in integrated mental health-primary care models: a national survey of child psychiatry program directors.

The objective of this study was to assess current trainee exposure to integrated mental health/primary care models in US child and adolescent psychiatry fellowship programs. In June 2013, an electronic survey was sent to all US child and adolescent psychiatry fellowship program directors (N=123). Fifty-two responses were obtained from the 120 eligible participants (43%). The majority of the program directors who responded (63%) indicated that fellows in their programs regularly participate in clinical care and/or consultation within an outpatient pediatric primary care setting. Program directors identified barriers to increasing training exposure to integrated care delivery as competing clinical demands and challenging financial models for indirect consultation in primary care settings. Many child psychiatry fellowship program directors view training in integrated care models as an important part of their teaching and service mission, and are creating novel avenues for exposure. Current funding models, however, may limit the widespread implementation of these opportunities.

Effect of a Group Adherence Intervention for Mexican-American Older Adults With Type 2 Diabetes

I evaluated the effect of a culturally tailored, peer-led support group intervention on improvement in adherence behaviors of Mexican-American older adults with type 2 diabetes mellitus and obtained feedback on the cultural relevance of the manual that structured the intervention. The one-group pretest-posttest design used five self-report questionnaires and blood testing to measure change among 4 men and 12 women, ages 60-85. Empowerment, self-efficacy, and attitude were highly significant at 2-, 4-, and 6-mo posttests. Glycosylated hemoglobin test results were significant at p < .05 between pretest and 2-mo posttest with a stabilizing effect on the 6-mo posttest. Mexican-American older adults' adherence may improve with a culturally sensitive, structured peer-led program with indirect consultation from an occupational therapist.

The Consultation Conference: A New Model of Collaboration for Child Psychiatry and Primary Care

Because of the relative shortage of available child psychiatrists, primary-care providers are increasingly expanding their role in the provision of mental health care. Accordingly, there is an increased need to develop a standardized approach to teaching specialized skills to these providers. One method of doing so is to expand the child psychiatrist’s consultative role to include the structured discussion of patient cases. By emphasizing the reasoning behind treatment recommendations, the psychiatrist can assist the primary-care provider in applying this knowledge to other patients in his or her practice. A group setting, or “consultation conference,” can be used to involve more providers—who, in turn, become resources for each other. This model of a group conference adapts principles of adult learning (1–5) to facilitate the dual consultative and educational goals. Providers who care for patients in the same (or similar) setting come together as a group to share their experience and knowledge. The psychiatrist assists in that group setting, functioning both as expert resource and facilitator. Participants discuss problem cases, thus learning in their own context while receiving assistance in the understanding and management of actual patients (indirect consultation).

Migration et vulnérabilité des jeunes étrangers isolés

The path through life of isolated foreign minors is often beset by any number of difficulties and paradoxical situations, leading to depressive syndromes and complex post-traumatic disorders. Educational services regularly refer them to the &#8220;Maison des adolescents&#8221; of the Hospital Cochin (Paris). How is one to understand and work with these young people, whose clinical presentation and life history is so different ? We put forward a transcultural method with two lines of approach. There are transcultural consultations in which the problems of the young person are analysed on three levels, ontological ; aetiological and therapeutic. Then there are indirect consultations in which the professionals who take charge of the young people are seen in order to discuss the situation which causes them concern.

Treatment Intensity in Child and Adolescent Mental Health Services and Health Care Reform in Norway, 1998–2006

Treatment Intensity in Child and Adolescent Mental Health Services and Health Care Reform in Norway, 1998–2006

Treatment Intensity in Child and Adolescent Mental Health Services and Health Care Reform in Norway, 1998–2006

The aim of this study was to assess trends in treatment intensity in outpatient child and adolescent mental health services (CAMHS) in Norway from 1998 to 2006. During this period, Norway experienced substantial growth in available CAMHS resources. In 2002 hospital ownership was recentralized and health enterprises were established. A nonexperimental, interrupted time-series design was used to estimate trends adjusted for patient case mix and CAMHS size. From a panel of 37 CAMHS units, two subsamples were extracted. These patients (N=94,173) were aged 0-17 years and had participated in at least one treatment session with a therapist (direct consultation) during the year of observation. Direct and indirect consultations (appointments with cooperating services) were separately analyzed with multilevel regression analyses. Patient-level factors were the main sources of variation in number of consultations. CAMHS unit size was positively associated with direct consultations in both subsamples. A trend of increased direct consultations was observed in one subsample. Comparing the period 2002-2006 with 1998-2001 revealed a positive shift in treatment intensity for both consultation types in both subsamples. Trends and shifts differed between patient groups according to the main reason for referral and gender. The main health policy objective during the study period was increased access to mental health treatment. Both access and treatment intensity increased. The study was inconclusive about whether incentives related to CAMHS performance measurement caused treatment intensity to increase, specifically after the 2002 hospital ownership reform.

Beyond the specific child What is ‘a child's case’ in general practice?

Too many abused and neglected children are being overlooked by GPs and other professionals who are in contact with the families. Some suggestions for a definition of 'a child in need' have been given, but the functionality of these definitions has not been tested in general practice. To describe the problems presented by GPs as cases with children in need during supervision, and from here to suggest an empirically-based definition of a child in need in general practice. A mixed-method evaluation design was used. Twenty-one GPs, in Denmark, participated in supervision groups concerning cases with children in need in general practice. The data were analysed via field notes and video recordings; case categorisation into sex, ethnicity, and developmental stages; thematically using the GPs' own descriptions; and a theoretically supported style. Analysis of the data led to the suggested definition of a case concerning 'a child in need' in general practice as one that directly or indirectly involves problems with a specific child, an as-yet unborn child, or one or both parents of a family currently or potentially threatening the wellbeing of the family or the child. Based on this analysis, one suggestion as to why some abused and neglected children are overlooked in general practice is that GPs often have to navigate in difficult indirect consultations, where there is a high risk of losing the overview.

‘Everybody's talking at me’: the dynamics of information disclosure and consultation in high‐skill workplaces in the UK

This article examines the dynamics of direct and indirect consultation processes in three high‐skill work establishments in the UK. Drawing on a mix of case study survey and interview data, it analyses the experiences and attitudes of predominantly well‐qualified professional employees. Adopting the concept of ‘embeddedness’ of employee consultation at the workplace level, we find that despite considerable breadth and depth of practice, many employees remain dissatisfied with the extent of their individual and collective influence over management decision‐making processes. Four underlying contributory factors are presented: extant hierarchical and bureaucratic management styles, the negative impact of work overload, the individualisation of consultation through computerisation, and the weakness of cooperative forms of union engagement.

Supporting Primary Care Through Pediatric Telepsychiatry

This paper describes a pediatric telepsychiatry program serving communities in rural Ontario, Canada. Since the program's inception in 2000, over 4,300 direct clinical consultations have been provided for a variety of presenting issues. Indirect consultations and educational sessions have augmented clinicians' knowledge. Participant evaluation of the program indicates that a comprehensive model of psychiatric consultation and education can be delivered effectively via live interactive videoconferencing to support primary care and to enhance capacity in remote, underserviced areas in Ontario.