Psychosocial Goals Research Articles

Using Intervention Mapping to co-design a psychosocial service with youth experiencing mental illness

BackgroundDescriptions of service development processes in the youth mental health sector are lacking. Further, youth with lived experience of mental illness are rarely involved in service design. Intervention Mapping (IM) is a well-established framework for program development, implementation and evaluation, yet its applicability in the youth mental health sector is unknown. This paper describes the use of IM methodology to co-design and develop a psychosocial service to support youth aged 10–25 years experiencing mental illness in Tasmania, Australia. MethodsThe six steps of IM were followed: 1) needs assessment; 2) define program outcomes and objectives; 3) program design; 4) program production; 5) implementation planning; and 6) evaluation planning. ResultsKey outputs of each IM step are described. The service was successfully co-designed with young people at the centre of each step. The service includes wrap-around psychosocial support from lived-experience peer-support workers; outreach; and flexible frequency/intensity/duration to achieve young people’s psychosocial goals. ConclusionsThis is the first study to document the use of IM in co-designing a psychosocial service with youth experiencing mental illness. IM may provide a valuable roadmap for the youth mental health sector in supporting collaborative service design, implementation and evaluation planning, and systematic documentation of service development.

Supervised on-site dosing in injectable opioid agonist treatment-considering the patient perspective. Findings from a cross-sectional interview study in two German cities.

Injectable opioid agonist treatment (iOAT) is an effective option to support people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral OAT. However, iOAT has been criticised based on theoretical and practical grounds for its dosing policies: Current regulations demand supervised, on-site application and require patients to frequently visit their treatment facility. The current study aims to investigate how patients experience on-site application and derive strategies to enhance the acceptability and effectiveness of iOAT-delivery. This article is based on semi-structured interviews with 27 individuals currently or previously in iOAT in two German outpatient iOAT-clinics. We undertook an inductive qualitative content analysis, which included blinded, independent coding and the analysis of individual cases. Comments regarding on-site application and daily visits to the clinic were grouped into positive and negative aspects, iOAT as the best alternative option, facilitators of daily visits, and suggestions for improvement. Positive aspects took the factors stability and social support in regard. Negative aspects ranged from general inconveniences to major impediments to individuals' daily lives and towards achieving psychosocial goals. Participants reported rigorous adherence to iOAT's treatment regime, often due to a perceived lack of alternative options. Meeting iOAT's demands was eased by the patients' coping-strategies and through facilitating measures implemented by iOAT-clinics. Despite acknowledgement of the potential detriments from easing regulations, take-home arrangements were frequently suggested by participants to improve iOAT. Being required to attend the clinic for supervised iOAT-application is not experienced uniformly. While clinics can support their patients to cope with strict regulations, alternative approaches to iOAT-application should be considered to accommodate patients' individual needs. Examples from other treatment modalities (e.g., remote supervision and delivery services) might aid to reconcile individualisation while providing adequate safety measures and improve iOAT in the long term.

Bridging the gap: A quality improvement project to implement psychosocial care standards into clinical practice in pediatric oncology.

Psychosocial guidelines and standards systematically describe stressors and resources in particularly challenging situations and hence serve as a basis for interventions to achieve defined psychosocial goals. Despite fundamental principles and guidelines for psychosocial methods, the quality of provided care varies considerably depending on setting, provision, and profession. The purpose of the present protocol is to illustrate the development and evaluation of the standardized psychological intervention "My Logbook", a practical guide accompanying children through all stages of treatment by directly translating current quality standards of psychosocial care into practice. In an evidence-based set-up, using face-to-face discussions and telephone conferences, a multi-professional team of local experts decide on critical disease-related issues, structure, content (information and intervention elements) and design of the quality improvement tool. Via delphi surveys an extended expert team is asked to rate the content, method, and design of all booklets which is concluded by a final agreement by the specialist group for quality assurance of the psychosocial working group in the Society for Pediatric Oncology (PSAPOH). The developed tools are piloted in an international multicenter study to evaluate the patient-reported outcome and feasibility and to integrate practical views of patients, as well as psychosocial and interdisciplinary professionals into the further development of the "My Logbook". The iterative development of the "My Logbook" including local and international experts as well as the patient and practical perspective allow for the design of a process-oriented, consensus - and evidence-based tool directly translating the S3-Guideline into clinical practice. Feasibility and applicability are fostered through an iterative process of constant evaluation and adaptation of the tool by international experts and through the clinical experience gathered in the multi-centered pilot study. Furthermore, the systematic evaluation of the tool by patients, psychosocial, and interdisciplinary professionals enables the identification of persisting gaps between evidence-based standards and clinical practice, discrepancies between the various stakeholders' perspectives as well as regional differences in feasibility, thereby directly linking practice and research. The preliminary results emphasize that psychological support can be standardized, enabling an evaluation and optimization of psychosocial care which future studies need to assess in multicenter clinical randomized controlled trials.

Investigating Prior Mentoring Experiences of Medical Students and Its Perceived Benefits.

ABSTRACTSuccessful mentoring relationships allow mentees to gain the confidence and knowledge they need to reach their goals, but students from populations generally underrepresented in science and health fields have been shown to receive less mentorship than their well-represented peers. In highly competitive processes, like medical school admissions, mentoring may be particularly valuable. We investigated the prior mentoring experiences of medical students and whether their perceptions of mentoring differed based on their mentoring goals or demographics (race/ethnicity, gender identity, household income, or parental highest level of education) through surveys and interviews of medical students from three different institutions. These medical students had widely participated in mentoring, though student race and household income impacted their access to medical professionals to serve as informal mentors. Medical students shared the same gender identity as their mentor more often than would be expected under the null hypothesis. Students reported having both career and psychosocial goals for mentoring, and there was a positive association between the strength of the mentees’ goals for mentoring and the number of formal mentors the mentees had. These respondents viewed mentoring as having provided them with both career and psychosocial benefits. Mentoring programs for aspiring medical students may benefit from focusing on both career and psychosocial functions to maximize the benefits of mentoring for students from diverse backgrounds.

Treatment goals and preferences of pediatric psoriasis patients, young adults, and parents

Background Treatment needs of young psoriasis patients and parents are not widely studied and could advance patient-centered care. Objective To explore treatment goals and preferences of pediatric psoriasis patients, young adults, and parents. Methods A web-based survey among Dutch psoriasis patients aged ≥6 to ≤30 years and parents included multiple-choice, open-ended, and 4-point Likert scale questions. Treatment goals and characteristic preferences of pediatric patients (≤17 years) were compared to young adults (≥18 years) and parents. Results 195 young patients (20.2 ± 6.3 years) and 45 parents were included. The most important treatment goals were ‘preventing lesions’, ‘reducing lesions’, ‘no itch’, and ‘no lesions’. Regarding treatment characteristics, ‘long-term safety’, ‘high effectiveness’, and ‘short-term safety’ were most important. We found differences by age, gender, and current treatment. Pediatric patients rated ‘not sticky’, ‘quick results’, and ‘no/few blood samples needed’ higher than parents and/or young adults. Young adults rated ‘feeling more confident’ and ‘better quality of sleep’ higher than pediatric patients. Parents considered safety most important. Psychosocial goals were more important for women and patients on biologics. Conclusion Young psoriasis patients and parents mainly strive to clear lesions and itch with effective and safe treatment. However, revealed differences underline the relevance of addressing individual needs.

Identifying the Role of Spatial Transitions in the Palliative Care Experiences of Unhoused Older Adults

The national population of unhoused older adults is predicted to nearly triple by 2030. Unhoused older adults have a mortality rate four to nine times higher than housed populations, and face structural barriers during illness trajectory that likely influence both where care takes place and processes around attaining psychosocial later-life goals. This study aimed to (1) document patterns in the healthcare trajectories of unhoused older adults and (2) examine the role of care transitions in psychosocial goal attainment. Retrospective chart review was completed in partnership with a mobile homeless palliative care team; additional data was gathered from provider focus group. Through a content analysis of this data, it was discovered that older unhoused palliative care patients experienced more transitions, and that numerous care transitions were associated with disruptions to goals. The type of care transitions patients experienced also did not reflect their later-life goals. Patients’ movements impacted the role of formal and informal care networks in care and highlighted the implications of place in common psychosocial goals, such as family reconciliation. Unconventional neighborhood supports were found to help facilitate treatment adherence. These findings offer translational opportunities for further research, including “rapid respite” models and other innovations in mobile palliative care for unhoused and precariously-housed people with life-limiting illness.

Recovery target priorities of people with spinal cord injuries in Korea compared with other countries: a survey.

Cross-sectional survey. To identify which functional areas are important in recovery and which psychosocial factors influence life quality among persons with spinal cord injuries in Korea and to compare our results with similar studies from other countries. University-affiliated rehabilitation hospital. The survey was distributed to people with spinal cord injuries and captured their targeted functional recoveries and psychosocial goals that can affect life quality. The respondents were asked to place these in order of priority. Participants were also asked questions regarding factors they felt were important for restoring function, their expectations for recovery and to evaluate their health status and satisfaction with their quality of life. Fifty-five people were tetraplegia and 45 people were paraplegia. The primary functional recovery goals included the recovery of upper extremity functions in tetraplegic persons and restoration of bladder and bowel functions in paraplegic persons. For psychosocial goals, stress management was the most important factor among both tetraplegic and paraplegic people. The two most important factors for restoring function were proper physical therapy and relationship with their clinician. About half of the respondents had no expectation of restoring their functions. Restoring upper extremity function, sexual function, and bladder and bowel function has been a common concern in previous studies. Our result, however, showed sexual function was less important. Coping with stress was important for life quality, another finding that differed from other studies. Thus, there may be cultural and social differences in the priorities of the target functions.

Therapeutic Music Training (TMT): A music therapy model using music training on an instrument to address therapeutic goals in the areas of cognition and psychosocial health

Music training has been noted for its benefits, both musical and non-musical, for the learner. Grounded in literature and informed by clinical work, the music therapy model Therapeutic Music Training (TMT) was developed. TMT uses the experience of learning to play an instrument to target specific non-music therapeutic goals in the areas of cognition and psychosocial health. Music training specifically is critical, as the components and characteristics of music contribute to the therapeutic mechanisms for both cognitive and psychosocial goals. Because of the engagement of the prefrontal cortex and the demands placed on cognitive control and working memory during TMT, it can be a unique and effective intervention for cognitive rehabilitation. The positive impact of new skill learning on self-perception, and the inherent expressiveness of music production, allows for TMT to be used to address a number of psychosocial goals. This paper introduces TMT and describes the theoretical bases for this music therapy model.

The role of physical activity promotion in typical exercise therapy concepts: a latent class analysis based on a national survey in German rehabilitation settings

Purpose: Contemporary multidisciplinary rehabilitation programs include the promotion of physical activity as a central goal. Exercise therapy is an essential element in rehabilitation programs working towards this goal. However, little is known about the role of physical activity promotion in exercise therapy practice in rehabilitation settings. The aim is to identify typical exercise therapy concepts in rehabilitation programs regarding the role of physical activity promotion. Further, we want to assess the representation of physical activity promotion among exercise therapy departments across Germany and in relation to different diagnostic categories.Methods: Heads of 713 exercise therapy departments participated in a nationwide questionnaire-based survey collecting information on therapy goals, contents, and methods. Participating facilities treated health conditions in the areas of cardiology, orthopedics, neurology, oncology, psychosomatics and addiction. We applied factor analyses to identify behavior-oriented goals, contents and methods of exercise therapy concepts and used latent class analyses to categorize typical exercise therapy concepts.Results: Six typical exercise therapy concepts were identified. Two of the classes (together 45% of the departments) emphasized physical activity promotion and used related methods. Other concepts focused primarily on physical functioning and exercise or focused on psychosocial goals and positive experiences with physical activity. Typical exercise therapy concepts are only partially determined by the type of health condition.Conclusions: The dissemination of content and methods for a substantial physical activity promotion in exercise therapy, has so far partly taken place in Germany. The results imply that the different status quo in rehabilitation facilities have to be considered to foster the knowledge exchange between science and practice.Implications for rehabilitationThe results on typical exercise therapy concepts give a structured overview of different priorities with regard to aims, content, and methods of exercise therapy in the light of the International Classification of Functioning, Disability, and Health.The study reveals that the dissemination of theoretically sound, evidence-based concepts for physical activity promotion has reached a half of the institutions in German rehabilitation settings. This national example generally suggests that there is a need for an increased exchange of knowledge between science and practice related to exercise therapy in rehabilitation settings.The results enable practitioners to reflect on their exercise therapy concepts with respect to contemporary exercise therapy concepts that integrate physical activity promotion appropriately.Stakeholders and rehabilitation professionals can use the results to design strategies for quality development, taking into account the different status quo of therapy concepts in the "real world" of rehabilitation practice.The results of the survey provide the basis for a scientifically-based comparison of exercise therapy across countries and health care systems.

“I try, I do”: Child feeding practices of motivated, low-income parents reflect trade-offs between psychosocial- and nutrition-oriented goals

Although there is increased focus on behavior change programs targeting parents to promote healthy child feeding, success of these programs has been limited. To close this gap, we sought to understand parents' goals for child feeding and their motivations, abilities, and contextual environment that challenged or enabled goal achievement, with a focus on parents' own childhood food experiences. We conducted semi-structured qualitative interviews (n = 21) with low-income parents of at least one child aged 3–11 years in three semi-rural counties in upstate New York to explore their emic perspectives on child feeding goals and practices. Transcripts were coded by at least two researchers using the constant comparative approach. Emergent themes were identified and interpreted in the context of the Motivation-Ability-Opportunity framework. Low-income parents articulated and were clearly motivated to achieve both nutrition- and psychosocial-oriented goals. Salient psychosocial goals (e.g., family meals to promote family relationships, help child feel secure), often led to different child feeding practices than indicated by parents' nutrition-oriented child feeding goals (e.g., nutritious diet, healthful relationship with food). Sometimes these psychosocial goals were in conflict with the nutrition-oriented goals; for example, some parents gave into child food preferences to avoid conflict or hesitated to introduce changes in diets of overweight children to preserve child self-esteem. Prominent contextual barriers included child preferences, life disruptions, and the inflexible time and financial restrictions of poverty. Parents exhibited awareness and motivation to achieve healthy eating goals but success was often thwarted by the salience of psychosocial goals that often motivated less-healthy practices. Thus, behavior change programs should acknowledge the value and relevance of both types of goals and help parents develop strategies to address the tensions between them.

Building Better Bridges into STEM: A Synthesis of 25 Years of Literature on STEM Summer Bridge Programs.

Summer bridge programs are designed to help transition students into the college learning environment. Increasingly, bridge programs are being developed in science, technology, engineering, and mathematics (STEM) disciplines because of the rigorous content and lower student persistence in college STEM compared with other disciplines. However, to our knowledge, a comprehensive review of STEM summer bridge programs does not exist. To provide a resource for bridge program developers, we conducted a systematic review of the literature on STEM summer bridge programs. We identified 46 published reports on 30 unique STEM bridge programs that have been published over the past 25 years. In this review, we report the goals of each bridge program and whether the program was successful in meeting these goals. We identify 14 distinct bridge program goals that can be organized into three categories: academic success goals, psychosocial goals, and department-level goals. Building on the findings of published bridge reports, we present a set of recommendations for STEM bridge programs in hopes of developing better bridges into college.

Social work interventions in Sweden for patients newly diagnosed with type 1 or type 2 diabetes

ABSTRACTWe evaluated psychosocial work with patients in ordinary clinical practice who were newly diagnosed with type 1 or type 2 diabetes and experienced psychosocial problems at disease onset. We examined types of psychosocial problems, causes of these problems, psychosocial interventions, extent of achievement of psychosocial treatment goals, and whether the patients felt they benefited from the treatment. Eighty-nine working-age (18–65-year-old) Swedish adults newly diagnosed with diabetes were included. Each was interviewed and responded to questionnaires at the beginning and end of the study period. Thirty-four (38%) received psychosocial treatment as needed over 2 years. A psychosocial treatment plan with a defined goal was developed for each. Interventions included counseling, problem-focused support, social information, and advice. The treatment process was documented. Eighteen patients had type 1, and 16 had type 2 diabetes. One-third had emotional problems directly caused by receiving a diagnosis. Several of them had crisis reactions. The rest had problems primarily caused by their life situations. Those with psychosocial problems caused by receiving a diagnosis achieved treatment goals more frequently than the others. Distinguishing the cause of the psychosocial problems of newly diagnosed patients may help ensure that social work resources in health care are used as effectively as possible.

Teaching Genetic Counseling Skills: Incorporating a Genetic Counseling Adaptation Continuum Model to Address Psychosocial Complexity.

Genetic counselors are trained health care professionals who effectively integrate both psychosocial counseling and information-giving into their practice. Preparing genetic counseling students for clinical practice is a challenging task, particularly when helping them develop effective and active counseling skills. Resistance to incorporating these skills may stem from decreased confidence, fear of causing harm or a lack of clarity of psycho-social goals. The author reflects on the personal challenges experienced in teaching genetic counselling students to work with psychological and social complexity, and proposes a Genetic Counseling Adaptation Continuum model and methodology to guide students in the use of advanced counseling skills.

Can promoting romantic relationship quality help gay and bisexual men better face HIV stigma?

Advancements in antiretroviral treatment and a greater access to medication have contributed to an increased life expectancy for people who live with HIV/AIDS. As a result, new psychosocial goals in the treatment of HIV, such as improving the quality of life and levels of well-being of those who are infected, have become increasingly relevant. Since men who have sex with men, particularly those who identify as gay and bisexual, continue to be a group of primary concern within the HIV-affected population, new interventions to help them reach the aforementioned goals must be developed. Considering HIV stigma represents a paramount psychosocial threat for individual’s psychological and physical well-being, the authors embrace a resilience-oriented perspective and propose a relational approach to helping gay and bisexual men living with HIV/AIDS better face social stigma. Through an integrative literature review that discusses scholarly works published in the past 15 years on the topics of HIV stigma, relationship quality, and interventions with couples dealing with chronic illness, the authors suggest several couple-oriented interventions as promising strategies to help gay and bisexual men living with HIV/AIDS cope with the social stigma. Future directions in research and plausible components for interventions with these HIV-affected male couples are also discussed.

The long-term psychosocial impact of corrective surgery for adults with strabismus

Background/AimLong-term assessments of the impact of strabismus surgery in adults are rare and very limited in focus. Consequently, this study was designed to consider the psychosocial status of adults a...

A Hand Transplant Candidate Status Designation System

Introduction: Over the past few years there has been an exponential increase in the number of hand transplant programs in the United States. With this increase, patients have greater choice in programs at which to pursue their evaluation. It is likely that some patients will pursue evaluation at multiple programs. Hand transplantation, unlike solid organ transplantation is life enhancing but not life saving or prolonging. The field is also in its early stages. As such there is no pressure to urgently proceed to transplant. Patients may be deemed as; “excellent candidates” who could proceed to transplant immediately, unsuitable for transplant due to multiple coomorbidities, potential candidates once the fields advances more or if certain relative contraindications can be resolved. Various programs will have different acceptance criteria and different centers may place the same candidate into a different category. Nurturing trust and confidence in this field necessitates clear communication with patients and also among different programs. Methods: We reviewed our current experience in evaluating hand transplant candidates and how we can group them into distinct categories that reflect our action plan for each patient. Results: We propose that each hand transplant candidate at the end of the evaluation be given one of four designations. Class A: Approved and listed awaiting a donor. Class B: anatomically acceptable candidate. Some medical or psychosocial goals need to be resolved or met before listing e.g. smoke cessation, availability of caregiver. The candidate is expected to meet these goals within one year. Class C: At this time the program does not want to proceed but may consider the patient in the futures. This could be due to the level of amputation, awaiting improved immunosuppression, post-traumatic stress disorder, very young age, psychological immaturity etc. Class D: patient not a transplant candidate and will not be considered by the program in the future, e.g. too old, active malignancy, peripheral neuropathy. Conclusion: The four designations will make it easier to communicate the status of patients both among the various programs and to patients. This will limit misunderstanding and engendering trust.

Healing Psychosocial Trauma in the Midst of Truth Commissions: The Case of <i>Gacaca</i> in Post-Genocide Rwanda

Post-conflict governments and multilateral organizations have advocated truth commissions since the end of the Cold War. The mandate of truth commissions has been to combine the rule of law with psychosocial goals in the hope that they will break systemic cycles of violence and facilitate reconciliation. While these commissions emphasize the dimensions of truth telling, apology, forgiveness, and reconciliation, in practice, they are often challenged to fulfill the mandate of healing psychosocial traumas through these dimensions in countries that suffer not only from the traumatic experience of wars and genocide, but also from the multiple psychosocial issues that result from these forms of mass violence. The present article examines the psychosocial role of gacaca, a form of truth commission that was introduced in post-genocide Rwanda in 2002, and argues that relying on gacaca alone to heal psychosocial trauma in Rwanda underestimates the depth of suffering that genocide created both at the individual and...

Exposed and embedded corrections in aphasia therapy: issues of voice and identity

Because communication after the onset of aphasia can be fraught with errors, therapist corrections are pervasive in therapy for aphasia. Although corrections are designed to improve the accuracy of communication, some corrections can have social and emotional consequences during interactions. That is, exposure of errors can potentially silence the 'voice' of a speaker by orienting to an utterance as unacceptable. Although corrections can marginalize speakers with aphasia, the practice has not been widely investigated. A qualitative study of corrections during aphasia therapy was undertaken to describe corrections in therapy, identify patterns of occurrence, and develop hypotheses regarding the potential effects of corrections. Videotapes of six individual and five group aphasia therapy sessions were analysed. Sequences consistent with a definition of a therapist 'correction' were identified. Corrections were defined as instances when the therapist offered a 'fix' for a perceived error in the client's talk even though the intent was apparent. Two categories of correction were identified and were consistent with Jefferson's (1987) descriptions of exposed and embedded corrections. Exposed corrections involved explicit correcting by the therapist, while embedded corrections occurred implicitly within the ongoing talk. Patterns of occurrence appeared consistent with philosophical orientations of therapy sessions. Exposed corrections were more prevalent in sessions focusing on repairing deficits, while embedded corrections were prevalent in sessions focusing on natural communication events (e.g. conversation). In addition, exposed corrections were sometimes used when client offerings were plausible or appropriate, but were inconsistent with therapist expectations. The observation that some instances of exposed corrections effectively silenced the voice or self-expression of the person with aphasia has significant implications for outcomes from aphasia therapy. By focusing on accurate productions versus communicative intents, therapy runs the risk of reducing self-esteem and communicative confidence, as well as reinforcing a sense of 'helplessness' and disempowerment among people with aphasia. The results suggest that clinicians should carefully calibrate the use of exposed and embedded corrections to balance linguistic and psychosocial goals.

Effecten van psychosociale interventies bij hart- en vaatziekten: coronaire hartziekten, hartfalen en cerebrovasculaire aandoeningen

The Netherlands Heart Foundation aims in one of her programs at improving the psychosocial care for cardiovascular patients. Effective and efficient care should be organised in such a way that it is connected to the patient’s process of adaptation. For psychosocial interventions this means that the efficacy of interventions is dependent on the attuning of these interventions to the needs and problems of patients. To attune these interventions some aspects should be taken in consideration: the patient’s process of adaptation, individual differences between patients, and disease specific aspects. A model based on these aspects gives global directions for the way interventions should be implemented in psychosocial care systems.With this perspective in mind interventions directed at coronary heart disease, heart failure and cerebrovascular accident were reviewed. It became clear that the efficacy and efficiency of interventions could be improved by screening patients on psychosocial risk factors, psychosocial problems and psychopathology at several moments in the adaptation process. For the development of interventions clear goals should be formulated to make it possible to attune specific interventions to specific groups of patients. At the moment most revalidation programs have a mix of health related and psychosocial goals, which makes it impossible to tell which ingredients of a program are responsible for its effects. Another conclusion is that there is a lack of attention for psychosocial problems in the chronic stage of cardiovascular diseases. Interventions for this stage should be developed.

Treating and Preventing Adolescent Mental Health Disorders: What We Know and What We Don’t Know, A Research Agenda for Improving the Mental Health of Our Youthedited by Dwight L. Evans, Edna B. Foa, Raquel E. Gur, Herbert Hendin, Charles P. O’Brien, Martin E. P. Seligman, and B. Timothy Walsh. New York, Oxford University Press, 2005, 864 pp., $59.50.

Treating and Preventing Adolescent Mental Health Disorders: What We Know and What We Don’t Know, A Research Agenda for Improving the Mental Health of Our Youthedited by Dwight L. Evans, Edna B. Foa, Raquel E. Gur, Herbert Hendin, Charles P. O’Brien, Martin E. P. Seligman, and B. Timothy Walsh. New York, Oxford University Press, 2005, 864 pp., $59.50.