Psychosocial Programming Research Articles

Clinical Education: Addressing Prior Trauma and Its Impacts in Medical Settings.

Prior trauma exposure significantly increases the risk of developing PTSD following medical stressors and may contribute to the development of medically induced PTSD. However, healthcare systems often overlook the interaction between prior trauma and current medical stressors, contributing to negative psychosocial and health-related outcomes for patients. Integration of both trauma-informed and trauma-focused practices into psychosocial programming in medical settings may be key to effectively addressing the needs of trauma-exposed patients. Yet, there is a lack of practical guidance on how clinical psychologists in medical settings can respond to trauma's effects in routine clinical practice. This paper aims to provide an overview of trauma-focused theory, assessment, and treatment considerations within medical settings, emphasizing the importance of incorporating trauma-focused intervention into integrated psychosocial programming to address prior trauma and its impacts on care in order to improve patient outcomes.

Accessibility and Perceived Impact of a Group Psychosocial Intervention for Women in Ecuador: A Comparative Analysis by Migration Status.

There is increasing guidance promoting the provision of mental health and psychosocial support programs to both migrant and host community members in humanitarian settings. However, there is a lack of information on the respective experiences and benefits for migrant and host community members who are participating in mental health and psychosocial support programming. We evaluated a community-based psychosocial program for migrant and host community women, Entre Nosotras, which was implemented with an international non-governmental organization in Ecuador in 2021. Data on participant characteristics and psychosocial wellbeing were collected via pre/post surveys with 143 participants, and qualitative interviews were conducted with a subset (n = 61) of participants. All quantitative analyses were conducted in STATA, and qualitative analysis was done in NVivo. Attendance was higher for host community members. Specifically, 71.4% of host community members attended 4-5 sessions, whereas only 37.4% of migrants attended 4-5 sessions (p = 0.004). Qualitative analysis shows that the intervention was less accessible for migrants due to a variety of structural barriers. However, this analysis also demonstrated that both groups of women felt a greater sense of social connectedness after participating in the program and expressed gratitude for the bonds they formed with other women. Some migrant women described negative experiences with the host community because they felt as though they could not confide in host community women and speak freely in front of them. These results underscore how the migratory context influences the implementation of mental health and psychosocial support (MHPSS) programs. As humanitarian guidelines continue to emphasize the integration of host community members and displaced persons, it is critical to account for how the same intervention may impact these populations differently.

Enhancing mental health and well-being in adults from lower-resource settings: A mixed-method evaluation of the impact of problem management plus.

Mental health conditions, recognised as a global crisis, were further exacerbated by the COVID-19 pandemic. Access to mental health services remains limited, particularly in low-income regions. Task-sharing interventions, exemplified by Problem Management Plus (PM+), have emerged as potential solutions to bridge this treatment gap. This study presents an evaluation of the PM+ scale-up in Sub-Saharan Africa (Ethiopia and Benin) and Eastern Europe (Croatia and Bosnia and Herzegovina) as part of a mental health and psychosocial support programming including 87 adult participants. A mixed-method approach assesses the impact of the intervention. Quantitative analyses reveal significant reductions in self-reported problems, depression, anxiety and improved functioning. Qualitative data highlight four main themes: general health, family relationships, psychosocial problems and daily activities. These thematic areas demonstrate consistent improvements across clients, irrespective of the region. The findings underscore the impact of PM+ in addressing a broad spectrum of client issues, demonstrating its potential as a valuable tool for mitigating mental health challenges in diverse settings. This study contributes to the burgeoning body of evidence supporting PM+ and highlights its promise in enhancing mental health outcomes on a global scale, particularly for vulnerable populations.

Promotive and preventive interventions for adolescent mental health in Sub-Saharan Africa: a combined scoping and systematic review

IntroductionPoor mental health in adolescence is associated with mental, physical and social problems in later life. Adolescence is, therefore, a critical time for promoting mental well-being and preventing mental illness,...

Trauma recidivism is reduced with engagement in psychosocial programming following orthopaedic trauma

IntroductionRecidivism is common following injury. Interventions to enhance patient engagement may reduce trauma recidivism. Education, counseling, peer mentorship, and other resources are known as Trauma Recovery Services (TRS). The authors hypothesized that TRS use would reduce trauma recidivism. MethodsOver five years at a level 1 trauma center, 954 adults treated operatively for pelvic, spine, and femoral fractures were reviewed. Recidivism was defined as return to trauma center for new injury within 30-months. All patients were offered TRS. Multivariate logistic regression statistical analysis was used to identify predictors of recidivism. ResultsThree hundred and ninety-seven of all patients (42 %) utilized TRS, including educational materials (n = 293), peer visits (n = 360), coaching (n = 284), posttraumatic stress disorder (PTSD) screening (n = 74), and other services. Within the entire sample, 136 patients (14 %) returned to the emergency department for an unrelated trauma event after mean 21 months. 13 % of TRS users became recidivists. Overall, 49 % of recidivists had history of pre-existing mental illness. High rates of TRS engagement between recidivists and non-recidivists were seen (75 %); however, non-recidivists were more likely to use multiple types of recovery services (49 % vs 34 %, p = 0.002), and were more likely to engage with trauma peer mentors (former trauma survivors) more than once (91 % vs 81 %, p = 0.03). After multivariable analysis, patients using multiple different recovery services had a lower risk of recidivism (p = 0.04, OR 0.42, 95 % CI [0.19–0.96]). ConclusionsMultifaceted engagement with recovery programming is associated with less recidivism following trauma. Future study of resultant reductions in healthcare costs are warranted. Level of EvidenceLevel II; Prognostic

"It just made me feel better": qualitative examination of the implementation of a novel virtual psychosocial support program for adolescents with cancer.

Adolescents with cancer routinely report feelings of isolation and exclusion, including from medical decision-making. To address this problem and support adolescents, we designed and implemented the novel, virtual, weekly Teens4Teens peer support group and patient education program. We examined the views of participating adolescents, program guest speakers, and program moderators as they pertained to the need for the program, its feasibility, acceptability, and perceived impact. We recruited all available adolescents, moderators, and guest speakers who participated in Teens4Teens to take part in audio-recorded, semi-structured interviews. Interviews were transcribed, coded, and analyzed using thematic analysis. We conducted 21 interviews across participant groups. We identified four broad themes: pathways into the Teen4Teens program, Teens4Teens implementation capacity, perspectives of the positive impact of Teens4Teens, and suggestions to improve Teens4Teens. These themes described a perceived need for adolescent-centered psychosocial programming in pediatric cancer care, provided lessons on how best to build and apply such a program, and highlighted the value of the program for both adolescents' and clinicians' acceptability, feasibility, and perceived utility. Adolescents, guest speakers, and moderators valued Teens4Teens and made suggestions to improve capacity to routinely implement the program. Adolescent-tailored psychosocial programming, such as Teens4Teens, is positioned to be integrated into clinical care with relative ease and may serve to improve the cancer care experience of adolescents and their families. This study has potential to provide researchers and clinicians with valuable information about the content, design, and delivery of virtual peer support programming for adolescents with cancer.

Impact of novel psychosocial programming on readmission and recidivism rates among patients with violence-related trauma.

The Victims of Crime Advocacy and Recovery Program (VOCARP) provides advocacy, mental health resources, and educational materials. This study will report complications, readmissions, and recidivism among crime victims, and who used or did not use victim services. Patients engaged with programming from 3/1/17 until 12/31/18 were included. Control groups were patients injured by violent trauma without VOCARP use (N = 212) and patients injured by unintentional injuries (N = 201). Readmissions, complications, reoperations, and trauma recidivism were reported. 1019 patients (83%) used VOCARP. VOCARP users were less often male (56% vs. 71%), less commonly married (12% vs. 41%), and had fewer gunshot wounds (GSWs, 26% vs. 37%) and sexual assaults (4.1% vs. 8%), all p < 0.05. Of all 1,423 patients, 6.6% had a readmission and 7.4% developed a complication. VOCARP patients had fewer complications (4.5% vs. 13.7%), infections (2% vs. 9%), wound healing problems (1% vs. 3.3%), and deep vein thromboses (0.3% vs. 1.9%), all p < 0.05, but no differences in unplanned operations (4.5%). GSW victims had the most complications, readmissions, and unplanned surgeries. Prior trauma recidivism was frequent among all groups, with crime victim patients having 40% prior violence-related injury (vs 9.0% control, p < 0.0001). Trauma recidivism following VOCARP use occurred in 8.5% (vs 5.7% for non-users, p = 0.16). Crime victims differ from other trauma patients, more often with younger age, single marital status, and unemployment at baseline. Complications were lower for VOCARP patients. GSW patients had the most complications, readmissions, and unplanned secondary procedures, representing a population for future attention.

Psychosocial Programming in Uganda: Adaptations during COVID-19

Psychosocial Programming in Uganda: Adaptations during COVID-19

Factors influencing participation in psychosocial programming among orthopaedic trauma patients with PTSD

IntroductionPost Traumatic Stress Disorder (PTSD) commonly occurs following acute trauma. Post-injury outcomes are negatively impacted by PTSD. Trauma Recovery Services (TRS) programming was developed at our institution in 2013 to provide psychosocial programming that increases patient satisfaction with care and ability to return to work and decreases PTSD symptoms. We sought to identify factors that influence patients’ decision to participate in programming. MethodsOver a 3-year period at a single, urban level 1 trauma center, 172 patients over the age of 18 screened positive for PTSD on the validated PTSD checklist for DSM-5 (PCL-5) screening tool. Demographic, socioeconomic, injury, and medical comorbidity information was collected. Variables were initially compared in a univariate manner via Chi-squared, Fisher exact, t-test, or Mann-Whitney U, as appropriate. Variables that had a p-value <0.2 on univariate analysis were entered into a backward stepwise logistic regression model to identify independent predictors of participation in TRS programming. ResultsMean age was 37.8 years. 70.1% of patients were male. The most common mechanisms of injury were gunshot wound (33.7%), motor vehicle crash (19.0%), and burn. 33.5% of patients participated in TRS programming. Nine predictors had p<.2 on univariate analysis and were entered into the stepwise regression model. Four predictors remained in the final model. Patients with private insurance (RR=2.2, p=.038), high school diploma or greater (RR=1.53, p=.002; Table 1), and PCL-5 score greater than 50 were more likely to participate in TRS programming (RR=1.42, p=.046). Patients who live 20 or more minutes away by car from TRS were less likely to participate in programming (RR=0.47, p=.065). DiscussionPatients with more severe PTSD, higher levels of education, and private insurance were more likely to participate in TRS programming. Participation in TRS and similar psychosocial programs may be improved by minimizing the participant's potential commute to the program location.

The use of formative research to culturally adapt a psychosocial support program for perinatal Mayan women in Guatemala

Indigenous Mayan women in Guatemala are at increased risk for perinatal psychological distress due to higher base rates of anxiety, depression, and PTSD linked to oppression, poverty, and a legacy of femicide. This paper discusses the process of adapting the Thinking Healthy Program (THP), a task-sharing intervention that targets perinatal depression, for use within a community health organization serving indigenous, Tz'utujil Mayan families in the Sololá region of Guatemala.The cultural adaptation of scalable psychological interventions conceptual framework was used throughout the adaptation process. A formative, mixed-methods approach triangulated findings from 1) qualitative key informant interviews with perinatal community health workers (PCHWs) and local mothers, 2) observational mock-role plays between PCHWs and distressed perinatal women, 3) a self-report questionnaire examining stigma and culturally-sanctioned help-seeking approaches, and 4) consultation with local stakeholders.Results of this study suggest that the THP can be adapted for Tz'utujil Mayan women by centering the adaption on the cultural idiom of Qajnaq ruchojq'aq’ (low force/energy). The explanatory model of Qajnaq ruchojq'aq’ is interpersonal in nature, thus the integration of techniques from a low-intensity interpersonal therapy intervention are indicated. Symptoms of Qajnaq ruchojq'aq’ were largely cognitive and behavioral, thus the primary treatment elements of the THP are well-aligned. Training adaptations were also identified, including addressing safety concerns and mental health stigma in the community. The next step is to pilot the adapted intervention, making iterative changes as necessary to best meet the psychosocial needs of Tz'utujil Mayan women. This model of adaptation, and findings regarding implementation of interpersonal elements and aspects to address safety, should be considered in future psychosocial programming for perinatal women in Latin American indigenous contexts.

COVID-19 induced psychosocial challenges in South African higher education: Experiences of staff and students at two rural universities

Although the global impact of the COVID-19 pandemic on the education and mental health of the university environment is relatively unknown, it is expected to be very significant considering the high incidence of emotional reactions amongst university students and staff. While fears around COVID-19 exposure, anxieties, and the challenges of support normalize stress, anxiety, and depression as emotional reactions in the face of the pandemic, this psychosocial impact has negative consequences for the university community. Thus, in order to salvage the higher education institutions from the debilitating effects of the pandemic, there is a clear need to safeguard the welfare of students and staff. Hence, it becomes vital to examine the experience of members of the university community during the COVID-19 crisis in order to develop measures and implement interventions that will assist in navigating psychosocial challenges. To achieve this objective, the study employed a mixed-method research approach in which data was collected using web-based survey and online interviews. Concurrent triangulation sampling technique was employed to select a sample of fifteen (15) students, five (5) university managers, and five (5) lecturers – making twenty-five (25) respondents at each of the two universities, thus making a cumulative total of fifty (50) at two (2) rural universities in the Eastern Cape Province, South Africa. Thus, qualitative and quantitative data collected were analysed concurrently by first reporting the qualitative findings and then comparing them to the quantitative findings. Findings revealed that although the university environment traditionally provided opportunities for strengthening social ties which satisfy the universal need to belong to a community, the COVID-19 pandemic has altered rural university life, thus, significantly impacting on psychosocial wellbeing. The study recommends that rural institutions must facilitate psychosocial wellness programming with the assistance of wider stakeholders such as the government and the private sector who can assist in financing this initiative.

How Has COVID-19-Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya?

PurposeAdolescent mental health has been under-researched, particularly in Africa. COVID-19-related household economic stress and school closures will likely have adverse effects. We investigate the relationship among adolescent mental health, adult income loss, and household dynamics during the pandemic in Kenya. MethodsA cross-sectional mobile phone-based survey was conducted with one adult and adolescent (age 10–19 years) pair from a sample of households identified through previous cohort studies in three urban Kenyan counties (Nairobi, Kilifi, Kisumu). Survey questions covered education, physical and mental health, and COVID-19-related impacts on job loss, food insecurity, and healthcare seeking. Logistic regression models were fit to explore relationships among adult income loss, household dynamics, food insecurity, and adult and adolescent depressive symptoms (defined as PHQ-2 score ≤2). ResultsA total of 2,224 adult–adolescent pairs (Nairobi, n = 814; Kilifi, n = 914; Kisumu, n = 496) completed the survey. Over a third (36%) of adolescents reported depressive symptoms, highest among older (15–19 years) boys. Adult loss of income was associated with skipping meals, depressive symptoms, household tensions/violence, and forgoing healthcare. Adolescents had 2.5 higher odds of depressive symptoms if COVID-19 was causing them to skip meals (odds ratio 2.5, 95% confidence interval 2.0–3.1), if their adult head of household reported depressive symptoms (odds ratio 2.6, 95% confidence interval 2.1–3.2). ConclusionsIncome loss during the pandemic adversely affects food insecurity, household dynamics, healthcare-seeking behavior, and worsening adolescent depressive symptoms. With schools reopening, adolescent mental health should be formally addressed, potentially through cash transfers, school or community-based psychosocial programming.

Protocol for a caregiver psychosocial support intervention for populations affected by displacement in Uganda

BackgroundChild psychological distress in refugee settings is a significant public health concern, which is exacerbated by poor caregiver mental health and functioning. However, there are limited studies about effective interventions to improve caregiver mental health in support of child wellbeing. The objective of the current study is to evaluate the effectiveness and implementation of the Journey of Life (JoL) intervention to improve caregiver mental health in a refugee camp in Western Uganda.MethodsA waitlist-control quasi-experimental design is being implemented in the Kiryandongo refugee settlement (intervention n = 600, control n = 600). Caregiver mental distress, measured using the Kessler-6, was selected as the primary outcome. Secondary outcomes include (a) functioning measured by the World Health Organization Disability Assessment Schedule, (b) social support measured by the Medical Outcomes Study Social Support Survey, and (c) caregiving behaviors according to the Parental Acceptance and Rejection Questionnaire and the Child Protection Index. The study aims to examine the implementation of the JoL intervention through qualitative assessments of intervention feasibility, adaptations, and reach.DiscussionThis trial will add much-needed evidence for the implementation of caregiver psychosocial programming within the humanitarian community. Findings will be disseminated amongst local, regional, and global actors in order to guide potential scale up within humanitarian settings.Trial registrationClinical Trials NCT04817098 (Registered: 3/24/21).

"I Go up to the Edge of the Valley, and I Talk to God": Using Mixed Methods to Understand the Relationship between Gender-Based Violence and Mental Health among Lebanese and Syrian Refugee Women Engaged in Psychosocial Programming.

Lebanon’s intersecting economic and political crises exacerbate complex public health issues among both host and refugee populations. This mixed-methods study by a Lebanese service provider, in partnership with an international research institute, seeks to better understand how experiences of gender-based violence (GBV) and mental health intersect in the lives of Syrian and Lebanese women, and how to better meet these needs. It employs a randomized cross-sectional survey of 969 Abaad service users and focus groups with community members and service providers. There were significant associations between GBV and ill mental health; notably, respondents reporting transactional sex had 4 times the likelihood of severe distress (aOR 4.2; 95% CI 1.2–14.8; p ≤ 0.05). Focus groups emphasized less-visible forms of violence, such as emotional violence, and the importance of environmental factors in one’s ability to cope, noting “it always came back to the economy”. Recommendations include providing a more holistic and coordinated approach between GBV, mental health, livelihood, and basic assistance sectors; and sensitive, accessible, and higher-quality mental health services informed by GBV response actors’ experience putting in place survivor-centered programming and made available to both host and refugee community members.

How Has COVID-19 Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya?

Background: Adolescent mental health has been under-researched, particularly in Africa. COVID-19 related household economic stress, coupled with school closures, will likely have adverse effects on adolescent mental health. We investigate the relationship between adolescent mental health, adult income loss, and household dynamics during the pandemic in Kenya. Methods: A mobile phone-based survey was conducted with one adult and adolescent (age 10-19 years) pair from a sample of households identified through previous cohort studies in three Kenyan counties (Nairobi, Kilifi, Kisumu). Survey questions covered education, physical and mental health, and COVID-19 related impacts on job loss, food insecurity, and healthcare seeking. Logistic regression models were fit to explore relationships between adult income loss, household dynamics, food insecurity, adult and adolescent depressive symptoms (defined as PHQ-2 score ≤ 2). Findings: A total of 2,224 adult – adolescent pairs (Nairobi n=814; Kilifi n=914; Kisumu n=496) completed the survey. Of all adolescents, 36% reported depressive symptoms, highest among older (15-19 years) boys. Adult complete loss of income was associated with adult and adolescent skipping meals, adult depressive symptoms, household tensions/violence. Adolescents had 2.5 higher odds of depressive symptoms if COVID-19 was causing them to skip meals (Odds Ratio (OR)=2.5; 95% Confidence Intervals (CI): 2.0, 3.1) and if their adult head of household reported depressive symptoms (OR=2.6; 95% CI: 2.1, 3.2). Adolescents also had 2.5 higher odds of skipping necessary health services if their adult head of household had lost full income (OR=2.5; 95% CI: 1.6, 3.9). Interpretation: Income loss during the pandemic adversely affects food insecurity, household dynamics, and healthcare-seeking behavior, worsening adolescent depressive symptoms. With schools re-opening, adolescent mental health should be formally addressed, potentially through cash transfers, school or community-based psychosocial programming.Funding: Innovation for Poverty Action, University of California San Diego, UK Foreign Commonwealth and Development OfficeDeclaration of Interest: No conflict of interests to declare.Ethical Approval: We received ethical approval from both the Population Council IRB (p936) and AMREF ESRC (P803/2020). Participants 18 years and over provided verbal informed consent, and those under 18 provided verbal assent with parent or guardian consent. Participants were told they could terminate the survey at any time or refuse to answer specific questions. Participants wereinformed beforehand that they would be paid 100 Kenyan shillings (~US$1) for their time(transferred via mPesa mobile money).

A proactive approach: Examples for integrating disaster risk reduction and mental health and psychosocial support programming

Natural disasters and humanitarian emergencies exert devastating impacts globally. Among these effects are disruptions in mental health and psychosocial well-being. Traditionally, mental health and psychosocial support (MHPSS) interventions have been implemented in response and recovery phases. Yet, the field of disaster management has demonstrated a shift towards disaster risk reduction (DRR). The degree to which the MHPSS field has followed this trend has been limited by several factors, including a lack of consensus-based guidance for MHPSS and DRR integration. However, examples from the field exist and demonstrate the feasibility of taking proactive approaches to supporting mental health and well-being and building better before emergencies occur. The following article outlines two case examples, one project in Sierra Leone and another in India, integrating MHPSS and DRR approaches and principles. Lessons learned from these cases and specific challenges in each context are highlighted and discussed.

Connection Through Calls: The Impact of a Seniors Center Without Walls on Older Adults' Social Isolation and Loneliness.

The Edmonton Seniors Centre Without Walls program provides free health, psychosocial, and educational telephone programming for older adults who experience multiple barriers to traditional in-person programming. The aim of this program evaluation was to assess outcomes of participation using validated scales of loneliness and psychosocial and health quality of life. Telephone interviews were conducted pre (n = 160) and post (n = 99) with participants. Given the variation in average attendance, results were assessed by level of participation: Low, Moderate, and High Users. There was statistically significant improvement in all participants’ attitudes towards their self-realization and towards energy levels, and EQ-5D-5L anxiety/depression scale after participation, along with a significant reduction in feelings of social isolation. The highest rates of improvement were seen within High Users. These findings suggest that telephone-based programs could be a useful intervention to improve the wellbeing and socially connectedness of older adults.

Task-shifting for refugee mental health and psychosocial support: A scoping review of services in humanitarian settings through the lens of RE-AIM.

Decades of war, famines, natural disasters, and political upheaval have led to the largest number of displaced persons in human history. The refugee experience is fraught with obstacles from preflight to resettlement, leading to high rates of mental distress including post-traumatic stress disorder, depression, and anxiety. However, there is a paucity of mental health services for refugees in transit. To meet the needs of this vulnerable population, researchers are experimenting with teaching lay community members basic tools for the delivery of mental health and psychosocial support services (MHPSS). However, there are research gaps about the use of implementation science to inform the delivery of applicable interventions, especially within low resource settings, and even less in the humanitarian context. This review utilizes an implementation science framework (RE-AIM) to assess the reach, effectiveness, adoption, implementation, and maintenance of these interventions. Studies included varying interventions and modes of delivery within refugee camp and urban settings. A comprehensive search strategy led to the inclusion and analysis of 11 unique studies. While current research documents adaptation strategies, feasibility, and fidelity checks through routine monitoring, there is still a dearth of evidence regarding capacity building of lay providers in humanitarian settings. Barriers to this data collection include a lack of homogeneity in outcomes across studies, and a lack of comprehensive adaptation strategies which account for culture norms in the implementation of interventions. Furthermore, current funding prioritizes short-term solutions for individuals who meet criteria for mental illnesses and therefore leaves gaps in sustainability, and more inclusive programming for psychosocial services for individuals who do not meet threshold criteria. Findings contribute to the literature about task-shifting for MHPSS in humanitarian contexts, especially illuminating gaps in knowledge about the lay counselor experiences of these interventions. There is a growing number of refugees forced to make homes in temporary camps or urban centers as they await resettlement, a process that can last decades. These refugees are at risk of serious mental health outcomes due to ongoing stress and trauma. One strategy commonly used in global mental health is the training of lay providers to deliver basic mental health and psychosocial programming to communities. While this tactic is currently being tested in refugee settings, there is limited evidence about the implementation of this strategy. The following scoping review aims to assess the implementation of task-shifting interventions within refugee settings, through the use of a robust implementation science framework.

Filling the gap: Mental health and psychosocial paramedicine programming in Ontario, Canada.

Paramedics respond to acute medical and trauma emergencies in the community and transport patients to emergency departments (ED). In some cases, paramedics are not only attending calls for mental health and psychosocial care but are also connecting individuals with more appropriate services to address their needs. This study qualitatively explores to what extent there are promising practices to be learned from paramedic services that are connecting patients to mental health and psychosocial programming. The study is organised as follows. In terms of the methods, we conducted a critical ethnographic case study of mental health and psychosocial care within paramedic services in Ontario, Canada. Interviews were conducted with frontline paramedics (n=31), paramedic services management (n=5), educators at paramedic college programmes (n=5) and Base Hospital physicians/directors (n=5). Work observations were also performed in three paramedic services, with multiple crews across different shifts (n ~90hr). The study findings outline three promising practices: diversion programmes that transfer patients to a destination other than the ED; crisis response teams that attend calls identified as involving mental health and community paramedicine programmes including referral programmes. We outline the social, political and economic conditions in which these programmes were established and are provided. We also describe the conditions required to enable connecting patients to non-ED supports. The benefits of implementing specific programming for mental health-related calls within paramedic services are discussed, as well as the importance of reaching beyond the prehospital and mental healthcare system to comprehensively and preventatively address mental health needs. Tensions are explored related to running programmatic interventions for mental health by paramedic services. We conclude by noting some public policy-level challenges including the need to focus more broadly on prevention and address the social determinants of health to aid the de-escalation of distress.

Facilitators and Barriers to Utilization of Psychosocial Care in Adolescents and Young Adults with Advanced Cancer: Integrating Mobile Health Perspectives.

Purpose: Although targeted psychosocial programming for adolescents and young adults (AYAs) with advanced cancer is a well-described priority, how best to engage AYAs in that programming is less clear. We aimed to examine AYA perspectives on facilitators and barriers to utilization of psychosocial programs and preferred mode of delivery. Methods: In this nested cohort study, AYAs participated in semistructured 1:1 interviews on communication needs. The present analysis focused on questions regarding psychosocial program delivery. Data were analyzed using directed content analysis followed by thematic content analysis to further organize and refine identified global themes and organizational themes. Results: We interviewed 32 patients (Mage = 18, range 14-25, 41% female). Key facilitators to utilization of psychosocial services by AYAs were to (1) align in importance of coping skills, (2) emphasize AYA self-motivation and agency in approach and introduction to services, and (3) offer services to everyone and at multiple timepoints. Key AYA barriers included (1) considering themselves an exception to the rule when discussing the psychosocial needs of AYAs with cancer, (2) the challenge of starting something new, and (3) reluctance to share emotional problems with psychosocial clinicians. Regarding the mode of delivery, some preferred in-person delivery due to opportunities for developing a close relationship and therapeutic rapport-building. Mobile app-based delivery was universally appealing. Conclusion: We provide a potential framework to increase uptake of psychosocial services in the high needs population of AYAs with advanced cancer. Future research will explore implementation strategies for increasing AYA engagement in psychosocial intervention programs.