Provision Of Mental Health Services Research Articles

Barriers and facilitators to healthcare utilisation by Arab sexual minority women migrants in the USA

Limited research on sexual minority women migrants demonstrate that they face elevated rates of mental health problems compared to their heterosexual and male counterparts, and less is known about their healthcare seeking behaviours. This study aimed to identify barriers and facilitators to mental and physical healthcare utilisation among first-generation (foreign-born) Arab sexual minority women migrants in the USA and to assess whether Penchansky and Thomas’ theory of access can be used to understand their healthcare utilisation behaviours. We conducted 20 semi-structured interviews via Zoom. Employing community-engaged research methods, four advisors, Arab sexual minority women migrants and a mental health service provider, assisted in recruitment and thematic data analysis providing a rich and nuanced understanding of study findings. Five main themes demonstrated the pivotal role of cultural humility from providers and access to medical insurance in shaping healthcare-seeking decisions. Difficulties finding therapists and navigating the referral process and wait times encouraged participants to seek care outside of the USA in their Arab countries of origin. Stigma and social support further influenced participants’ decisions to seek mental healthcare. The study findings inform policy and practice to foster the development of inclusive healthcare services grounded in cultural humility and to develop support groups specifically for Arab sexual minority women migrants to the USA.

Attitudes of the general population and mental health practitioners towards blended therapy in Austria.

Mental health problems are steadily increasing worldwide. In Austria, the overall supply of mental health services is low, especially in rural areas. Mobile technology and ablended care approach have the potential to overcome problems with service provision. The aim of this study was to map the attitudes of practitioners and people living in Austria towards blended therapy. Two individual online questionnaires (including the Unified Theory of Acceptance and Use of Technology, advantages and disadvantages, useful features) were distributed to practitioners and the general population in Austria. The questionnaires were answered by 152 members of the general public and 129 practitioners. The general population and practitioners seem to be cautious, but slightly positive about blended therapy. Previous experience of practitioners with blended therapy was low. Practitioners are most worried about the therapeutic process and their work-life balance, while the general population is worried about being overwhelmed by the concept, mainly due to the time investment. Tracking, recording and reminding functions (e.g., for mood, homework) were seen as especially valuable features and accessibility was deemed the biggest advantage by both samples. Practitioners' attitudes are important for implementation of blended therapy. More awareness might help against the cautiousness as well as implementing digital health applications in Austrian health policies.

Workforce estimate to treat mental disorders in the Kingdom of Saudi Arabia

BackgroundMental, neurological, and substance abuse (MNS) disorders describe a range of conditions that affect the brain and cause distress or functional impairment. In the Middle East and North Africa (MENA), MNS disorders make up 10.88 percent of the burden of disease as measured in disability-adjusted life years. The Kingdom of Saudi Arabia (KSA) is one of the main providers of mental health services and one of the largest contributors to mental health research in the region. Within the past decade, mental health resources and services has increased.MethodsWe employ a needs-based workforce estimate as a planning exercise to arrive at the total number of psychiatrists, nurses, and psychosocial care providers needed to meet the epidemiological need of mental health conditions of the population of KSA. Estimates for a potential mental health workforce gap were calculated using five steps: Step 1—Quantify target population for priority mental health conditions. Step 2—Identify number of expected cases per year. Step 3—Set target service coverage for each condition. Step 4—Estimate cost-effective health care service resource utilization for each condition. Step 5—Estimate service resources needed for each condition.ResultsThe planning exercise indicates an epidemiologic need for a total of 17,100 full-time-equivalent (FTE) health care providers to treat priority MNS disorders. KSA appears to have a need-based shortage of 10,400 health workers to treat mental disorders. A total of 100 psychiatrists, 5700 nurses, and 4500 psychosocial care providers would be additionally needed (that is, above and beyond current levels) to address the priority mental health conditions. The shortfall is particularly severe for nurses and psychosocial workers who make up 98.9 percent of the shortfall. This shortage is substantial when compared to other high-income countries. Overall, the workforce needed to treat MNS conditions translates to 49.2 health workers per 100,000 population.ConclusionChallenges to addressing the shortfall are Saudi specific which includes awareness of cultural customs and norms in the medical setting. These challenges are compounded by the lack of Saudi nationals in the mental health workforce. Saudi nationals make up 29.5 percent of the physician workforce and 38.8 percent of the nursing workforce. Policymakers and planners supplement this shortfall with non-Saudi providers, who must be mindful of Saudi-specific cultural considerations. Potential solutions to reducing the shortfall of mental health care workers includes nurse task shifting and training of general practitioners to screen for, and treat, a subset of MNS disorders.

Adapting of Mental Healthcare Facilities to the COVID-19 Challenges

The healthcare sector is one of the largest in the US economy (generating about 18% of GDP). It is the main employer of American workers. Unfortunately, it has been one of those most affected by the COVID-19 pandemic, as certain medical services had to be suspended under strict quarantine (at least 150 hospitals in the US were forced to send employees on leave or dismiss them, primary care practices reported a 70% decrease in the number of patients). The purpose of the article is to analyse challenges in the US healthcare sector during COVID-19 and to justify ways to overcome these challenges (on the example of the Life Chance Mental Health Medical Group, a leading provider of mental health services in the US with a strong regional network, established good reputation and a wide and loyal customer base). The case of this company was chosen in this context based on the fact that, as the SWOT analysis in the article showed, during the COVID-19 pandemic, the greatest vulnerabilities of medical institutions in the mental health sector are related to the quality of basic services (face-to-face therapy sessions). That is significantly reduced if provided online. In order to operate effectively even during epidemics and pandemics, companies in this specific area should expand partnerships with telemedicine platforms, transform their product portfolio, and ensure that their doctors’ qualification profiles meet the requirements of remote therapy. The article analyses the mechanisms for overcoming pandemic challenges in mental healthcare facilities using the postulates of transformational leadership theory, change management theory, theory of constraints, and organisational culture theory.

Exploring changing trends in depression and anxiety among adolescents from 2012 to 2019: Insights from My World repeated cross-sectional surveys.

Research has indicated a rise in the prevalence of depression and anxiety among adolescents over the past three decades. However, the factors underpinning increases in mental health difficulties remain poorly understood. This study examines psychological, social and environmental risk and protective factors that may explain changes in depression and anxiety among adolescents. Data were taken from two nationally representative My World Surveys of adolescents aged 12-19 years in 2012 (N = 5,490) and 2019 (N = 9,844). Survey data on depression and anxiety and a range of potential risk (e.g., alcohol use, psychotic symptoms) and protective factors (e.g., resilience, self-esteem) were assessed at both time points. Multiple group analyses assessed whether the predictive ability of risk/protective factors changed from wave 1 to wave 2. Results showed that the prevalence of depression and anxiety increased significantly between 2012 and 2019, particularly among females. Predictors accounted for between 37% and 61%of the variance in outcomes across waves. While some risk/protective factors were consistent predictors of depression and anxiety at both waves (e.g., bullying, discrimination, optimism), reporting female genderand having higher formal help-seeking tendencies more strongly predicted anxiety at wave 2, while lower self-esteem andlowerresilience(personalcompetence)strongly predicted both depression and anxiety at wave 2. Findings highlight the need to prioritize adolescent mental health service provision, especially in females. Self-esteem and resilience are potentially important targets for supporting adolescent mental health. Further research is required to understand the causal factors associated with increases in anxiety and depression.

Applying the extension for community healthcare outcomes (ECHO) model to promote collaborative and effective school mental health services.

School staff increasingly seek to implement evidence-based school mental health services to promote student mental health. However, barriers to accessing programming and support mean that implementing these programs is difficult. Popular strategies to address these challenges, like one time professional development, often fail to be effective or sustainable. This study used mixed methods to evaluate how a set of training activities-sequential online learning modules combined with interprofessional telementoring, following the extension for community healthcare outcomes (ECHO) model-influenced provision of school mental health services. School counselors, nurses, psychologists, and social workers (n = 46) participated in training activities, which included nine, cohort-based ECHO sessions and 12 modules. We used a concurrent mixed methods design in which quantitative (implementation data and pre-post surveys) and qualitative (posttraining focus groups with a subset of participants, n = 11) data were used to evaluate training. Quantitative results indicated statistically significant pre-post improvements in participants' clinical self-efficacy (d = .83) and knowledge of evidence-based practices (d = .37). Qualitative data corroborated quantitative results. Post training, focus groups described positive reactions, learning, and behavior change, particularly with respect to equitable service provision and interprofessional teaming. ECHO appeared to facilitate the application of evidence-based strategies to real-life practice and improved participants' understanding of effective coordination of services. Taken together, findings suggest that group-based telementoring may be a high-impact strategy for supporting the implementation of effective, culturally specific, and collaborative school mental health services. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effective provider communication for personal agency in mental health recovery: A cross-sectional study on Japanese users' perspectives.

INTRODUCTION: Recovery-oriented practice in community-based mental health services is crucial for individuals with mental illness, with communication with familiar individuals being important for recovery in Japanese and Asian cultures. This study aimed to examine effective communication factors for personal agency in recovery by investigating the association between perceived support provided through communication and personal agency of individuals with mental illness. A cross-sectional study was conducted among community-dwelling Japanese mental health service users, assessing subjective agency, decisional conflict, staff support for personal recovery, activation for mental health self-management, demographic variables and living difficulties. Multiple linear regression analysis identified factors predicting subjective agency, revealing characteristics of effective provider communication for recovery. Data from 222 users were analysed, revealing negative correlations between uncertainty about treatment choices and ineffective decision-making with higher subjective agency, while staff support for personal recovery positively correlated with higher subjective agency. In recovery-oriented practice, prioritizing users' emotional experiences during decision-making and supporting their self-determination in their unique recovery journeys is crucial. Providers should approach dialogue as carefully as medication prescriptions, prioritizing therapeutic partnerships with users. The findings extend beyond nursing to all mental health service providers, advancing the theory of recovery-oriented practice.

Developing mental health curricula and a service provision model for clinical associates in South Africa: a Delphi survey of family physicians and psychiatrists

BackgroundClinical associates are a health professional cadre that could be utilised in mental health task sharing in South Africa but this is training dependent. The objectives of the study were to identify the potential curricula content, training sites, and teaching modalities for undergraduate and potential postgraduate clinical associate mental health training and to identify the tasks that they should perform based on these curricula.MethodsWe utilised the Delphi method to reach consensus on items with the panel comprising psychiatrists and family physicians. The first round questionnaire of the Delphi survey was developed based on a literature review and the results from earlier phases of the overall study. The survey was administered electronically and consisted of three rounds. Following both the first and second rounds, an updated questionnaire was constructed omitting the items on which consensus was reached. The questionnaire consisted primarily of nine-point scales with consensus based on 70% of participants rating 1,2,3 or 7,8,9.ResultsThere were 26 participants in the first round with this number falling to 23 in later rounds. There was strong consensus on a training attachment to a mental health clinic at a community health centre (CHC) at undergraduate (96.2%) and postgraduate level (100%). Consensus was reached on the importance of training on the management of six categories of disorders at the undergraduate level and nine categories of disorders at the postgraduate level. Clerking patients as a teaching modality reached 100% consensus at both undergraduate and postgraduate levels. PHC clinics, CHCs and district hospitals reached consensus as appropriate settings for clinical associates to provide mental health services. In addition, GP practices and secondary hospitals reached consensus for those with postgraduate training. Consensus was reached on ten of the 21 listed tasks that could be performed based on undergraduate training and 20 of the 21 tasks based on a postgraduate qualification in mental health.ConclusionsThe Delphi panel’s recommendations provide a clear roadmap for enhancing mental health curricula for clinical associates, enabling their utilisation in mental health service provision. A future postgraduate mental health qualification for clinical associates would allow for expanded task sharing.

The Maintenance Model of Restrictive Practices: A Trauma-Informed, Integrated Model to Explain Repeated Use of Restrictive Practices in Mental Health Care Settings

Nurses are at the forefront of care in mental health services but their role is conflicted; they carry the most responsibility for care and also for restrictive practices. The harmful effects of restrictive practices for mental health patients are well documented, have attracted negative media attention, public concern, and criticism directed specifically at nursing staff. The need to reduce restrictive practices has been highlighted by patients, carer groups, legislators, policy makers, academics, and mental health service providers. Policies and best practice guidelines have resulted, but restrictive practices remain a global problem. This theory paper proposes that inertia is partly due to the absence of a coherent model that explains the initiation and maintenance of restrictive practice in inpatient mental health settings. The conceptual development and synthesis of the model and its practical implications are discussed.

Barriers to help-seeking, accessing and providing mental health support for medical students: a mixed methods study using the candidacy framework

BackgroundThe mental health of medical students is a national and international problem increasing in both demand and acuity. Medical students face barriers to accessing mental health support that is clinically effective, timely and appropriate for their needs. This mixed methods study aimed to explore experiences of these barriers and the challenges to health service delivery aligned to the Candidacy Framework.MethodsOne hundred three medical students studying at The University of Sheffield completed an online survey comprising the CCAPS-34 and follow-up questions about service access and use. Semi-structured interviews with a nested sample of 20 medical students and 10 healthcare professionals explored barriers to service access and provision. A stakeholder panel of medical students and professionals met quarterly to co-produce research materials, interpret research data and identify touchpoints by pinpointing specific areas and moments of interaction between a medical student as a service user and a mental health service.ResultsMedical students who experienced barriers to help-seeking and accessing support scored significantly higher for psychological symptoms on the CCAPS-34. Uncertainty and fear of fitness to practice processes were important barriers present across all seven stages of candidacy. The fragmented structure of local services, along with individual factors such as perceived stigma and confidentiality concerns, limited the progression of medical students through the Candidacy Framework (a framework for understanding the different stages of a person’s journey to healthcare).ConclusionThis study outlines important areas of consideration for mental health service provision and policy development to improve access to and the quality of care for medical students.

Perspectives of service providers on vocational rehabilitation for mental health service users in Namibia: a qualitative study

Purpose Chronic mental illness disrupts the ability to work, often resulting in the need for vocational rehabilitation in which occupational therapists play a role. Namibia does not have an occupational therapy vocational rehabilitation practice framework for service users with chronic mental illness. This study explored the contextual factors that should be considered for a vocational rehabilitation practice framework in Namibia. Materials and methods A qualitative collective case study design was utilized. In-depth interviews were conducted with nine mental health service providers that were purposively selected from two study sites. An inductive thematic analysis of data was done using ATLAS.ti. Results The need for collaborative advocacy for service users to raise awareness and engage stakeholders such as family members, employers and policy makers was highlighted. Vocational rehabilitation resources needed include sheltered workshops, financial resources and trained human resources. Recognition that vocational rehabilitation services are too limited to meet the needs of mental health service users. A vocational rehabilitation policy and strategy is required. Supported employment and self-employment are potential strategies that should be considered. Conclusion Vocational rehabilitation for service users with chronic mental illness is limited in Namibia and there is a need to collaboratively improve the service.

Machine learning identifies different related factors associated with depression and suicidal ideation in Chinese children and adolescents

BackgroundDepression and suicidal ideation often co-occur in children and adolescents, yet they possess distinct characteristics. This study sought to identify the different related factors associated with depression and suicidal ideation. MethodsA nationwide cross-sectional survey collected data from Chinese children and adolescents aged 8 to 18 (N = 160,962; 48.91 % girls). The survey included inquiries about demographics, depression, suicidal ideation, anxiety, perceived stress, academic burnout, internet addiction, non-suicidal self-injury, bullying, and being bullied. Fifteen machine learning algorithms were conducted to identify the different related factors associated with depression and suicidal ideation. Additionally, we conducted external validation on an independent sample of 1,812,889 children and adolescents. ResultsOur findings revealed seven related factors linked to depression and six associated with suicidal ideation, with average accuracy rates of 86.86 % and 85.82 %, respectively. For depression, the most influential factors were anxiety, perceived stress, academic burnout, internet addiction, non-suicidal self-injury, experience of bullying, and age. Similarly, anxiety, non-suicidal self-injury, perceived stress, internet addiction, academic burnout, and age emerged as paramount factors for suicidal ideation. Moreover, these related factors showed notable variations in their predictive capacities for depression and suicidal ideation across different subgroups. ConclusionAnxiety emerged as the predominant shared factor for both depression and suicidal ideation, whereas the other related factors displayed distinct predictive patterns for each condition. These findings highlight the critical need for tailored strategies from public mental health service providers and policymakers to address the pressing concerns of depression and suicidal ideation.

A two-year longitudinal evaluation of the impact of the COVID-19 pandemic on pre-existing mental health service attenders.

To examine if the COVID-19 pandemic was associated with a differential effect longitudinally in relation to its psychological and functional impact on patients with bipolar disorder and Emotionally Unstable Personality Disorder (EUPD). Semi-structured interviews were conducted with 29 individuals attending the Galway-Roscommon Mental Health Services with an ICD-10 diagnosis of either bipolar disorder (n = 18) or EUPD (n = 11). The impact of the COVID-19 pandemic was assessed in relation to anxiety and mood symptoms, social and occupational functioning, and quality of life utilising psychometric instruments and Likert scale data, with qualitative data assessing participants' subjective experiences. Individuals with EUPD exhibited significant anxiety and depressive symptoms and increased hopelessness compared to individuals with bipolar disorder. Repeated measures data demonstrated no significant change in symptomatology for either the EUPD or bipolar disorder group over time, but demonstrated an improvement in social (t = 4.40, p < 0.001) and occupational functioning (t = 3.65, p = 0.03), and in quality of life (t = 4.03, p < 0.001) for both participant groups. Themes attained from qualitative data included the positive impact of the discontinuation of COVID-19 mandated restrictions (n = 19), and difficulties experienced secondary to reductions in the provision of mental health services during the COVID-19 pandemic (n = 17). Individuals with EUPD demonstrated increased symptomatology over a two-year period compared to those with bipolar disorder. The importance of face-to-face mental health supports for this cohort are indicated, particularly if future pandemics impact the delivery of mental health services.

"I Felt a Sense of Mission during Moments of Crisis": Mental Health Professionals' Perspectives on Their Initial Treatment of Evacuees during the Israel-Hamas Conflict.

This study examines mental health service providers who provided care to evacuees during the Israel-Hamas conflict. Utilizing a phenomenological qualitative method, the research delves into the psychological impact on the participants' lived experiences. The sample included 25 mental health providers (13 female, age range 28-63, mean 42.4, SD 7.3; 15 psychologists and 10 social worker, average seniority 10.8 years, SD 5.2, range 2-18 years). Data were collected through semi-structured interviews conducted between December 2023 and March 2024. The data analysis revealed a dual narrative: Participants paid a major personal price and experienced secondary traumatization manifesting in emotional detachment, physical symptoms, and heightened arousal. They also derived a profound sense of meaning and fulfillment from their work, contributing to personal and professional growth. These findings underscore the complexity of their experiences, which were marked by the challenges of secondary trauma and the resilience fostered through their work. This study emphasizes the importance of support systems, including social and familial networks and professional supervision, in navigating these challenges. This study has several limitations, including small sample size and the use of virtual interviews, suggesting the need for further research with a broader participant base and in different contexts.

Families supporting people with mental health challenges during the COVID-19 pandemic: learnings from a co-designed and co-delivered study

The significant demand for and reduction in mental health services during the COVID-19 pandemic resulted in family carers providing higher levels and increased hours of support of increased complexity. Guided conversations within seven co-designed online focus groups with 73 family carers, representing diverse communities and ages, explored the experiences of and desired changes for mental health service provision. Six themes emerged: service users’ experiences; the effects of system failures and service provisions; the impact on carers’ health and well-being; unmet community needs; responsive innovations; and policy and practice recommendations. Co-producing research with families elevated family voices and supported carers in expressing their experiences, needs and rights.

Presenting a Personal Knowledge Management Model of Self-Care and Experience in Individuals with Bipolar Disorder and Families: A Study Protocol

Background. Bipolar disorder is a chronic condition that necessitates lifelong medication, therapeutic interventions, and self-care. People with bipolar disorder and their families may have varied experiences regarding sleep management, stress, interpersonal relationships, and anger, which are frequently overlooked. In the current study, the knowledge acquired by patients with bipolar disorder and their families was evaluated. Then, an appropriate model for managing self-care knowledge among individuals with bipolar disorder was proposed. Methods. The current mixed-methods study was conducted in four stages. The first stage involved a systematic review and meta-synthesis study in the field of knowledge management in the healthcare system. The second stage involved assessing the self-care experiences of patients with bipolar disorder. In the third stage, the codes obtained from the previous stages were prioritized by experts using Delphi techniques. In the fourth stage, a researcher prepared, validated, and distributed a questionnaire among mental health service providers stages. Finally, the personal knowledge management model of self-care and experience in individuals with bipolar disorder and their families was presented. Conclusion. Almost half of patients with bipolar disorder do not adhere to their long-term treatment. Also, this disease requires patients to perform self-care activities in addition to drug therapy. So, the design and implementation of a knowledge management model for self-care and experience in people with bipolar disorder can be effective in improving their self-care behaviors and quality of life.

Mental Health First Aid™ for Deaf communities: responses to a lack of national Deaf mental health service provision

PurposeFor over 15 years, Mental Health First Aid™ (MHFA) has successfully been delivered in Wales, United Kingdom, with growing interest in the MHFA programme and increasing course attendees. Trainers, aware of the need for support, know the importance of MHFA being accessible for different communities and learner groups. MHFA has always focused on increasing mental health literacy. One marginalised group, with lower mental health literacy than the general population, is Deaf people, a group with increased risk of mental health problems. This paper aims to provide insights about why Deaf people are twice as likely as hearing people to experience mental health problems.Design/methodology/approachDuring this paper, the authors have used four focal points i) exploring situational contexts for Deaf people; ii) reasons why Deaf individuals are at greater risk of mental health problems; iii) the authors explore a project, “Hear Deaf”, and implementation of MHFA Wales by Deaf MHFA trainers; and iv) initiatives to influence and impact on policymakers.FindingsDuring the project, nine MHFA courses were delivered to Deaf communities across different locations in Wales, often with information and advertisements circulated directly to Deaf communities through Deaf clubs, resulting in 120 Deaf people trained. The authors conclude with their own reflections as a researcher and an MHFA who work predominantly with Deaf communities.Originality/valueThis paper provides a discussion on the specific risks for Deaf people around mental health and the importance of mental health promotion programmes for Deaf communities. Further research is needed regarding the impact of MHFA on Deaf populations.

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial.

Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting. Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140). With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points. The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

Partnering with Schools to Adapt a Team Science Intervention: Processes and Challenges

AbstractPublic schools are a major provider of mental health services for children in the US. Mental and behavioral health services range from universal programming to individualized clinical supports to address student needs. These services in schools are delivered by various professionals including non-teaching and teaching school personnel, school-employed clinicians, and/or contracted community mental health partners. Provision of mental health services requires complex coordination of providers across disciplines, although few professionals have training in multidisciplinary collaboration strategies. Attention to team processes, such as delineating team members' roles, improving communication, and identifying collaboration strategies, may impact the effectiveness of evidence-based mental health service provision in real world settings. One intervention, Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), has been used in healthcare with positive outcomes and has been adapted to educational settings. The current paper describes the community-partnered subsequent adaptation of TeamSTEPPS for schools. Needs assessment interviews identified challenges, successes, and goals for student mental health. Overarching themes extracted from interviews include limited resources at multiple levels (e.g., financial support, time, and personnel), communication challenges, and poor role clarity. A community advisory board provided guidance during the adaptation and implementation planning process. Adaptations to the intervention included tailoring the intervention to the school context and the development of flexible training plans. In addition, individualized implementation plans were developed with each school partner to mitigate foreseeable barriers to rolling-out TeamSTEPPS. Our team is currently piloting the adapted TeamSTEPPS intervention and implementation strategies in partnership with three school districts.

Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study.

The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients.