Mental Health Training Research Articles

Motivation to train during a pandemic: The role of fitness resources, mental health, and motivational profiles among student-athletes in team sports.

The sporting season across post-secondary institutions was canceled in March 2020 due to COVID-19, and student-athletes had to maintain their training at home. It is unclear what personal and contextual factors facilitated student-athletes' ability to maintain their training routines at home when social distancing and lockdown (SD/L) policies were put in place. Our cross-sectional study of 433 student-athletes examined (a) how athletes adapted their training, (b) what training barriers they experienced, (c) whether motivational profiles were associated with differences in training behaviors and mental health, and (d) what variables predicted athletes' motivation to train during this prolonged offseason. Student-athletes across Canada were recruited to complete an online survey between August and September 2020. Results showed that athletes significantly reduced their training load and intensity, with approximately 25% exercising two or fewer days a week. Barriers to training included limited access to fitness resources and equipment, having inconsistent training schedules, and experiencing emotional distractions, with some of these barriers more common among female athletes than male athletes. For motivation profiles, athletes with higher levels of intrinsic motivation tended to maintain the intensity of their workouts and experienced lower mood disturbance. A hierarchical multiple regression revealed that being male, being younger, having higher levels of intrinsic and introjected motivation, having access to fitness resources, maintaining a steady training schedule, having fewer emotional distractions, and lower mood disturbance were significant predictors to being motivated to train during the pandemic. We discuss strategies coaches and trainers can implement to best support their student-athletes.

Long-Term Use and Application of Systematic Tailored Assessment for Responding to Suicidality (STARS) Protocol Following Original Training.

Background: Understanding the use of Systematic Tailored Assessment for Responding to Suicidality protocol (STARS-p) in practice by trained mental health practitioners over the longer- term is critical to informing further developments. The study aim was to examine practitioners’ experiences of STARS-p and factors associated with its use in practice over a 12–24-month period after training. Method: Practitioners who undertook the STARS-p training completed an online survey 12–24 months post training. The survey focused on the frequency of use of STARS-p (in full and each section) as well as perceptions about STARS-p applied in practice. Analyses included correlations, logistic regression and content analysis. Results: 67 participants (81% female, Mage = 43.2, SD = 10.3) were included in the analyses. A total of 80.6% of participants had used the entire STARS-p at some time-point in their practice and less than half (44.7%) frequently used the entire STARS-p (all components in one administration). Parts A, B and C were used frequently in suicide risk assessment (SRA) by 84%, 71% and 82% of participants, respectively. Use of the entire protocol and different sections was most related to male gender, perceived ease of administration and confidence in the use of the protocol. Qualitative results revealed three main themes. Conclusions: STARS-p as a whole or its parts, is frequently used. Advantages of, and barriers to, using STARS-p in practice can inform further developments of STARS-p and STARS training.

The Use of Automated Machine Translation to Translate Figurative Language in a Clinical Setting: Analysis of a Convenience Sample of Patients Drawn From a Randomized Controlled Trial.

BackgroundPatients with limited English proficiency frequently receive substandard health care. Asynchronous telepsychiatry (ATP) has been established as a clinically valid method for psychiatric assessments. The addition of automated speech recognition (ASR) and automated machine translation (AMT) technologies to asynchronous telepsychiatry may be a viable artificial intelligence (AI)–language interpretation option.ObjectiveThis project measures the frequency and accuracy of the translation of figurative language devices (FLDs) and patient word count per minute, in a subset of psychiatric interviews from a larger trial, as an approximation to patient speech complexity and quantity in clinical encounters that require interpretation.MethodsA total of 6 patients were selected from the original trial, where they had undergone 2 assessments, once by an English-speaking psychiatrist through a Spanish-speaking human interpreter and once in Spanish by a trained mental health interviewer-researcher with AI interpretation. 3 (50%) of the 6 selected patients were interviewed via videoconferencing because of the COVID-19 pandemic. Interview transcripts were created by automated speech recognition with manual corrections for transcriptional accuracy and assessment for translational accuracy of FLDs.ResultsAI-interpreted interviews were found to have a significant increase in the use of FLDs and patient word count per minute. Both human and AI-interpreted FLDs were frequently translated inaccurately, however FLD translation may be more accurate on videoconferencing.ConclusionsAI interpretation is currently not sufficiently accurate for use in clinical settings. However, this study suggests that alternatives to human interpretation are needed to circumvent modifications to patients’ speech. While AI interpretation technologies are being further developed, using videoconferencing for human interpreting may be more accurate than in-person interpreting.Trial RegistrationClinicalTrials.gov NCT03538860; https://clinicaltrials.gov/ct2/show/NCT03538860

Online consultations in mental healthcare: Modelling determinants of use and experience based on an international survey study at the onset of the pandemic

IntroductionWhile online consultations have shown promise to be a means for the effective delivery of high-quality mental healthcare and the first implementations of these digital therapeutic contacts go back nearly two decades, uptake has remained limited over the years. The onset of the COVID-19 pandemic dramatically altered this relative standstill and created a unique turning point, with a massive amount of both professionals and clients having first hands-on experiences with technology in mental healthcare. ObjectiveThe current study aimed to document the uptake of online consultations and explore if specific characteristics of mental health professionals across and beyond Europe could predict this. MethodsAn international survey was designed to assess mental health professionals' (initial) experiences with online consultations at the onset of the pandemic: their willingness to make use of them and their prior and current experiences, alongside several personal characteristics. Logistic mixed-effects models were used to identify predictors of the use of online consultations, personal experience with this modality, and the sense of telepresence. ResultsA total of 9115 healthcare professionals from 73 countries participated of which about two-thirds used online consultations during the initial COVID-19 outbreak. The current study identifies multiple determinants relating to the use and experience of online consultations, including the professionals' age, experience with the technology before the outbreak, the professional context, and training. ConclusionsDespite strong evidence supporting the relevance of training in digital mental health, this is clearly still lacking. Nevertheless, the COVID-19 pandemic presented a first, and potentially transformative, experience with online consultations for many healthcare professionals. The insights from this study can help support professionals and, importantly, (mental) healthcare organisations to create optimal circumstances for selective and high-quality continued use of online consultations.

Development of the Mental Health Peer Support Questionnaire in colleges and vocational schools in Singapore

BackgroundA nation-wide mental health peer support initiative was established in college and vocational schools in Singapore. The purpose of this cross-sectional study was to develop and validate a 20-item self-report instrument, the Mental Health Peer Support Questionnaire (MHPSQ), to assess young adults’ perceived knowledge and skills in mental health peer support.MethodsWe administered the questionnaire to 102 students who were trained as peer supporters, and 306 students who were not trained as peer supporters (denoted as non-peer supporters), in five college and vocational schools. Exploratory factor analysis and descriptive statistics were conducted. Cronbach’s α was used to assess reliability, and independent sample t-tests to assess criterion validity.ResultsExploratory factor analysis indicated a three-factor structure with adequate internal reliability (discerning stigma [α = .76], personal mastery [α = .77], skills in handling challenging interpersonal situations [α = .74]; overall scale [α = .74]). Consistent with establishing criterion validity, peer supporters rated themselves as significantly more knowledgeable and skilled than non-peer supporters on all items except two: (1) letting peer support recipients make their own mental health decisions, and (2) young adults’ self-awareness of feeling overwhelmed. Peer supporters who had served the role for a longer period of time had significantly higher perceived awareness of stigma affecting mental health help-seeking. Peer supporters who had reached out to more peer support recipients reported significantly higher perceived skills in handling challenging interpersonal situations, particularly in encouraging professional help-seeking and identifying warning signs of suicide.ConclusionsThe MHPSQ may be a useful tool for obtaining a baseline assessment of young adults’ perceived knowledge and skills in mental health peer support, prior to them being trained as peer supporters. This could facilitate tailoring of training programs based on young adults’ initial understanding of mental health peer support. Subsequent to young adults’ training and application of skills, the MHPSQ could also be applied to evaluate the effectiveness of peer programs and mental health training.

Altered Brain Functional Connectivity in Female Athletes Over the Course of a Season of Collision or Contact Sports.

University athletes are exposed to numerous impacts to the body and head, though the potential cumulative effects of such hits remain elusive. This study examined resting-state functional connectivity (rsFC) of brain networks in female varsity athletes over the course of a season. Nineteen female university athletes involved in collision (N = 12) and contact (N = 7) sports underwent functional magnetic resonance imaging scans at both pre- and post-season. A group-level independent component analysis (ICA) was used to investigate differences in rsFC over the course of a season and differences between contact and collision sport athletes. Decreased rsFC was observed over the course of the season between the default mode network (DMN) and regions in the frontal, parietal, and occipital lobe (p false discovery rate, ≤0.05) driven by differences in the contact group. There was also a main effect of group in the dorsal attention network (DAN) driven by differences between contact and collision groups at pre-season. Differences identified over the course of a season of play indicate largely decreased rsFC within the DMN, and level of contact was associated with differences in rsFC of the DAN. The association between exposure to repetitive head impacts (RHIs) and observed changes in network rsFC supplements the growing literature suggesting that even non-concussed athletes may be at risk for changes in brain functioning. However, the complexity of examining the direct effects of RHIs highlights the need to consider multiple factors, including mental health and sport-specific training and expertise, that may potentially be associated with neural changes.

Editorial introductions.

Editorial introductions.

A 16-week Periodized Program To Remediate Underdeveloped Tactical Athletes At A Senior Military College

PURPOSE: Approximately half of recruits fail the Army Physical Fitness Test (APFT) and 70% of all injuries in the US military are musculoskeletal in nature. The purpose of this study was to investigate whether underdeveloped musculoskeletal and cardiovascular fitness levels of senior military college cadets could be improved by an evidence-based remedial physical training program (RPTn) compared to the current remedial physical training program (RPTo). METHODS: The program was a 16- week periodized and progressive model, incorporating cardiovascular (CVT) and bodyweight resistance training (RT), mobility training, and general mental health and wellbeing sessions. A total of n = 138 cadets (n = 70 RPTn and n = 68 RPTo) that failed the APFT (total score < 180, or < 60 in scored sit-ups, pushups or run time) were assessed. Subjects were randomized to one of three battalions (BN). 1BN received RPTn while 2BN and PBN received RPTo. RESULTS: After training, 58 (82.9%) of RPTn passed the APFT compared to 19 (27.9%) of RPTo. Paired t-tests demonstrated significant improvement (p < 0.01) for RPTn in total APFT scores (42 ± 31.5points), sit-ups (13.8 ± 9.4) pushups (6.5 ± 11) and run time (83 ± 123 s). In RPTo, significant improvements (p < 0.01) were also noted in total APFT scores (16 ± 27.8), sit-ups (3.3 ± 6.7) pushups (3.69 ± 8.0) and run time (43 ± 127 s). Between-group analyses demonstrated RPTn had significantly higher improvements compared to RPTo in APFT total score (p < 0.01) and sit-ups (p < 0.01) but not pushups (p = 0.08) or run time (p = 0.06). Higher perceived program enjoyment was also demonstrated for RPTn when compared to RPTo (P < 0.01). CONCLUSION: This new program addresses the national readiness problem by incorporating customized, individualized, and scaled training that can effectively match a unit’s fitness level or developmental status.

Why is Spiritual Psychotherapy for Inpatient, Residential, and Inpatient Treatment (SPIRIT) more effective when provided by nonreligious clinicians?

Previous research suggests that patients receiving spiritual psychotherapy may have better outcomes when treatment is provided by nonreligious clinicians, compared to religious clinicians. We examined these effects within a large and clinically heterogeneous sample of patients (N = 1,443) receiving Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT; Rosmarin et al., 2019) by a diverse sample of clinicians (n = 22). In addition to demographics, patients completed a brief measure of their experience in SPIRIT; clinicians completed measures of previous mental health training, previous training in spiritual psychotherapy, and attitudes toward spiritual psychotherapy, and also provided details regarding modalities, clinical interventions, and spiritual interventions utilized at each SPIRIT session. Perceived benefit of SPIRIT was greater when treatment was delivered by non-religious clinicians. Mediating factors on these effects were evaluated using correlations and multiple regression analyses. Of 26 potential explanatory factors, only 4 were significant, all of which related to the therapeutic process. Nonreligious clinicians were more likely to utilize dialectical behavior therapy (DBT), facilitate coping, encourage spiritual coping, and explore the relevance of spirituality to mental health, all of which also predicted better perceived benefit from SPIRIT. All four variables jointly, but not severally, mediated relationships between clinician religion and perceived benefit of SPIRIT. These findings suggest that DBT may be the most effective modality for delivering spiritual psychotherapy to acute patients, particularly in a group setting. Future research should further examine preferences for clinical modalities and techniques among religious and nonreligious clinicians, and effects of such preferences on perceived benefit, in a variety of settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Associations between co-occurring conditions and age of autism diagnosis: Implications for mental health training and adult autism research.

Adult autism studies are increasingly comprised of later-diagnosed adults, yet little is known about how these adults compare to those diagnosed earlier in life. The present study examines medical and psychiatric conditions endorsed by autistic adults and documents differences between those diagnosed with ASD in childhood versus adulthood, as well as across age groups and sex at birth. 4657 legally independent adults (ages 18-85, M =33.4 years) with professional ASD diagnoses who completed a medical questionnaire were drawn from the Simons Powering Autism Research Knowledge (SPARK) study. Chi square analyses, t-tests, and logistic regressions were used to compare medical and psychiatric conditions between age groups, sex at birth and adults diagnosed in childhood (before age 21) versus adulthood (at or after 21 years). Overall number of conditions endorsed as being diagnosed by a professional was high, with an average of 1.69 (SD=2.01) medical or developmental and 2.98 (SD=2.29) psychiatric conditions reported across the sample. Females were more likely to endorse psychiatric conditions (OR=1.68). Adult-diagnosed adults were more likely to endorse psychiatric conditions (OR=2.71) and reported more lifetime psychiatric diagnoses (M=3.15, SD=2.23) than their childhood-diagnosed counterparts (M=2.81, SD=2.33). These findings underscore the need for research to better understand and treat co-occurring psychiatric conditions in autistic adults and report and consider the age of diagnosis in adult autism samples. Moreover, results suggest it is imperative that mental health professionals receive autism training to promote accurate differential diagnosis and equitable access to mental health care for autistic adults with co-occurring psychiatric conditions.

Mental Health Education, Awareness and Stigma Regarding Mental Illness Among College Students

Objective: The present study examined whether psychoeducational tools are beneficial in improving awareness and reducing stigma regarding mental health. This study aims to increase mental health awareness and reduce the stigma associated with mental illness. Methods: The study is quantitative research. In this study, 147 students registered in the Abnormal Psychology course, which focuses on mental illness, were recruited. Students signed informed consent and participated in the study voluntarily. Students completed the demographic questions, Beliefs Toward Mental Illness Scale (BTMI), and Stig-9 questionnaire (stig-9). Results: Our findings revealed a significant difference in beliefs and awareness about mental health and a decrease in stigma after students completed the Abnormal Psychology course. The statistical analysis revealed that students believe mental health is more curable and less embarrassing after taking mental health education. Finally, our findings demonstrated a direct impact of the educational experience on student attitudes toward mental health. Conclusion: Our finding indicates that mental health education is a promising tool to raise awareness and understanding and reduce the stigma regarding mental health. Providing students with mental health education and training enabled students to learn and understand issues with mental illness. This study demonstrated a direct impact on the educational experience on student attitudes toward mental health.

Clinician Opinions: Perceived Utility of and Barriers to Incorporating Pretreatment Ecological Momentary Assessment Into Clinical Care

Increasingly, clinicians have the option of including technological components into clinical care. However, little research has assessed clinicians’ interest in utilizing technology in their clinical work. Here, clinicians reported their opinions related to using a mobile assessment platform (MAP) to collect ecological data from clients before providing clinical care. Practicing and training mental health clinicians (N = 221) reported demographics, characteristics of their clinical work, and confidence in their clinical skill. Participants then read a description of MAP and responded to questions about their perceived benefits of and barriers to its use. Last, participants rated their interest in using MAP in their clinical work. These perceptions were then factor-analyzed and the resulting factor scores were regressed onto clinician characteristics. Interest in using MAP was significantly lower for the group that endorsed a psychodynamic/psychoanalytic orientation and those with greater confidence in their clinical skills. Across scales, we found a pattern that participants who did not identify as male, those with a psychodynamic/psychoanalytic orientation, and those with greater confidence in their clinical skills tended to have lower ratings of the benefits of and higher ratings for the barriers to using MAP. Results revealed that significant differences in opinions about incorporating technology into clinical work exist between different groups of clinicians. This information may be useful in future work that attempts to implement technological tools into clinical settings.

Professor Hippo-on-Campus: Developing and evaluating an educational intervention to build mental health literacy among university faculty and staff

Objective: The development and evaluation of the Professor Hippo-on-Campus Student Mental Health Education Program, a mental health literacy intervention for post-secondary faculty and staff, is described. It includes 3-hour virtual, asynchronous e-modules and an optional 2-hour, synchronous workshop. Participants: All faculty and staff in a single university were invited to participate (February 2020–January 2021). Methods: Pre-and post-module and post-workshop surveys were conducted, assessing knowledge, attitudes, stigma, behavioral intentions, and confidence. Paired t-tests and regressions assessed change. Satisfaction was assessed through closed and open-ended questions, analyzed descriptively and through qualitative content analysis. Results: Four hundred and fifty staff and faculty completed the pre-survey, 262 completed the post-survey, and 122 completed a workshop survey. Participation resulted in improvements in knowledge, attitudes, stigma, and confidence with high levels of satisfaction. Conclusion: The program provides tailored student mental health training to post-secondary staff and faculty, which appears to increase their mental health literacy.

The impact of COVID-19 on self-reported burnout and health and mental health services in Nampula, Mozambique.

BackgroundThe purpose of this study was to examine the impact of the COVID-19 pandemic on self-reported burnout of health workers, quality of care, and perceptions of COVID-19-related stigma in Mozambique.MethodWe conducted a cross-sectional quantitative assessment of 170 frontline health workers in Nampula District, Mozambique, including 149 (87.6%) primary care providers and 21 (12.4%) mental health specialists.ResultsOf the 170 frontline workers, only 10.1% of frontline workers were experiencing more professional burnout, whereas 33.3% felt it had lessened. The perceived impact on quality of care also varied, without any significant differences by sex, education level, or mental health training background. Compared to the beginning of the COVID-19 pandemic in March 2020, 42.3 and 38.1% providers felt that their ability to provide mental health and general health care, respectively, had worsened, compared to 57.7 and 61.9% who believed that either there was no change, or that the work had become easier. Likewise, 26.8% of providers felt that their ability to meet patients' needs had gotten more difficult, whereas 43.4% reported no change and 29.8% reported that it was easier. Twenty-two percent of providers reported an overall increase in caseloads since before the pandemic whereas the majority (67.9%) reported a decrease. Providers believed that 57.1% of people in general were afraid of people with COVID-19, 27.5% were afraid of a person recovered from COVID-19, and 39.9% were afraid of a person with family members with COVID-19. The perceived stigma about healthcare professionals was also low; only 27.4% believed that people in general were afraid of healthcare providers who deliver care to people with COVID-19.ConclusionIn contrast with other global studies, many healthcare workers in our sample reported a reduction in burnout, which may be associated with the lower overall caseloads seen during this period. Similarly, the quality of care was minimally impacted. More research is needed to determine whether the experience in Mozambique is unique, or similarly observed in other low-resource settings.

Transgender and Gender non-Conforming Mental Health Training and Knowledge for High School Staff: A Scoping Review.

Youth who identify as transgender or gender non-conforming (TGNC) are at greater risk than their peers for mental health concerns. School staff knowledge and training on supporting the mental health of these students may have a significant effect on this population. To better understand where school staff are provided such training, we conducted a scoping review to determine any differences in staff knowledge and training between urban, suburban, and rural high schools. We searched five electronic databases using keywords: transgender or gender variant or gender non-conforming, mental health, school, and student. Twelve articles met the criteria for review. We found no comparative studies that differentiate staff training and knowledge across high school settings. Most articles demonstrated the efficacy of training school staff in supporting TGNC students, and demand from school staff for access to such training. School nurses can lead and advocate for such training to support TGNC students.

Impact of an Online Course to Improve School Nurses' Mental Health Competencies.

School nurses play a key role in supporting student mental health, and many school nurses report the need for additional mental health education. The Mental Health Training Intervention for Health Providers in Schools (MH-TIPS) is a training and implementation support system for school nurses to enhance their skills in promoting student mental health. The current study evaluated the feasibility of the MH-TIPS online curriculum for school nurses, and its impact on their preparedness and ability to support student mental health. Participants included 1,282 registered nurses and nurse practitioners. Descriptive statistics indicated that MH-TIPS online was feasible, relevant, and accessible for school nurses and helped them support student mental health. School nurses reported significant improvements in their preparedness to conduct brief mental health interventions with students and motivate students to seek help. MH-TIPS online is a promising tool to increase the ability of school nurses to support student mental health.

Mechanisms of action for stigma reduction among primary care providers following social contact with service users and aspirational figures in Nepal: an explanatory qualitative design

BackgroundThere are increasing initiatives to reduce mental illness stigma among primary care providers (PCPs) being trained in mental health services. However, there is a gap in understanding how stigma reduction initiatives for PCPs produce changes in attitudes and clinical practices. We conducted a pilot randomized controlled trial of a stigma reduction intervention in Nepal: REducing Stigma among HealthcAre Providers (RESHAPE). In a previous analysis of this pilot, we described differences in stigmatizing attitudes and clinical behaviors between PCPs receiving a standard mental health training (mental health Gap Action Program, mhGAP) vs. those receiving an mhGAP plus RESHAPE training. The goal of this analysis is to use qualitative interview data to explain the quantitative differences in stigma outcomes identified between the trial arms.MethodsPCPs were randomized to either standard mental health training using mhGAP led by mental health specialists or the experimental condition (RESHAPE) in which service users living with mental illness shared photographic recovery narratives and participated in facilitated social contact. Qualitative interviews were conducted with PCPs five months post-training (n = 8, standard mhGAP training; n = 20, RESHAPE). Stigmatizing attitudes and clinical practices before and after training were qualitatively explored to identify mechanisms of change.ResultsPCPs in both training arms described changes in knowledge, skills, and confidence in providing mental healthcare. PCPs in both arms described a positive feedback loop, in which discussing mental health with patients encouraged more patients to seek treatment and open up about their illness, which demonstrated for PCPs that mental illness can be treated and boosted their clinical confidence. Importantly, PCPs in the RESHAPE arm were more likely to describe a willingness to treat mental health patients and attributed this in part to social contact with service users during the training.ConclusionsOur qualitative research identified testable mechanisms of action for stigma reduction and improving clinical behavior: specifically, recovery stories from service users and social engagement led to greater willingness to engage with patients about mental illness, triggering a feedback loop of more positive experiences with patients who benefit from mental healthcare, which further reinforces willingness to deliver mental healthcare.Trial registration ClinicalTrials.gov identifier, NCT02793271

Coverage and equity of essential care services among stroke survivors in the Western Province of Sri Lanka: a community-based cross-sectional study

BackgroundStroke survivors require continuing services to limit disability. This study assessed the coverage and equity of essential care services received during the first six months of post-stroke follow-up of stroke survivors in the Western Province of Sri Lanka.MethodsA multidisciplinary team defined the essential post-stoke follow-up care services and agreed on a system to categorize the coverage of services as adequate or inadequate among those who were identified as needing the said service. We recruited 502 survivors of first ever stroke of any type, from 11 specialist hospitals upon discharge. Six months following discharge, trained interviewers visited their homes and assessed the coverage of essential services using a structured questionnaire.ResultsForty-nine essential post-stroke follow-up care services were identified and categorized into six domains: monitoring of risk conditions, treatment, services to limit disabilities, services to prevent complications, lifestyle modification and supportive services. Of the recruited 502 stroke survivors, 363 (72.3%) were traced at the end of 6 months. Coverage of antiplatelet therapy was the highest (97.2% (n = 289, 95% CI 95.3- 99.1)) while referral to mental health services (3.3%, n = 12, 95% CI 1.4–5.1) and training on employment for the previously employed (2.2%, n = 4, 95% CI- 0.08–4.32), were the lowest among the six domains of care. In the sample, 59.8% (95% CI 54.76–64.48) had received an ‘adequate’ level of essential care services related to treatment while none received an ‘adequate’ level of services in the category of support services. Disaggregated service coverage by presence and type of limb paralysis within the domain of services to prevent complications, and by sex and education level within the domain of education level, show statistically significant differences (p < 0.05).ConclusionsApart from treatment services to limit disabilities, coverage of essential care services during the post-stroke period was inadequate. There were no apparent inequities in the coverage of vast majority of services. However focused policy decisions are required to address these gaps in services.

"Treat Them Like a Human Being…They are Somebody's Somebody": Providers' Perspectives on Treating Patients in the Emergency Department After Self-Injurious Behavior.

To understand ED providers' perspective on how to best care for individuals who present to US emergency departments (EDs) following self-injurious behavior, purposive recruitment identified nursing directors, medical directors, and social workers (n = 34) for telephone interviews from 17 EDs. Responses and probes to "What is the single most important thing ED providers and staff can do for patients who present to the ED after self-harm?" were analyzed using directed content analysis approach. Qualitative analyses identified four themes: treat patients with respect and compassion; listen carefully and be willing to ask sensitive personal questions; provide appropriate care during mental health crises; connect patients with mental health care. Participants emphasized treating patients who present to the ED after self-injurious behavior with respect and empathy. Hospitals could incentivize provider mental health training, initiatives promoting patient-provider collaboration, and reimbursement strategies ensuring adequate staffing of providers with time to listen carefully.

Enhancing the primary care pediatrician's role in managing psychosocial issues: a cross sectional study of pediatricians and parents in Israel

BackgroundPsychosocial issues are an integral part of children's health and well-being, and it is widely acknowledged that pediatricians should be involved in their management. We examined the current perception of the pediatrician’s role in the management of psychosocial problems in Israel from the perspective of parents and pediatricians, and identified possible barriers.MethodsWe assessed parents' and pediatricians' perspectives through a cross sectional survey. 1000 parents with children under 10 were randomly selected from a large database representing the Israeli population and phone-surveyed by a polling company. Due to a low response-rate (5.4%), there was an overrepresentation of married parents and underrepresentation of parents with primary or secondary education. 173 Pediatricians were recruited both at a medical conference and by a web-based questionnaire.Results55% of the parents reported they were concerned with at least one psychosocial problem, yet less than 50% of them discussed these issues with the pediatrician. 59.9% of the parents did not perceive psychosocial problems as relevant to the pediatrician's role. Pediatricians with some previous training related to psychosocial issues were more likely to report on a lack of professional confidence (p = .037) and insufficient available resources (p = .022) as barriers to their involvement, while pediatricians who had no training were more likely to report on the parents' perception of their role as the barrier to involvement (p = .035).ConclusionsParents tend to avoid the discussion of psychosocial concerns in pediatric settings due to their perception that it's irrelevant to the pediatrician's role. Trained pediatricians feel unconfident in their ability to manage psychosocial issues and report on a lack of suitable resources. These findings suggest current pediatric mental-health training is insufficient to equip pediatricians with the knowledge and skills required to their involvement in psychosocial problems, and imply necessary changes to environment of community-based pediatrics. In order to change the practice of pediatricians in the community to enable them to address a variety of psychological issues, appropriate training is needed, through all stages of the pediatrician’s professional life, including medical school, pediatric residency and continuous medical education.