IntroductionPeople who use alcohol and/or drugs (PWUAD) are at high risk of medical complications... more IntroductionPeople who use alcohol and/or drugs (PWUAD) are at high risk of medical complications, frequent hospitalisation and drug-related death following discharge from inpatient settings and emergency departments (EDs). Harm reduction strategies implemented in these settings may mitigate negative health outcomes for PWUAD. However, the scope of harm reduction strategies used globally within inpatient settings and EDs is unknown. The objective of this review is to identify and synthesise reported harm reduction strategies that have been implemented across inpatient settings and EDs for PWUAD.Methods and analysisThis review will include studies from any country and health service reporting on harm reduction strategies implemented in inpatient settings or EDs. The population of interest includes people of any race, gender and age identifying as PWUAD, or individuals who provided care to PWUAD. Studies which describe implementation strategies and barriers and enablers to implementat...
BACKGROUND The COVID-19 pandemic has increased the demand for youth mental health services in Can... more BACKGROUND The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada. OBJECTIVE A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector. METHODS The ...
Background Mobile device–based tools to help adolescents practice skills outside of cognitive beh... more Background Mobile device–based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. Objective This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. Methods This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scal...
Background The vast majority of adolescent mental health and substance use disorders go undiagnos... more Background The vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions. Objective The objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging–based interventions for mental health and addiction services among adolescents. Methods A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for f...
BACKGROUND Internet-based cognitive-behavioural therapy (iCBT) is a necessary step towards increa... more BACKGROUND Internet-based cognitive-behavioural therapy (iCBT) is a necessary step towards increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to therapeutic principles of CBT or usability standards. Additionally, many existing iCBT programs do not include treatments targeting both anxiety and depression – commonly co-occurring conditions. OBJECTIVE Evaluate the usability and fidelity of Tranquility, a novel iCBT program for anxiety, to CBT principles, and engage in a co-design process to adapt Tranquility to include treatment elements for depression. METHODS CBT experts (n = 6) and mental health informed peers (n = 6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression using two simulated client case examples. Mental health informed peers engaged in two co-design focus groups to discuss adaptations to th...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Purpose Giving birth is the most common reason for hospital admission, with Cesarean delivery bei... more Purpose Giving birth is the most common reason for hospital admission, with Cesarean delivery being the most frequently performed inpatient surgery. Through a needs assessment and iterative design process involving patients and obstetric anesthesiologists, we previously developed a mobile application, C-Care, for patients undergoing Cesarean delivery. The focus of C-Care is perioperative education and self-monitoring of potential anesthetic complications. This study aimed to obtain feedback on patient engagement with C-Care. Method We conducted a prospective cohort study of patients C 18 yr (n = 36) undergoing elective Cesarean delivery. Anonymous usage data were recorded for 30 days. On postoperative days 1-5, participants received daily self-monitoring questionnaires within C-Care. Fourteen days after surgery, participants received an online survey regarding satisfaction and use of C-Care. Results Thirty-five out of 36 participants visited the application after orientation, with a median [interquartile range (IQR)] age of 32 [31-36] yr. Each participant visited the application a median of 15 [9-31] times over 30 days and completed a median of 3 [2-4] out of five selfmonitoring questionnaires. Each participant viewed a median of 4 [2-7] out of eight education topics, with the most viewed patient education topics being ''Controlling Pain'' and ''The First Few Days''. Visits to the application were highest in the first week postpartum. Of the 18 respondents who completed the day 14 survey, 83% (n = 15) participants would recommend C-Care to other women, and the median participant satisfaction score was 7.5 out of 10 (range, 2-10). Conclusion Most participants used this mobile application for patient education and self-monitoring after elective Cesarean delivery. Insights into patient engagement with C-Care after Cesarean delivery could help design more effective perioperative mobile telehealth programs. Trial registration www.ClinicalTrials.gov (NCT03746678); registered 5 November 2018. Résumé Objectif L'accouchement est la raison la plus courante d'admission a`l'hôpital, et l'accouchement par ce´sarienne constitue la chirurgie hospitalie`re la plus fre´quemment pratique´e. Graˆce a`une e´valuation des besoins et un processus de conception ite´rative impliquant des patientes et des anesthe´siologistes obste´tricaux, nous avions mis au
BACKGROUND In light of the COVID-19 pandemic, people had to adapt their daily life routines to th... more BACKGROUND In light of the COVID-19 pandemic, people had to adapt their daily life routines to the public health measures in place, which is likely to have resulted in a lack of social contacts in person, physical activity or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people making them aware of maladaptive behavioral adjustments to the pandemic. OBJECTIVE This study aimed to explore the views of people on mobile sensing apps passively recording behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic. METHODS We conducted an anonymous online survey including people with and without mental disorders asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey took place in May, 2020. RESULTS The majority of participants particularly those with a menta...
BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its desig... more BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its design combines therapeutic content, technological features, and interactions between the user and the program to reduce anxiety for children and adolescents. How iCBT is designed and delivered differs across programs. Although iCBT is considered an effective approach for treating child and adolescent anxiety, rates of program use (eg, module completion) are highly variable for reasons that are not clear. As the extent to which users complete a program can impact anxiety outcomes, understanding what iCBT design and delivery features improve program use is critical for optimizing treatment effects. OBJECTIVE The objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes. METHODS A search of published and gr...
IntroductionDischarge communication is an important aspect of patient care but frequently has sho... more IntroductionDischarge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the ED with minimal opportunity to ask questions or to ensure comprehension of important information. Strategies for improving discharge communication have primarily targeted patients and/or parents, although neither group has been engaged in intervention design or implementation. Furthermore, ED healthcare providers (HCPs), important actors in discharge communication practice, are rarely consulted regarding intervention design decisions. We will generate evidence to enhance discharge communication by engaging youth, parents and HCPs in the codesign of ED discharge communication strategies (EDUCATE) for asthma and minor head injury.Methods and analysisThis mixed methods study will take place at two academic paediatric EDs in Canada. The study will occur in two phases: (A) c...
BACKGROUND Mobile device-based (mHealth) tools to help adolescents practice skills outside of cog... more BACKGROUND Mobile device-based (mHealth) tools to help adolescents practice skills outside of cognitive behavioural therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. OBJECTIVE To develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, an mHealth app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. METHODS This was a three-phase study from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, two high-fidelity testing sessions took place using the Think Aloud approach (acceptability, learnability, usability) and 10 item System Usability Scale with 10 adole...
Background Inexperience and forgetting perioperative care instruction are significant drivers of ... more Background Inexperience and forgetting perioperative care instruction are significant drivers of parental stress during pediatric tonsillectomy care. With the widespread use of mobile technology, parents now desire a system that provides them with information that is timely, accessible, and comprehensive. Tonsil-Text-To-Me (TTTM) is a text messaging system that sends out automated and timed texts to parents of children who are undergoing tonsillectomy. Objective The objective of this study was to pilot-test TTTM to assess for feasibility and usability and collect suggestions for system improvements desired by parents from a pediatric otolaryngology text message service. Methods Parents of pediatric patients who were being scheduled for tonsillectomy with or without adenoidectomy were prospectively enrolled. An exploratory qualitative study using a semistructured interview guide was performed after parents received the automated texts 2 weeks before and 1 week after their child’s sur...
Background: The delivery of interventions for traumatic stress disorders by paraprofessionals is ... more Background: The delivery of interventions for traumatic stress disorders by paraprofessionals is of interest across mental health systems as decision-makers work to meet growing need for services and demand for evidence-based care. Given the need for any system change to reflect scientific evidence, our scoping review aimed to identify and summarize the research on paraprofessional-delivered trauma-focused psychological interventions for adults, with a particular focus on the role and training of paraprofessionals. Method: We searched seven databases for peerreviewed published studies that employed controlled trial designs to evaluate paraprofessional-led interventions for traumatic stress. Using Covidence software, we completed iterative eligibility screening and extracted study data. Descriptive statistics were used to identify trends and gaps in the literature and inform synthesis of findings. Results: Fourteen studies met inclusion criteria. The majority of studies (71%; 10/14) evaluated interventions that were delivered face-to-face across a diverse patient populations and clinical contexts. Training of paraprofessionals ranged in length from two training sessions (approx. 16 hours) to a 6-week full day, in-person course. Ongoing supervision of paraprofessionals during the intervention was reported in 64% (9/14) of the studies, but few details of supervision processes were reported. Conclusion: Paraprofessionals are taking on therapeutic roles in the delivery of trauma-focused psychological interventions but there are significant knowledge gaps around training and supervision they require. Lack of consensus on the defining characteristics of a "paraprofessional" makes synthesizing this literature particularly challenging.
IntroductionEarly identification and appropriate treatment of child and adolescent mental health ... more IntroductionEarly identification and appropriate treatment of child and adolescent mental health disorders can often be hampered by patchwork services with poorly planned or unclear pathways. The Choice and Partnership Approach (CAPA) is an evidence-based transformational model of community (community-based or outpatient) mental health and addictions services for children and adolescents that aims to better match services to needs and to improve timely access to care. CAPA has been variably implemented across jurisdictions but has not been comprehensively evaluated for its impact on system and client outcomes. Our research question is, ‘To what degree does CAPA work, for whom and under what circumstances?’. The purpose of this review is twofold: (1) to gain an understanding of the extent and outcomes of the implementation of CAPA in community mental health and addictions services; and (2) to identify the role of context as it influences the implementation of CAPA and resulting clien...
BACKGROUND Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a p... more BACKGROUND Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a persuasive system that combines 3 major components to therapy—therapeutic content, technological features, and interactions between the user and program—intended to reduce users’ anxiety symptoms. Several reviews report the effectiveness of iCBT; however, iCBT design and delivery components differ widely across programs, which raise important questions about how iCBT effects are produced and can be optimized. OBJECTIVE The objective of this study was to review and synthesize the iCBT literature using a realist approach with a persuasive systems perspective to (1) document the design and delivery components of iCBT and (2) generate hypotheses as to how these components may explain changes in anxiety symptoms after completing iCBT. METHODS A multi-strategy search identified published and gray literature on iCBT for child and adolescent anxiety up until June 2019. Documents that met our pres...
BACKGROUND More than half of adult mental disorders have their onset before the age of 18 and nea... more BACKGROUND More than half of adult mental disorders have their onset before the age of 18 and nearly one third of children and adolescents with a mental illness are estimated to have more than one diagnosable disorder. Improving broad dissemination of developmentally appropriate treatment and scaling up evidence-based interventions is vital to addressing issues before adulthood. Interventions delivered using text messaging have been effective in promoting behavioural change in various clinical contexts, but the reach and implementation of text messaging interventions within child and adolescent mental health and addictions are not well understood. OBJECTIVE The objective of this scoping review was to map and categorize the current state of peer-reviewed research around the use of text messaging based interventions for mental health and addictions services among children and adolescents. METHODS A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s m...
IntroductionPeople who use alcohol and/or drugs (PWUAD) are at high risk of medical complications... more IntroductionPeople who use alcohol and/or drugs (PWUAD) are at high risk of medical complications, frequent hospitalisation and drug-related death following discharge from inpatient settings and emergency departments (EDs). Harm reduction strategies implemented in these settings may mitigate negative health outcomes for PWUAD. However, the scope of harm reduction strategies used globally within inpatient settings and EDs is unknown. The objective of this review is to identify and synthesise reported harm reduction strategies that have been implemented across inpatient settings and EDs for PWUAD.Methods and analysisThis review will include studies from any country and health service reporting on harm reduction strategies implemented in inpatient settings or EDs. The population of interest includes people of any race, gender and age identifying as PWUAD, or individuals who provided care to PWUAD. Studies which describe implementation strategies and barriers and enablers to implementat...
BACKGROUND The COVID-19 pandemic has increased the demand for youth mental health services in Can... more BACKGROUND The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada. OBJECTIVE A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector. METHODS The ...
Background Mobile device–based tools to help adolescents practice skills outside of cognitive beh... more Background Mobile device–based tools to help adolescents practice skills outside of cognitive behavioral therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. Objective This study aimed to develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, a smartphone-based app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. Methods This 3-phase study took place from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, we conducted 2 high-fidelity testing sessions using the think-aloud approach (acceptability, learnability, usability) and 10-item System Usability Scal...
Background The vast majority of adolescent mental health and substance use disorders go undiagnos... more Background The vast majority of adolescent mental health and substance use disorders go undiagnosed and undertreated. SMS text messaging is increasingly used as a method to deliver adolescent health services that promote psychological well-being and aim to protect adolescents from adverse experiences and risk factors critical for their current and future mental health. To date, there has been no comprehensive synthesis of the existing literature on the extent, range, and implementation contexts of these SMS text message interventions. Objective The objective of this scoping review was to map and categorize gaps in the current body of peer-reviewed research around the use of SMS text messaging–based interventions for mental health and addiction services among adolescents. Methods A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s methodological framework for scoping reviews in six iterative stages. A search strategy was cocreated and adapted for f...
BACKGROUND Internet-based cognitive-behavioural therapy (iCBT) is a necessary step towards increa... more BACKGROUND Internet-based cognitive-behavioural therapy (iCBT) is a necessary step towards increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to therapeutic principles of CBT or usability standards. Additionally, many existing iCBT programs do not include treatments targeting both anxiety and depression – commonly co-occurring conditions. OBJECTIVE Evaluate the usability and fidelity of Tranquility, a novel iCBT program for anxiety, to CBT principles, and engage in a co-design process to adapt Tranquility to include treatment elements for depression. METHODS CBT experts (n = 6) and mental health informed peers (n = 6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression using two simulated client case examples. Mental health informed peers engaged in two co-design focus groups to discuss adaptations to th...
Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Purpose Giving birth is the most common reason for hospital admission, with Cesarean delivery bei... more Purpose Giving birth is the most common reason for hospital admission, with Cesarean delivery being the most frequently performed inpatient surgery. Through a needs assessment and iterative design process involving patients and obstetric anesthesiologists, we previously developed a mobile application, C-Care, for patients undergoing Cesarean delivery. The focus of C-Care is perioperative education and self-monitoring of potential anesthetic complications. This study aimed to obtain feedback on patient engagement with C-Care. Method We conducted a prospective cohort study of patients C 18 yr (n = 36) undergoing elective Cesarean delivery. Anonymous usage data were recorded for 30 days. On postoperative days 1-5, participants received daily self-monitoring questionnaires within C-Care. Fourteen days after surgery, participants received an online survey regarding satisfaction and use of C-Care. Results Thirty-five out of 36 participants visited the application after orientation, with a median [interquartile range (IQR)] age of 32 [31-36] yr. Each participant visited the application a median of 15 [9-31] times over 30 days and completed a median of 3 [2-4] out of five selfmonitoring questionnaires. Each participant viewed a median of 4 [2-7] out of eight education topics, with the most viewed patient education topics being ''Controlling Pain'' and ''The First Few Days''. Visits to the application were highest in the first week postpartum. Of the 18 respondents who completed the day 14 survey, 83% (n = 15) participants would recommend C-Care to other women, and the median participant satisfaction score was 7.5 out of 10 (range, 2-10). Conclusion Most participants used this mobile application for patient education and self-monitoring after elective Cesarean delivery. Insights into patient engagement with C-Care after Cesarean delivery could help design more effective perioperative mobile telehealth programs. Trial registration www.ClinicalTrials.gov (NCT03746678); registered 5 November 2018. Résumé Objectif L'accouchement est la raison la plus courante d'admission a`l'hôpital, et l'accouchement par ce´sarienne constitue la chirurgie hospitalie`re la plus fre´quemment pratique´e. Graˆce a`une e´valuation des besoins et un processus de conception ite´rative impliquant des patientes et des anesthe´siologistes obste´tricaux, nous avions mis au
BACKGROUND In light of the COVID-19 pandemic, people had to adapt their daily life routines to th... more BACKGROUND In light of the COVID-19 pandemic, people had to adapt their daily life routines to the public health measures in place, which is likely to have resulted in a lack of social contacts in person, physical activity or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people making them aware of maladaptive behavioral adjustments to the pandemic. OBJECTIVE This study aimed to explore the views of people on mobile sensing apps passively recording behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic. METHODS We conducted an anonymous online survey including people with and without mental disorders asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey took place in May, 2020. RESULTS The majority of participants particularly those with a menta...
BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its desig... more BACKGROUND Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its design combines therapeutic content, technological features, and interactions between the user and the program to reduce anxiety for children and adolescents. How iCBT is designed and delivered differs across programs. Although iCBT is considered an effective approach for treating child and adolescent anxiety, rates of program use (eg, module completion) are highly variable for reasons that are not clear. As the extent to which users complete a program can impact anxiety outcomes, understanding what iCBT design and delivery features improve program use is critical for optimizing treatment effects. OBJECTIVE The objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes. METHODS A search of published and gr...
IntroductionDischarge communication is an important aspect of patient care but frequently has sho... more IntroductionDischarge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the ED with minimal opportunity to ask questions or to ensure comprehension of important information. Strategies for improving discharge communication have primarily targeted patients and/or parents, although neither group has been engaged in intervention design or implementation. Furthermore, ED healthcare providers (HCPs), important actors in discharge communication practice, are rarely consulted regarding intervention design decisions. We will generate evidence to enhance discharge communication by engaging youth, parents and HCPs in the codesign of ED discharge communication strategies (EDUCATE) for asthma and minor head injury.Methods and analysisThis mixed methods study will take place at two academic paediatric EDs in Canada. The study will occur in two phases: (A) c...
BACKGROUND Mobile device-based (mHealth) tools to help adolescents practice skills outside of cog... more BACKGROUND Mobile device-based (mHealth) tools to help adolescents practice skills outside of cognitive behavioural therapy (CBT) sessions for treating an anxiety disorder may lead to greater treatment gains. OBJECTIVE To develop, design, and test the acceptability, learnability, heuristics, and usability of MindClimb, an mHealth app for adolescents with anxiety to use between CBT sessions to plan and complete exposure activities using skills (cognitive, relaxation, exposure practice, and reward) learned in treatment. METHODS This was a three-phase study from August 2015 to December 2018. In phase 1, the app was designed and developed in consultation with young people and CBT therapists to identify desired functions and content. Feedback was subjected to thematic analysis using a general inductive approach. In phase 2, two high-fidelity testing sessions took place using the Think Aloud approach (acceptability, learnability, usability) and 10 item System Usability Scale with 10 adole...
Background Inexperience and forgetting perioperative care instruction are significant drivers of ... more Background Inexperience and forgetting perioperative care instruction are significant drivers of parental stress during pediatric tonsillectomy care. With the widespread use of mobile technology, parents now desire a system that provides them with information that is timely, accessible, and comprehensive. Tonsil-Text-To-Me (TTTM) is a text messaging system that sends out automated and timed texts to parents of children who are undergoing tonsillectomy. Objective The objective of this study was to pilot-test TTTM to assess for feasibility and usability and collect suggestions for system improvements desired by parents from a pediatric otolaryngology text message service. Methods Parents of pediatric patients who were being scheduled for tonsillectomy with or without adenoidectomy were prospectively enrolled. An exploratory qualitative study using a semistructured interview guide was performed after parents received the automated texts 2 weeks before and 1 week after their child’s sur...
Background: The delivery of interventions for traumatic stress disorders by paraprofessionals is ... more Background: The delivery of interventions for traumatic stress disorders by paraprofessionals is of interest across mental health systems as decision-makers work to meet growing need for services and demand for evidence-based care. Given the need for any system change to reflect scientific evidence, our scoping review aimed to identify and summarize the research on paraprofessional-delivered trauma-focused psychological interventions for adults, with a particular focus on the role and training of paraprofessionals. Method: We searched seven databases for peerreviewed published studies that employed controlled trial designs to evaluate paraprofessional-led interventions for traumatic stress. Using Covidence software, we completed iterative eligibility screening and extracted study data. Descriptive statistics were used to identify trends and gaps in the literature and inform synthesis of findings. Results: Fourteen studies met inclusion criteria. The majority of studies (71%; 10/14) evaluated interventions that were delivered face-to-face across a diverse patient populations and clinical contexts. Training of paraprofessionals ranged in length from two training sessions (approx. 16 hours) to a 6-week full day, in-person course. Ongoing supervision of paraprofessionals during the intervention was reported in 64% (9/14) of the studies, but few details of supervision processes were reported. Conclusion: Paraprofessionals are taking on therapeutic roles in the delivery of trauma-focused psychological interventions but there are significant knowledge gaps around training and supervision they require. Lack of consensus on the defining characteristics of a "paraprofessional" makes synthesizing this literature particularly challenging.
IntroductionEarly identification and appropriate treatment of child and adolescent mental health ... more IntroductionEarly identification and appropriate treatment of child and adolescent mental health disorders can often be hampered by patchwork services with poorly planned or unclear pathways. The Choice and Partnership Approach (CAPA) is an evidence-based transformational model of community (community-based or outpatient) mental health and addictions services for children and adolescents that aims to better match services to needs and to improve timely access to care. CAPA has been variably implemented across jurisdictions but has not been comprehensively evaluated for its impact on system and client outcomes. Our research question is, ‘To what degree does CAPA work, for whom and under what circumstances?’. The purpose of this review is twofold: (1) to gain an understanding of the extent and outcomes of the implementation of CAPA in community mental health and addictions services; and (2) to identify the role of context as it influences the implementation of CAPA and resulting clien...
BACKGROUND Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a p... more BACKGROUND Internet-based cognitive behavioral therapy (iCBT) for children and adolescents is a persuasive system that combines 3 major components to therapy—therapeutic content, technological features, and interactions between the user and program—intended to reduce users’ anxiety symptoms. Several reviews report the effectiveness of iCBT; however, iCBT design and delivery components differ widely across programs, which raise important questions about how iCBT effects are produced and can be optimized. OBJECTIVE The objective of this study was to review and synthesize the iCBT literature using a realist approach with a persuasive systems perspective to (1) document the design and delivery components of iCBT and (2) generate hypotheses as to how these components may explain changes in anxiety symptoms after completing iCBT. METHODS A multi-strategy search identified published and gray literature on iCBT for child and adolescent anxiety up until June 2019. Documents that met our pres...
BACKGROUND More than half of adult mental disorders have their onset before the age of 18 and nea... more BACKGROUND More than half of adult mental disorders have their onset before the age of 18 and nearly one third of children and adolescents with a mental illness are estimated to have more than one diagnosable disorder. Improving broad dissemination of developmentally appropriate treatment and scaling up evidence-based interventions is vital to addressing issues before adulthood. Interventions delivered using text messaging have been effective in promoting behavioural change in various clinical contexts, but the reach and implementation of text messaging interventions within child and adolescent mental health and addictions are not well understood. OBJECTIVE The objective of this scoping review was to map and categorize the current state of peer-reviewed research around the use of text messaging based interventions for mental health and addictions services among children and adolescents. METHODS A scoping review was conducted according to Levac’s adaptation of Arksey and O’Malley’s m...
Uploads
Papers by Lori Wozney