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BackgroundTelepsychiatry is an increasingly used model of mental health care that connects patients with psychiatrists at a distance via videoconference. Telepsychiatry is an effective clinical intervention that improves access to quality care in regions with limited resources or in clinical situations where in-person care is unavailable. ObjectiveThis study aims to develop a validated survey tool to measure patient experience and satisfaction with telepsychiatry based on the quality of care domains. This study also seeks to understand which health service outcomes were most strongly correlated with overall satisfaction in the context of telepsychiatry. MethodsThe survey created in this study was developed and validated with a panel of subject matter and process experts and was piloted with 274 patients who received clinical consultations through the TeleMental Health Program at the Centre for Addiction and Mental Health. Factor analysis was used to determine correlations between questions and quality of care domains and was also used to assess model fit. ResultsThe study provides a validated survey to measure patient satisfaction and experience with telepsychiatry across 4 domains: access and timeliness, appropriateness, effectiveness, and safety. Both safety and access and timeliness were found to be statistically significant predictors of satisfaction in our sample. ConclusionsBy situating patient satisfaction and experience within this framework, the survey facilitates patient data collection and interpretation through a clinical quality lens.

Social workers have an important role in the field of mental health, and social work programs have a responsibility to prepare students for practice in the field. This scoping review mapped and synthesized the literature on mental health, addictions, and suicide in social work education and training. We found 51 articles that examined social work education in addictions (n=23), suicide (n=17), and mental health (n=7), and some articles (n=4) focused on more than one area. Most articles were empirical studies that used quantitative methods, and only one article did not examine social work education in the United States. The studies showed variability in teaching methods, format of training programs, extent to which theory and practice were linked, and the integration of culture and diversity in the programs. The articles contained recommendations to increase teaching students about mental health, addictions, and suicide in all social work programs. Studies also recommended training for faculty and field instructors, using simulation-based learning methods, including competencies in training programs that target knowledge, skills, values, and beliefs; identifying a theoretical framework; integrating culture and diversity; and evaluating training programs. The article discusses implications for best practices in social work education in mental health, addictions, and suicide.

Reflection is a key component of practice, supporting social workers to learn from past experiences and navigate the uncertainty and ambiguity that is common within our work. While the benefits of reflective practice are well documented, there remains considerable debate as to how it is taught and evaluated, with variability across the health and social service professions. The authors sought to evaluate an embodied approach to teaching reflective practice, grounded in mindfulness and contemplative pedagogy. Using a mixed-methods case study research design, we evaluated the teaching approach by triangulating three sources of data: questionnaires, written reflective exercises, and a focus group. The findings suggest that the teaching approach described in this study supported participants to develop the competency of reflection in a way that was distinct from previous learning. It also supported participants to strengthen learning about themselves, both personally and professionally, and to apply mindfulness and reflection in practice. The authors see potential for expanding this teaching approach beyond the specific context of a social work direct practice course in mindfulness and recommend research to further explore adaptation of the approach. [ABSTRACT FROM AUTHOR]

Objectives: Pharmacists have been increasingly integrated into primary care teams, leading to improved health outcomes for patients. The two objectives of this study were (i) to describe how the COVID-19 pandemic impacted pharmacists' role in mental health care within Canadian primary care teams and (ii) to describe Canadian pharmacists' experiences collaborating with other healthcare providers in the delivery of mental health services during the COVID-19 pandemic. Methods: Cross-sectional observational study utilizing an online survey consisting of closed-ended and open-ended questions. Primary care pharmacists in Ontario were eligible to participate. Descriptive statistics were collated, and qualitative data underwent thematic analysis. A total of 51 pharmacists participated in the study. Key findings: The COVID-19 pandemic has led to the expanding role of pharmacists in attending to the mental health care of patients. Working within a collaborative, interprofessional healthcare environment, pharmacists support patients' mental health in a variety of ways, including medication education and management, non-pharmacologic approaches and supportive conversations, and identification of resources, including referrals, wellness checks, and consulting with physicians. Increasing demand for mental health services has led to higher referrals to pharmacists, which will likely persist and require further education of pharmacists in mental health along with better access to deliver virtual care. Conclusion: In response to the increasing mental health care needs of patients since the COVID-19 pandemic, primary care pharmacists reported increased attention spent on mental health care. Building capacity and ensuring support for pharmacists to continue to address the increasing mental health care demands is essential. [ABSTRACT FROM AUTHOR]

Engaging people with lived experience of mental health system encounters in the design and actualization of continuing professional development initiatives for mental health professionals can have transformative systemic impacts. Yet, despite evidence that involving people with lived experience benefits mental health professional education, far less focus has been placed on how to engage people with lived experience in continuing professional development initiatives. Tensions persist regarding the role of lived experience perspectives in continuing professional development, as well as how to establish people with lived experience as partners, educators and leaders in a thoughtful way. We propose that meaningful and equitable partnerships with people with lived experience can be realized by engaging in critical reflexivity and by systematically challenging assumptions. This paper explores three topics: (1) the current state of engagement with people with lived experience in continuing professional development initiatives; (2) barriers to meaningful engagement and (3) recommendations for using critical reflexivity to support the involvement and leadership of people with lived experience in continuing professional development for mental health professionals. Patient or Public Involvement: This viewpoint manuscript was co‐designed and co‐written by people with diverse lived and learned experiences. Each author's professional roles involve meaningfully and equitably partnering with and centring the perspectives of those with lived experience of mental health system encounters. In addition, approximately half of the authorship team identifies as having lived experience of accessing the psychiatric system and/or supporting family members who are navigating challenges related to mental health. These lived and learned experiences informed the conception and writing of this article. [ABSTRACT FROM AUTHOR]

Background: Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention adaptations or to support the effectiveness and satisfaction with virtual EPI services. Objective: This study aims to explore the adaptations required to deliver NAVIGATE, a model of coordinated specialty care used in EPI, in a virtual format. This study will evaluate implementation of the NAVIGATE model delivered virtually by describing the nature of the adaptations to the intervention, assessing fidelity to the EPI model and the satisfaction of clients, family members, and care providers. We will investigate barriers and facilitators to virtual NAVIGATE implementation, service engagement, and health equity impacts of this work. Methods: The Centre for Addiction and Mental Health (Toronto, Ontario, Canada) transitioned to delivering NAVIGATE virtually early in the COVID-19 pandemic. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions will be used to describe the adaptations required to deliver NAVIGATE virtually. Fidelity to the EPI model will be measured using the First Episode Psychosis Services Fidelity Scale and fidelity to NAVIGATE will be assessed by investigating adherence to its core components. Implementation facilitators and barriers will be explored using semistructured interviews with providers informed by the Consolidated Framework for Implementation Research. Satisfaction with virtually delivered NAVIGATE will be assessed with virtual client and provider experience surveys and qualitative interviews with clients, family members, and providers. Service engagement data will be collected through review of medical records, and potential impacts of virtually delivered NAVIGATE on different population groups will be assessed with the Health Equity Impact Assessment. Results: Virtual clinical delivery of NAVIGATE started in March 2020 with additional adaptations and data collection is ongoing. Data will be analyzed using descriptive statistics and survival analysis for quantitative data. Qualitative data will be analyzed using thematic content analysis. Integration of qualitative and quantitative data will occur at the data collection, interpretation, and reporting levels following a convergent design. Conclusions: This study will provide information regarding the type of intervention adaptations required for virtual delivery of NAVIGATE for youth with early psychosis, ensuring access to high-quality care for this population during the pandemic and beyond by guiding future implementation in similar contexts. [ABSTRACT FROM AUTHOR]

Introduction: Project Extension for Community Healthcare Outcomes (Project ECHO®) is a global-guided practice initiative aimed at building primary care capacity and improving health care quality for underserved populations. This tele-education model brings together primary care providers and subject-matter specialists in online communities of practice to share knowledge, discuss complexities in patient care, and collaborate to reduce health disparities. Methods: Using co-generated clinical care recommendations from ECHO Ontario Mental Health, a mental health focused ECHO program, we explored alignment of recommendations across the Institute of Medicine's (IOM) six domains of health care quality to characterize its impact. A total of 417 recommendations, made for 32 patient cases, were analyzed using a modified directed content analysis method. Each recommendation was coded with one or multiple codes, representing each of the six IOM domains. Key examples of recommendations within each domain are described. Results: An average of 13 recommendations were generated per patient case. The effective domain occurred at least once in each complete set of patient care recommendations. The next highest occurring domain was safe (71.9%), followed by patient-centered (68.8%), efficient (40.6%), equitable (18.8%), and timely (12.5%). Recommendation distribution across the entire data set was effective (97.8%), safe (15.6%), patient-centered (12.0%), efficient (3.6%), equitable (1.9%), and timely (1.4%). Discussion: As the first study to characterize ECHO's impact using health care quality domains, the study highlights ECHO's significant focus on effective, safe, and patient-centered care. These findings can inform ways for ECHO to target quality improvement and measure impact in additional health care quality domains, such as efficient, equitable, and timely. [ABSTRACT FROM AUTHOR]

Social work programs need to prepare students for practice in assessing mental health, addictions, and suicide risk assessment. In response to a call for increased training, we partnered with community social workers and re-designed a course on social work practice in mental health using a flipped classroom approach. We conducted a qualitative study using focus groups and individual interviews with MSW students (N = 15) to explore student perspectives on re-designed teaching approaches. Participants identified three teaching methods that increased knowledge, skills, and self-awareness: online educational modules, simulation, and integrated teaching with scaffolded learning. We discuss implications for social work education and practice. [ABSTRACT FROM AUTHOR]

Introduction: Primary care is the first point of access for health services and primary care teams play a central role in the coordination and integration of mental health services. The pandemic has seen a rising demand for mental health services and primary care teams are well positioned to address these needs. With the pandemic, primary care teams have made a transition to virtual care, however the impact on how teams collaborate to provide mental health care is unclear. The aim of the study is to understand primary care teams' experiences with collaboration related to mental health care during the COVID-19 pandemic. Aims Objectives Theory or Methods: A descriptive qualitative research design was employed. Family Health Teams (FHTs) are an interprofessional primary care model in Ontario. Using purposeful sampling, we sent invitational letters to executive directors of FHTs across all five Ontario Health regions. Focus groups were conducted with interprofessional healthcare providers providing mental health services in FHTs. Virtual focus groups, led by trained facilitators examined the delivery of collaborative mental health services and its impact on patients during the COVID-19 pandemic. The focus groups were audiorecorded and transcribed verbatim. Thematic analysis was used for data analysis and occurred in parallel with data collection. Highlights or Results or Key Findings: Eleven focus groups with 10 FHTs were conducted, with a total of 48 participants. Focus groups were conducted with two FHTs in each of the five Ontario Health regions. Three themes were identified in the data: i) pre-pandemic team functioning, ii) new communication processes, iii) collaboration. Teams were able to maximize collaboration from this rapid transition with the advantage of well-established team-based models prior to the pandemic. Teams created new processes for collaboration to adapt to the virtual changes via new channels of communication such as texting, video meetings and phone calls. Collaboration expanded beyond the FHT and into the communities as teams virtually collaborated with community partners. Nevertheless, some participants found virtual collaboration to be isolating due to the lack of in person communications and unscheduled hallway conversations that could only emerge in a co-located in-person setting. Conclusions: While teams found new ways of communicating, the overall experience of shifting to a virtual team was isolation with less overall collaboration. Virtual team-based communication will likely be a mode of collaboration moving forward, and its advantages and disadvantages will need to be considered. Implications for applicability/transferability sustainability and limitations: As virtual care becomes an integral way of delivering primary care, it will be crucial to understand and learn its impact on collaboration within teams. This will influence how health care providers support each other and in communities as many regions work to strengthen collaborations within Ontario Health Teams. [ABSTRACT FROM AUTHOR]

Background: Team-based Early Psychosis Intervention (EPI) services is standard of care for youth with psychosis. The COVID-19 pandemic required most EPI services to mount an unplanned, rapid pivot to virtual delivery , with limited guidance on how to deliver virtual clinical services or whether quality of re-implementation and treatment outcomes would be impacted. We used a structured approach to identify essential modifications for the delivery of core components and explored facilitators and barriers for re-implementation and fidelity of a virtually delivered EPI intervention., Materials and Methods: NAVIGATE is a structured approach to team-based EPI. It provides detailed modules to guide delivery of core components including medication management, psychoeducation and psychotherapies, supported employment/education, and family education. Having initially implemented NAVIGATE at the Centre for Addiction and Mental Health (CAMH) in 2017, the EPI service transitioned to virtual delivery amid the COVID pandemic. Using a practice profile developed to support implementation, we detailed how core components of NAVIGATE were rapidly modified for virtual delivery as reported in structured group meetings with clinicians. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions (FRAME) was used to describe modifications. Fidelity to the EPI standards of care was assessed by the First Episode Psychosis Fidelity Scale (FEPS-FS). Re-implementation barriers and facilitators and subsequent mitigation strategies were explored using structured clinician interviews guided by the Consolidated Framework for Implementation Research (CFIR)., Results: Identified modifications related to the intervention process, context, and training. We identified contextual factors affecting the re-implementation of virtually delivered NAVIGATE and then documented mitigating strategies that addressed these barriers. Findings can inform the implementation of virtual EPI services elsewhere, including guidance on processes, training and technology, and approaches to providing care virtually., Discussion: This study identified modifications, impacts and mitigations to barriers emerging from rapid, unplanned virtual delivery of EPI services. These findings can support delivery of high-quality virtual services to youth with psychosis when virtual care is indicated., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Tempelaar, Kozloff, Crawford, Voineskos, Addington, Alexander, Baluyut, Bromley, Brooks, de Freitas, Jindani, Kirvan, Morizio, Polillo, Roby, Sosnowski, Villanueva, Durbin and Barwick.)

Objective: The objective of this study was to describe Ontario primary care teams' experiences with collaboration during the COVID-19 pandemic. Descriptive qualitative methods using focus groups conducted virtually for data collection., Setting: Primary care teams located in Ontario, Canada., Participants: Our study conducted 11 focus groups with 10 primary care teams, with a total of 48 participants reflecting a diverse range of interprofessional healthcare providers and administrators working in primary care., Results: Three themes were identified using thematic analysis: (1) prepandemic team functioning facilitated adaptation, (2) new processes of team interactions and collaboration, and (3) team as a foundation of support., Conclusions: Results revealed the importance of collaboration for provider well-being, and the challenges of providing collaborative team-based primary care in the pandemic context. Caution against converting primary care collaboration to predominantly virtual modalities postpandemic is recommended. Further research on team functioning during the COVID-19 pandemic in other healthcare organisations will offer additional insight regarding how primary care teams can work collaboratively in a postpandemic environment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)