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Background: The critical need for Health Behaviour Change (HBC) for preventative care has been highlighted by the COVID-19 pandemic. This quality improvement project assessed the effectiveness and acceptability of Fountain of Health HBC tools as a minimal intervention for primary and secondary prevention among Canadian clinicians and their patients. Methods: Clinicians received HBC education and tools (paper tools and app-based) to assist their patients in setting a S.M.A.R.T (Specific, Measurable, Action-oriented, Realistic, Time-limited) goal at baseline and assessed four weeks later. Primary outcome measures were: 1) patient self-report of success at goal attainment; 2) patient self-reported evaluation of change in well-being and health attitudes; and 3) clinician experience and engagement. Results: A total of 2184 clinicians received HBC education. Of these, 759 clinicians registered to participate in the project. 961 patients set S.M.A.R.T. HBC goals using either the paper tools (PT) or the app format. Patient data revealed nearly all patients (89% of PT users and 90% of app users) at least partially succeeded in attaining their goal at a four-week follow-up. Most patients (85% of PT and 80% of app users) also reported improvement in their well-being. A significant difference in health beliefs and attitudes was found in both PT (p < 0.001) and app users (p = 0.003). Conclusions: HBC is challenging. Educating and providing clinicians with HBC tools as a minimal intervention was found to be a successful health prevention strategy to improve patient well-being and health attitudes, and achieve S.M.A.R.T. goals. Results show HBC tools, education, and support for clinicians are both acceptable and effective for HBC in frontline care. These findings are relevant and timely given greater reliance on virtual care in the wake of the COVID-19 pandemic. Further research with rigorous methodology is needed to implement programs to achieve sustainable HBC to promote health on a large scale.

Background:Positive psychiatry offers an unique approach to promote brain health and well-being in aging populations. Minimal interventions through behavioral activation to promote wellness are increasingly available using self-guided apps, yet little is known about the effectiveness of app technology or the difference between clinician-supported behavioral activation versus self-guided app methodologies.Objectives:Investigate the difference in users and outcomes between two methods of the Fountain of Health (FoH) positive psychiatry intervention for behavioral activation to promote brain health and well-being: (1) clinician-assisted and (2) independent app use for behavioral self-management.Design and setting:As part of a larger knowledge translation intervention in positive psychiatry, two specific methods of a behavioral activation intervention were retrospectively compared.Participants:Two subsets of patients were compared; 254 clinician-assisted patients; 333 independent app users.Intervention:A minimal positive psychiatry intervention in frontline care using the FoH health and behavior change clinical toolsMeasurements:Main outcomes were changes in psychological (health and resilience, well-being scores) and behavioral indices (goal attainment, items of goal SMART-ness). User profiles (age, sex and completion rates) were also compared.Results:Clinician-assisted patients were more likely to be male, older, and have lower health and resilience scores at baseline. Clinician-assisted patients had notably higher completion rates (99.2% vs. 10.8%). Psychological outcomes (improved health and resilience, and well-being) were similar regardless of intervention method for those who completed the intervention. Behavioral outcomes revealed clinician-assisted patients set goals that better adhered to key goal-setting items.Conclusions:Clinician–patient relationships appear to be an important factor for intervention completion and behavioral outcomes, while further exploration of best practices for intervention completion using health apps in clinical practice is needed. A preliminary goal-setting methodology for effective behavioral activation, to promote brain health and wellness, is given.

Background Benzodiazepine receptor agonist (BZRA) use disorder among older adults is a relatively common and challenging clinical condition. Method The Canadian Coalition for Seniors’ Mental Health, with financial support from Health Canada, has produced evidencebased guidelines on the prevention, identification, assessment, and management of this form of substance use disorder. Results Inappropriate use of BZRAs should be avoided by considering non-pharmacological approaches to the management of late life insomnia, anxiety, and other common indications for the use of BZRA. Older persons should only be prescribed BZRAs after they are fully informed of alternatives, benefits, and risks associated with their use. Clinicians should have a high index of suspicion for the presence of BZRA use disorders. The full version of these guidelines can be accessed at www.ccsmh.ca Conclusions A person-centred, stepped care approach utilizing gradual dose reductions should be used in the management of BZRA use disorder.

Background:The Fountain of Health (FoH) initiative is a knowledge transfer (KT) project on the science of brain health and resilience promotion, in alignment with positive psychiatry.Objectives:Assess the effectiveness of FoH KT delivered in individual and group-based formats.Design:Pre- and post-intervention quality assurance survey of FoH KT.Setting:Interventions occurred in Nova Scotia, Canada.Participants:Adults over age 50 years without pre-existing dementia were targeted. A total of 92 participants received FoH KT in individualized (n = 41) and group-based (n = 51) formats.Intervention:FoH KT (e.g. sharing evidence, lifestyle coaching, and goal setting) using a range of KT supports (e.g. FoH website, paper materials) was delivered to (1) individual patients by primary care clinicians and (2) community-based groups by lay leaders.Measurements:The main outcome measure was participant pre- and post-quality assurance self-reports.Results:Improvements were found in participant awareness of FoH, knowledge of evidence-based mental health promotion initiatives, and in application of this information in daily life in both individual and group-based settings. Improvements in participant knowledge about epigenetic factors that impact health and confidence with health behavior goal setting were reported in both contexts. Changes in self-perceptions of aging scores reached significance in the group intervention.Conclusions:FoH KT produced short-term positive self-reported changes in participants in both individual and group formats. Larger control studies with long-term follow up are needed to better assess effects of both individual and group formats of FoH KT and longer term impacts on health behaviors and outcomes.

Background The Fountain of Health (FoH) Initiative translates evidence-based science of brain health and resilience to the public with the goal of increasing awareness about optimal aging and promoting positive self-perceptions of aging, as well as preventing dementia, late life mental illnesses and supporting psychological health and development later in life, in alignment with Age-Friendly Communities principles. Methods This was an observational study. Five peer-led education series about brain health and resilience were offered to community-dwelling seniors in Nova Scotia, Canada. Each series lasted six weeks, 90-minutes per session. Outcome measures included a pre and post quality assurance self-report questionnaire for group participants, and a self-report questionnaire completed by group facilitators. Results Fifty-one participants attended six group sessions run in five different series. All (100%) completed the pre- and 27 (52.9%) the post-series questionnaire. Highly significant (p Conclusions The FoH peer-led educational series appears to be a useful health promotion program aligned with Age Friendly Communities. Larger studies are needed to further assess the impact of such an approach on behavior change and long-term impacts on longevity and quality of life.

Positive psychiatry offers a unique approach to promote brain health and well-being in aging populations. Health interventions are increasingly becoming available using self-guided apps, however, little is known about the effectiveness of app technology or the difference between in-person versus self-guided app methodology for behavioural activation. The objective of this study was to investigate the difference in users and outcomes between two formats of a positive psychiatry intervention to promote brain health and well-being in later-life: (1) clinician-assisted, and (2) independent app use for self-management. As part of a larger national knowledge translation intervention two methods of a behavioural activation intervention (Clinician-assisted vs. Independent app use) were retrospectively compared. Main outcomes were patient characteristics (age, sex, and completion rate), psychological outcomes (health and resilience, and well-being), and behavioural outcomes (goal attainment, and items of goal SMART-ness). Clinician-assisted patients (n=254) were more likely to be male, older, and had lower health and resilience scores at baseline than Independent app users (n=333). Clinician-assisted patients had notably higher completion rates (99.2% vs. 10.8%). Psychological outcomes were similar regardless of intervention method for those who completed the intervention. Clinician-assisted patients had higher rates of goal attainment and goal SMART-ness. A preliminary goal setting methodology for effective behavioural activation, to promote brain health and wellness, is given. Clinician-patient relationships were found to be an important factor for intervention completion, caution is given for app use referral. Results indicate a need for further exploration to determine best practices for health app use in clinical practice.

Positive psychiatry is dedicated to the science and promotion of biopsychosocial health and resilience. Positive psychiatry has broad relevance for patients with serious mental or physical illness as well as for the general public. In this chapter, the evidence base of applied positive psychiatry for mental health promotion is reviewed. Domains of human behavior with more robust evidence to promote brain health and resilience include physical activity, social connectedness, and cognitive stimulation, proactively taking care of mental health and cultivating a balanced, optimistic outlook. Practical considerations for the integration of positive psychiatry practice are reviewed. Suggested targeted questions and measures to assess mental wellness and resilience and specific interventions shown to promote brain neuroplasticity and resilience are outlined. Early models of successful practice applications are described, with current examples of successful applications in clinical practice and in the community, including resilience-enhancing community initiatives. The Fountain of Health Initiative for Optimal Aging is highlighted as an example of applied positive psychiatry both in healthcare and in community settings.

Background The Fountain of Health (FoH) initiative offers valuable evidence-based mental health knowledge and provides clinicians with evaluated tools for translating knowledge into practice, in order to reduce seniors’ risks of mental disorders, including dementia. Methods A presentation on mental health promotion and educational materials were disseminated to mental health clinicians including physicians and other allied health professionals either in-person or via tele-education through a provincial seniors’ mental health network. Measures included: 1) a tele-education quality evaluation form, 2) a knowledge transfer questionnaire, 3) a knowledge translation-to-practice evaluation tool, and 4) a quality assurance questionnaire. Results A total of 74 mental health clinicians received the FoH education session. There was a highly significant (p < .0001) difference in clinicians’ knowledge transfer questionnaire scores pre- and post-educational session. At a two-month follow-up, 19 (25.7%) participants completed a quality assurance questionnaire, with all 19 (100%) of respondents stating they would positively recommend the FoH information to colleagues and patients. Eleven (20.4%) translation-to-practice forms were also collected at this interval, tracking clinician use of the educational materials. Conclusions The use of a formalized network for knowledge transfer allows for education and evaluation of health-care practitioners in both acquisition of practical knowledge and subsequent clinical behavior change.

Depression in older adults is a pervasive and complex issue associated with poor health outcomes (Carter, Rodda & Walker, 2011). TELEPROM-G is a mobile-based TELEmedicine and Patient-Reported Outcome Measurement (PROM) platform designed to enhance delivery of health services among community-based older adults. This one-year pilot study will develop and test a digital system for treating 30 adults (aged 65 or older) with depressive symptoms living in the community by using mobile tablet devices equipped with a Collaborative Health Record (CHR), an e-Health mobile software platform created by InputHealth. Up to 15 multidisciplinary healthcare providers (HCPs) will be able to monitor changes in the health and functional well-being of their clients overtime allowing for early interventions if necessary. The built-in video conferencing functionality will allow for real-time clinical interactions in the client's home. This study will evaluate the value of InputHealth's CHR with clients through individual interviews and focus groups and conduct separate focus groups with HCPs to evaluate how it enhances their work with clients. The technology will be evaluated using four types of analyses including effectiveness, economic, policy, and ethics analysis (Forchuk, Rudnick, MacIntosh, Bukair & Hoch, 2016). Information gleaned from the results of the pilot will enhance the technology and lead to a larger cohort study across multiple sites.

Objective. To evaluate the effectiveness of audiovisual distraction compared with a blank TV screen in the reduction of pain associated with intramuscular immunization. Design. Subjects were randomly assigned to watch television (TV) (N = 29) or a blank TV screen (control) (N = 33) during immunization, and were videotaped. Immediately after the injection, the children rated their pain. Videotapes were coded for pain behaviors and for distraction. t tests determined between-group mean differences and chi-square tests compared proportions for clinically significant self-reported pain. Setting. Two urban pediatric practices in Halifax, Nova Scotia, Canada. Subjects. Five-year-old children (N = 62), undergoing diphtheria, polio, tetanus, and pertussis immunization, and their parents. Interventions. An age-appropriate musical cartoon or a blank TV screen. Outcome Measures. Pain measurements were the children's self-reports on Faces Pain Scale, facial actions on Child Facial Coding System, and Children's Hospital of Eastern Ontario Pain Scale. Distraction was measured by mean time spent watching the TV screen. Parents rated their own and their child's anxiety on a visual analogue scale. Results. There were no significant group differences for any pain or distraction measures. The relative risk estimate for clinically significant pain among the distraction group was 0.64 (range: 0.23–1.80). Higher levels of distraction (i.e., greater time looking at the TV screen) related to lower levels of pain on all three pain measures. Only correlations with objective pain measures were statistically significant. Conclusions. Watching cartoons did not distract children during needle injection nor reduce their pain. Looking at the TV screen was related to lower behavioral pain scores in the total sample.

Objective: To identify the structure of facial reaction to procedural pain and to determine the subset of facial actions that best describe the response. Design: Observational. Setting: Five rural and five urban physicians’ offices. Patients: One hundred twenty-three children aged 4 to 5 years undergoing routine diphtheria, pertussis, tetanus, and polio immunization. Outcome Measures: The Child Facial Coding System, comprising 13 discrete facial actions, was used to code each second of five 10-second phases from videotape: baseline, preneedle, needle, postneedle, and posthandling. Parents and a technician provided visual analog scale ratings of children’s pain. Children provided a self-report using a Faces Pain Scale, and parents and nurses rated the children’s pain and anxiety using visual analog scales. Results: A “pain face” similar to that reported in adults emerged with the onset of pain. Principal component analyses revealed the frequency and intensity of facial action during the needle phase could be represented by components reflecting pain sensation, a “brave face,” and the children’s expectations for pain. Children’s Faces Pain Scale and adult visual analog scale ratings were best predicted by components reflecting pain sensation and expectations of high pain. Conclusions: These results provide a preliminary indication that the Child Facial Coding System can be reduced to components that reflect several aspects of children’s acute pain experience and predict self-reports and observer reports of children’s pain. Key Words: Facial action—Immunization—Pain—Pain assessment—Pediatric.

Background The Canadian Coalition for Seniors’ Mental Health (CCSMH) developed national best-practice guidelines in seniors’ mental health. Promoting adoption of new guidelines is challenging, as paper dissemination alone has limited impact on practice change. Purpose We hypothesized that the existing knowledge transfer (KT) mechanisms of the Nova Scotia Seniors’ Mental Health Network would prove useful in transferring the CCSMH best-practice guidelines. Methods In this observational KT study, CCSMH best-practice guidelines were delivered through two interactive, case-based teaching modules on Depression & Suicide, and Delirium via a provincial tele-education program and local face-to-face sessions. Usefulness of KT was measured using self-report evaluations of material quality and learning. Evaluation results from the two session topics and from tele-education versus face-to-face sessions were compared. Results Sessions were well attended ( N = 347), with a high evaluation return rate (287, 83%). Most participants reported enhanced knowledge in seniors’ mental health and intended to apply knowledge to practice. Ratings did not differ significantly between KT session topics or modes of delivery. Conclusions The KT mechanisms of a provincial seniors’ mental health network facilitated knowledge acquisition and the intention of using national guidelines on seniors’ mental health among Nova Scotian clinicians. Key elements of accelerating KT used in this initiative are discussed.

Objective: This study surveyed residents’ experiences learning an emerging area of demand in psychiatry at a time when there is a lag in training resources. Unexpectedly, the data generated useful evidence in support of adult learning theory. The result is a post hoc examination of learner attitudes and activities during the spread of a new medical content domain. Implications of the results for adult learning theory are considered. Methods: A survey evaluating interest, motivation, perceptions, and barriers toward learning cognitive-behavioral therapy (CBT) was given to 85 psychiatry residents at a single institution, with a 95% return rate and even distribution across years of training. Results: The vast majority of residents were highly interested and motivated to learn CBT. One hundred percent considered CBT clinically useful, and 99% anticipated using it in future practice. Consistent with the model of adult learning theory, reasons for seeking CBT training tended to focus on personal interest (86%), motivation (81%), and opinion of its clinical usefulness (68%). Only a minority considered training requirements a motivation for seeking training (44%). The most commonly reported difficulty in gaining exposure to CBT was supervisor availability (65%). Conclusions: Residents exhibited qualities of adult learners for whom personal interests were more important than training requirements with regard to seeking training in new modes of treatment. In the wake of recent theoretical scrutiny of adult learning and its applicability to undergraduate medicine, these results suggest that postgraduate medicine might be uniquely suited to the study of adult learning theory.

In human newborns, small amounts of sucrose reduce crying with procedural pain by about 50%. To determine whether "sucrose analgesia" could be extended to painful procedures beyond the newborn period, 57 infants were randomly assigned to receive three 250-microliters doses of 50% sucrose solution (g/100 mL) or water before their diphtheria-tetanus-pertussis immunizations at 2 and 4 months of age. Crying during and after injection was measured separately to determine whether sucrose modified crying during the noxious stimulus, recovery from the stimulus, or both. Sucrose was effective in reducing crying only from 83 to 69%, and the reduction was limited to the postinjection period. We conclude that, although sucrose continues to have some effect beyond the newborn period, the effect is limited to recovery from the noxious stimulus, is clinically modest, and is probably smaller than in the newborn period.