4.57 Improved Access to Mental Health Care Using a Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial

2018 ◽  
Vol 57 (10) ◽  
pp. S222
Author(s):  
Tumaini R. Coker ◽  
Lorena Porras-Javier ◽  
Lily Zhang ◽  
Neelkamal Soares ◽  
Christine Park ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Pediatric Primary Care ◽  
Referral Process ◽  
Cluster Randomized

scholarly journals Advancing successful implementation of task-shifted mental health care in low-resource settings (BASIC): protocol for a stepped wedge cluster randomized trial

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shannon Dorsey ◽  
Christine L. Gray ◽  
Augustine I. Wasonga ◽  
Cyrilla Amanya ◽  
Bryan J. Weiner ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Task Shifting ◽  
Mental Health Intervention ◽  
Stepped Wedge ◽  
Cluster Randomized ◽  
Policies And Practices

Abstract Background The mental health treatment gap—the difference between those with mental health need and those who receive treatment—is high in low- and middle-income countries. Task-shifting has been used to address the shortage of mental health professionals, with a growing body of research demonstrating the effectiveness of mental health interventions delivered through task-shifting. However, very little research has focused on how to embed, support, and sustain task-shifting in government-funded systems with potential for scale up. The goal of the Building and Sustaining Interventions for Children (BASIC) study is to examine implementation policies and practices that predict adoption, fidelity, and sustainment of a mental health intervention in the education sector via teacher delivery and the health sector via community health volunteer delivery. Methods BASIC is a Hybrid Type II Implementation-Effectiveness trial. The study design is a stepped wedge, cluster randomized trial involving 7 sequences of 40 schools and 40 communities surrounding the schools. Enrollment consists of 120 teachers, 120 community health volunteers, up to 80 site leaders, and up to 1280 youth and one of their primary guardians. The evidence-based mental health intervention is a locally adapted version of Trauma-focused Cognitive Behavioral Therapy, called Pamoja Tunaweza. Lay counselors are trained and supervised in Pamoja Tunaweza by local trainers who are experienced in delivering the intervention and who participated in a Train-the-Trainer model of skills transfer. After the first sequence completes implementation, in-depth interviews are conducted with initial implementing sites’ counselors and leaders. Findings are used to inform delivery of implementation facilitation for subsequent sequences’ sites. We use a mixed methods approach including qualitative comparative analysis to identify necessary and sufficient implementation policies and practices that predict 3 implementation outcomes of interest: adoption, fidelity, and sustainment. We also examine child mental health outcomes and cost of the intervention in both the education and health sectors. Discussion The BASIC study will provide knowledge about how implementation of task-shifted mental health care can be supported in government systems that already serve children and adolescents. Knowledge about implementation policies and practices from BASIC can advance the science of implementation in low-resource contexts. Trial registration Trial Registration: ClinicalTrials.gov Identifier: NCT03243396. Registered 9th August 2017, https://clinicaltrials.gov/ct2/show/NCT03243396

scholarly journals A Telehealth-Enhanced Referral Process in Pediatric Primary Care: A Cluster Randomized Trial

PEDIATRICS ◽  
2019 ◽  
Vol 143 (3) ◽  
pp. e20182738 ◽  
Author(s):  
Tumaini R. Coker ◽  
Lorena Porras-Javier ◽  
Lily Zhang ◽  
Neelkamal Soares ◽  
Christine Park ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Pediatric Primary Care ◽  
Referral Process ◽  
Cluster Randomized

scholarly journals Embedded Maternal Mental Health Care in a Pediatric Primary Care Clinic: A Qualitative Exploration of Mothers’ Experiences

2019 ◽  
Vol 19 (8) ◽  
pp. 934-941 ◽  
Author(s):  
Chelsea Anne Young ◽  
Honora Burnett ◽  
Alexandra Ballinger ◽  
Gloria Castro ◽  
Shay Steinberg ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Maternal Mental Health ◽  
Primary Care Clinic ◽  
Pediatric Primary Care ◽  
Care Clinic ◽  
Qualitative Exploration ◽  
Mothers Experiences

scholarly journals Cluster Randomized Trial Reducing Missed Elevated Blood Pressure in Pediatric Primary Care

2019 ◽  
Vol 4 (5) ◽  
pp. e187 ◽  
Author(s):  
Michael L. Rinke ◽  
Hardeep Singh ◽  
Tammy M. Brady ◽  
Moonseong Heo ◽  
Steven W. Kairys ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Randomized Trial ◽  
Cluster Randomized Trial ◽  
Elevated Blood Pressure ◽  
Pediatric Primary Care ◽  
Elevated Blood ◽  
Cluster Randomized

Barriers to Mental Health Care for Urban, Lower Income Families Referred from Pediatric Primary Care

2011 ◽  
Vol 40 (3) ◽  
pp. 159-167 ◽  
Author(s):  
Justine Larson ◽  
Susan dosReis ◽  
Miriam Stewart ◽  
Rochelle Kushner ◽  
Emily Frosch ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Pediatric Primary Care ◽  
Lower Income

scholarly journals The effectiveness of a psycho-education intervention on mental health literacy in communities affected by the COVID-19 pandemic—a cluster randomized trial of 24 villages in central Uganda—a research protocol

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dickens Akena ◽  
Ronald Kiguba ◽  
Wilson W. Muhwezi ◽  
Brendan Kwesiga ◽  
Gwendolyne Kigozi ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Literacy ◽  
Randomized Trial ◽  
Mental Health Literacy ◽  
Cluster Randomized Trial ◽  
Stress Disorders ◽  
Education Intervention ◽  
Link Type ◽  
Cluster Randomized

Abstract Background Literature shows a high prevalence of psychological distress (PD) as well as common mental disorders (CMD) such as major depressive disorders (MDD), generalized anxiety disorders (GAD), post-traumatic stress disorders (PTSD), and substance misuse disorders (SUD) among people exposed to disasters and pandemics like the COVID-19. Moreover, CMD are associated with increased mortality (mainly through suicide) and morbidity (loss of productivity). A number of countries have made deliberate efforts to identify and manage CMD in light of COVID-19. However, low levels of mental health literacy (MHL) manifested by the individual’s unawareness of CMD symptoms, limited human and mental health infrastructure resources, and high levels of mental illness stigma (MIS) are barriers to integration of mental health care in general health care during pandemics and epidemics such as the COVID-19. Objectives For the proposed study, we will determine effectiveness of a psycho-education intervention delivered by village health team (VHT) members. Methods We will employ a cluster randomized trial design in 24 villages in central Uganda. We will collect baseline data to and document the prevalence of MHL, PD, MDD, PTSD, GAD, and SUD. We will distribute information education and communication materials (IEC) aimed at improving MHL to 420 adult individuals in the intervention arm (n = 12 villages). In the control arm (n = 12 villages), VHTs will distribute ministry of health COVID-19 information leaflets to 420 participants. Within 7 days of distributing the materials, research assistants will conduct a follow-up interview and assess for the same parameters (MHL, PD, MDD, PTSD, GAD, and SUD). We will use an intention to treat analysis to estimate the effectiveness of the psycho-education intervention. Discussion Findings from this research will guide policy and practice regarding the integration of mental health services in the community in the context of epidemic preparedness and response. Trial registration ClinicalTrials.govNCT04616989. Registered on 05 November 2020

scholarly journals Primary Care Practitioner Training in Child and Adolescent Psychiatry (PTCAP): A Cluster-Randomized Trial

2019 ◽  
Vol 65 (5) ◽  
pp. 319-329
Author(s):  
Stacey D. Espinet ◽  
Sandra Gotovac ◽  
Sommer Knight ◽  
Larry Wissow ◽  
Merrick Zwarenstein ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Adolescent Psychiatry ◽  
Child And Adolescent Psychiatry ◽  
Practitioner Training ◽  
Attitudes And Knowledge ◽  
Cluster Randomized ◽  
Pediatric Mental Health

Objectives Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs’ pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. Methods The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention ( n practices = 7; n PCPs = 42) or to wait-list control ( n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. Results Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions ( d = 1.81) and general concerns ( d = 1.73), as well as in making necessary referrals ( d = 1.27) and obtaining consults ( d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. Conclusion PTCAP enhances PCPs’ child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.

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