“One Degree of Separation”: A Mixed-Methods Evaluation of Canadian Mental Health Care User and Provider Experiences With Remote Care During COVID-19

Objectives The COVID-19 pandemic has contributed to a shift from in-person to remote mental health care. While remote care methods have long existed, their widespread use is unprecedented. There is little research about mental health care user and provider experiences with this transition, and no published studies to date have compared satisfaction between these groups. Methods Canadian mental health care users ( n = 332) and providers ( n = 107) completed an online self-report survey from October 2020 to February 2021 hosted by the Canadian Biomarker Integration Network in Depression. Using a mixed-methods approach, participants were asked about their use of remote care, including satisfaction, barriers to use, helpful and unhelpful factors, and suggestions for improvement. Results Overall, 59% to 63% of health care users and 59% of health care providers were satisfied with remote care. Users reported the greatest satisfaction with the convenience of remote care, while providers were most satisfied with the speed of provision of care; all groups were least satisfied with therapeutic rapport. Health care providers were less satisfied with the user-friendliness of remote care ( P < 0.001) than users, while health care users were less satisfied than providers with continuity of care ( P < 0.001). The use of a video-based platform was associated with remote care satisfaction among health care users ( P < 0.02), and qualitative responses support the importance of visual cues in maintaining therapeutic rapport remotely. The majority of users (55%) and providers (87%) reported a likelihood of using remote care after the pandemic. Conclusions Remote mental health care is generally accepted by both users and providers, and the majority would consider using remote care following the pandemic. Suggestions for improvement include greater use of video, increased attention to body language and eye contact, consistency with in-person care, as well as increased provider training and administrative support.

Community Courts & Race: An Examination of Community Court Judges, Staff, and Racial Dynamics

Current research has found racial disparities in outcomes of problem-solving courts throughout the country. However, most of the research has not explored the causes of these racial disparities. This research qualitatively explores two prominent community courts in the northeast. Themes emerge about courtroom racial dynamics through courtroom observations and semi-structured interviews. The findings indicate that the racial makeup of the staff and judges play a role in maintaining a therapeutic rapport with non-white participants. Suggestions on how problem-solving courts can potentially improve racial dynamics are discussed.

Co-ordinating meaning within a gender identity development service: What can the theory of the co-ordinated management of meaning offer clinicians working with young people, and their families, exploring their gender identities

Working with young people who present with diverse gender identifications and their families requires consideration and acknowledgement of a range of contexts (including relationship, family, social and cultural) as well as the influences of prior experience and language. Family members often present with diverse understandings and hopes from their referral to the Gender Identity Development Service and look to us to meet these. This article considers the contribution of Cronen and Pearce who introduced the theory of the co-ordinated management of meaning (CMM). We focus on their ideas about communication, the complexities of communication, meaning, context and multiple perspectives. This article relates to our practice as well as considers useful ways to work with families and young people, within a highly contested field. Clinical examples are used to illustrate how we have made use of the theory and models of CMM to facilitate engagement, build therapeutic rapport, facilitate understanding and support those we see in a way which takes into account the many contexts of their lives.

Evidence-Based Treatments for PTSD

Because suicide risk appears to be heightened with individuals who have posttraumatic stress disorder (PTSD), it is crucial that PTSD treatment providers assess for suicidal ideation and that, when mental health clinicians are working with a suicidal patient, they assess for PTSD. Evidence-based treatments for PTSD can significantly help those experiencing both PTSD and suicidality. Although co-occurring suicidality does not prohibit proceeding with these treatments, it does involve additional considerations in delivery of care. Good PTSD assessment involves both diagnostic interviewing and ongoing assessment via administration of self-report measures. A written safety plan should also be developed, actively engaging veterans and minimizing barriers to treatment. Once the decision is made to proceed with PTSD care, all treatments are implemented as usual with ongoing monitoring of suicidal ideation. Strong therapeutic rapport is a critical part of all evidence-based treatments for PTSD, as well as for effective response to suicide risk.

A qualitative study of clinicians’ experiences and attitudes towards telephone triage mental health assessments

This qualitative study investigated clinicians’ experiences and attitudes towards conducting mental health assessments over the telephone in an IAPT service. Nine participants completed a semi-structured questionnaire and data were evaluated using a Thematic Analysis model. Participants were largely apprehensive about telephone working, but many reported positive experiences. Telephone assessments were felt to be structured, focused and comprehensive, and therapeutic rapport was able to be established. However, concerns persisted around whether risk assessments could be adequately conducted over the telephone. Reports of spontaneous feedback from patients during telephone triage suggested that there was appreciation for this method of assessment and that it increased access to the service. Further research is needed to better understand what, for clinicians, contributes to acceptable assessment of complex and subjective situations, such as risk and feeling states, over the telephone.

Hypnosis: Teaching Children Self-Regulation

Hypnosis applies and strengthens a child's naturally enhanced ability to focus his or her concentration and imagination to change symptoms, physiology, and behavior. This field of naturalistic psychology is supported both experimentally and clinically. It can be incorporated into all clinical encounters, increasing therapeutic rapport, the young person's self-esteem, and efficiency. It is most effective when introduced before fearful responses become conditioned, and it can reduce the amount of medication required for relief of symptoms. This capacity can grow with the child, allowing him or her to approach future challenges with equanimity. It has been said, "All hypnosis is not therapy, but all therapy is hypnosis."30 Hypnosis training teaches us the sensitivity to language, to our patients' states of awareness, and to the power of our own positive expectancy and rapport that underlies what we call the "art of medicine."