The effectiveness of training community mental health therapists in an evidence-based intervention for ASD: Findings from a hybrid effectiveness-implementation trial in outpatient and school-based mental health services

An Individualized Mental Health Intervention for ASD (AIM HI) was developed in collaboration with community stakeholders for delivery in mental health services in response to therapist- and caregiver-identified need to improve services for children with autism spectrum disorder (ASD). Primary findings from a cluster randomized Hybrid Type 1 effectiveness-implementation trial conducted in publicly funded mental health programs demonstrated the effectiveness of AIM HI therapist training on child and caregiver outcomes. This study examined therapist outcomes and therapist experience as a moderator of training effects. Mental health programs were randomized to immediate AIM HI training or usual care. Therapists and child/caregiver clients were recruited from participating programs. Therapists in the AIM HI training condition received consultation for 6 months while delivering AIM HI. Differences between training conditions were examined using multilevel modeling. Therapists receiving AIM HI training were observed to use more extensive active teaching strategies with caregivers, engagement strategies with children, strategies promoting continuity of care, and had more structured sessions with more extensively pursued skill building. Therapist licensure moderated some training outcomes. The current study provides support for evidence-based practice implementation in usual care mental health services. Lay abstract Publicly funded mental health services play an important role in caring for school-age children with autism spectrum disorder (ASD); however, therapists report a lack of specialized ASD training, which families identity as a barrier in obtaining mental health services for their children. An Individualized Mental Health Intervention for ASD (AIM HI) was developed in collaboration with community stakeholders to respond to identified needs of children and community therapists. The current study examined the effects of therapist training in AIM HI on the changes in therapist practice, including therapists’ use of evidence-based intervention strategies in session. Data were collected from a study conducted in community outpatient and school based mental health programs randomly assigned to receive AIM HI therapist training or observation of routine care. Therapist and child clients were enrolled from participating programs. Therapists in AIM HI training received training and consultation for 6 months while delivering the AIM HI intervention to a participating client; therapists in usual care delivered routine care. Both groups of therapists video recorded psychotherapy sessions which were scored by trained raters. Differences between training groups were examined using multilevel modeling. Therapists trained in AIM HI were observed to use more extensive active teaching strategies with caregivers, engagement strategies with children, strategies promoting continuity of care, and had more structured sessions with more effective pursuit of caregiver and children skill teaching. Therapist licensure moderated some training outcomes.

Ego-resiliency Moderates the Risk of Depression and Social Anxiety Symptoms on Suicidal Ideation in Medical Students

BackgroundLittle is known about the role of protective factors in suicidal ideation among medical students. This study aimed to examine the association between suicidal ideation and protective (self-esteem/ego-resiliency/social support) and risk (depression/social anxiety) factors.MethodsData on sociodemographic factors, depression, social anxiety, self-esteem, ego-resiliency, social support, and current suicidal ideation were collected from 408 medical students. A logistic regression model was constructed to identify the independent impact of potential influencing factors on suicidal ideation. Potential moderating effects were also explored.ResultsThirty-eight participants (9.3%) reported experiencing suicidal ideation. Younger age, higher levels of depression, social anxiety, and lower levels of self-esteem, ego-resiliency, and social support were found to be significantly correlated with suicidal ideation. In the final model, higher levels of depression and social anxiety were associated with an increased risk of suicidal ideation, while higher levels of self-esteem and social support were associated with a decreased risk of suicidal ideation. Although the independent effect was not significant, the interactions of ego-resiliency with both depression and social anxiety on suicidal ideation were significant. Higher levels of ego-resiliency acted as a buffer against suicidal ideation among those with higher levels of depression or social anxiety.ConclusionsIn addition to risk factors, this study revealed the underlying protective and moderating factors of suicidal ideation among medical students. Mental health programs focusing on enhancing ego-resiliency, self-esteem, and social support may contribute to suicide prevention in medical students.

Mood Lifters: A Peer-Led Mental Health Program for Older Adults via Video Conferencing

Effective and scalable mental health programs are greatly needed for older adults, given the vast majority in need do not receive formal mental health services. In this study, we adapted Mood Lifters—a peer-led, community-based program promoting mental well-being—to address the unique needs of older adults. The 14 weekly program sessions were delivered via Zoom. Twelve older adults (mean age = 69.7 years; 4 men, 8 women) enrolled; 9 completed the program (2 of 3 dropouts were due to health issues). A battery of validated measures administered within one week before and after the program assessed domains including depression and anxiety, stress management, and health behaviors. Compared to baseline, participants who completed the program showed significant improvements in perceived stress (p=0.03), sleep quality (p=0.02), and emotion regulation via cognitive reappraisal (p=0.06). Depression and anxiety symptoms (assessed by the Geriatric Depression and Anxiety Scales, respectively) were lower at program completion, although improvements were not statistically significant. No significant changes from pre- to post-test were reported in loneliness and health behaviors. Participant ratings of program satisfaction were very high (mean = 4.78/5, with 1=poor, 5=excellent). Results from this pilot test of Mood Lifters for Seniors suggest it is feasible and acceptable for outreach to older adults, with preliminary evidence of benefits in several domains related to mental health and wellness. Future randomized trials with larger, more diverse samples will be necessary to confirm program benefits.

An assessment of mental health programs at community health centers in north Minahasa, Indonesia

Background: The Indonesian government recognizes the importance of mental health issues as indicated by the inclusion of such issues as indicators in the national program, the Healthy Indonesian Program with Family Approach (PIS-PK). This program is enforced in community health centers (puskesmas) in every regency in the country. However, the continually increasing number of mental disorder cases and the intense stigmatization of people with these disorders indicate the need to re-evaluate the capacity and delivery of designated centers’ mental health programs.Methods: This community survey involved interviewing the program directors of four community health centers in north Minahasa using the WHO-AIMS 2.2 questionnaire.Results: Very little effort has been made to improve mental health facilities and programs. Examples of aspects of health facilities that are lacking include training for health workers, the provision of psychotropic drugs, and supported employment or occupational rehabilitation.Conclusions: Community health centers are primary healthcare facilities for society. Therefore, mental health services should be implemented as one of their main programs.

469. The Mental Health Implications of Job Loss for Never-married Women During the COVID-19 Pandemic

Background The COVID-19 pandemic was associated with an array of social and economic events, influencing how the pandemic affected people of all genders. In particular, job losses surged during the COVID-19 pandemic, especially among women. We analyzed how the pandemic and rising job losses affected the mental health of unmarried women with and without children in order to identify possible health disparities, potential causal factors and opportunities for interventions. Methods Data were collected from Wave 3 (January 6-February 15, 2021) of the US Census COVID-19 Household Pulse online survey designed to measure the impact of COVID-19. Microdata files were downloaded from the Census website and included N=13,940 never-married female respondents aged 25-54 years old. Data were analyzed using χ2 tests, with z-tests for more granular between-group comparisons. Results When asked if they had felt anxiety in the past week, 31% of respondents without children in the household and 28% of those with children reported feeling anxiety nearly every day (p< .05). Among those who did not lose work during the pandemic, 24% of those without children felt anxiety nearly every day vs. 20% of those with children (p< .05). Among those who did experience pandemic-related job loss, 33% of those with children and 42% of those without children reported daily anxiety (p< .05). Conclusion Overall, COVID-19 job loss was associated with higher levels of anxiety for never-married adult women. Notably, respondents without children expressed significantly higher levels of anxiety than respondents with children, and this difference was even greater when comparing those who had lost jobs during the pandemic. Reasons are being further researched but may be related to mothers’ greater opportunities for social and community support, particularly when encountering difficult circumstances. These results have implications for the development of mental health programs serving women experiencing environmental stressors such as job loss, especially women without children who may not have the same mental health and community support. Disclosures All Authors: No reported disclosures

A mentális betegeket célzó szolgáltatások hatékonyságának fejlesztési lehetőségei két komplex nemzetközi program tükrében

Háttér és célkitűzésekA súlyos mentális betegségek és a betegség során előforduló relapszusok terhei és költségimplikációi egyéni és társadalmi szinten is jelentősek. A mentálhigiénés szolgáltatások elérhetősége és színvonala, a kliensek egészségkimenetele és a hagyományos pszichiátriai és addiktológiai ellátás költségei azonban egyszerre javíthatók innovatív kezelési, szolgáltatásszervezési és finanszírozási technikák együttes használatával. Tanulmányunk célja, hogy áttekintse a pozitív és a közösségi pszichiátriai szemléletmód, az integrált ellátásszervezés és a sikeralapú kifizetés mint innovatív finanszírozási technika alkalmazási lehetőségeit két, súlyos mentális betegek gondozásával és egészségfejlesztésével foglalkozó program bemutatásán keresztül.MódszerA pozitív pszichiátria, közösségi pszichiátria, az integrált ellátásszervezés és az innovatív szolgáltatásfinanszírozás koncepcióival kapcsolatban gyűjtöttünk hazai és nemzetközi szakirodalmat.EredményekA pozitív pszichiátria, a közösségi pszichiátria és az integrált ellátásszervezés tehermentesíthetik a költséges pszichiátriai és addiktológiai fekvőbeteg-ellátást, és elősegíthetik a szolgáltatások színvonalának fejlesztését egy integrált ellátási folyamat részeként. A sikeralapú kifizetés modellje új típusú magánbefektetők megjelenését eredményezi, elősegíti a teljesítménymérés és -értékelés kultúrájának terjedését, és újfajta kockázatmegosztási mechanizmust alkalmaz az interszektoriális együttműködések megvalósításakor.KövetkeztetésekA közösségi pszichiátria, a pozitív pszichiátria, az integrált ellátásszervezés és a sikeralapú kifizetés számos eszközt biztosít a mentális betegeket célzó szolgáltatások fejlesztéséhez, egyúttal elősegítve az interszektoriális együttműködések és a hosszú távú komplex programok kialakítását. A jelen közleményben ismertetett nemzetközi példák elősegíthetik a mentális betegeket célzó hazai programok fejlesztését.Background and ObjectivesThe burden and cost implications of serious mental illness and related relapses affect significantly both the individual and society. Access to and quality of mental health services, along with clients’ health outcomes and the costs of traditional hospital-centered mental health services can be improved by the use of innovative treatment, coordination of service delivery and financing techniques. Our objective is to explore the potential uses of positive psychiatric innovation, community-based psychiatry, integrated service delivery and the “pay for success” financing model, through presenting two mental health programs delivered to clients with serious mental illness.MethodsLiterature related to positive psychiatry, community psychiatry, integrated service delivery and innovative financing have been searched and reviewed.ResultsPositive psychiatry and community-based approaches to mental health care and service can further ease the costs of inpatient care and improve the quality of services as an integrated part of a service process. The “pay for success” model enables new types of private investors, promotes rigorous measurement and assessment of performance and uses an innovative risk-sharing mechanism in the implementation of intersectoral cooperations.ConclusionCommunity psychiatry, positive psychiatry, integrated service delivery and the pay for success model of financing provides various tools to improve mental health services while enabling intersectoral cooperations and long-term, complex programs. Our objective is to support the development of local mental health programs by presenting international examples.

The application of e-mental health in response to COVID-19: A review and bibliometric analysis (Preprint)

BACKGROUND The COVID-19 pandemic and its mitigation measures such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity and disrupted routines, have led to unprecedented declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, e-mental health programs and services have rapidly become the “new normal”. OBJECTIVE To assess current trends and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. METHODS A search of four academic databases (Ovid MEDLINE, EMBASE, PsychINFO, CINAHL) published from 31st December 2019 to 31st March 2021 using keywords for e-mental health and COVID-19. Article information was extracted relevant to the review objective including journal, type of article, keywords, focus and corresponding author. Information was synthesised by coding these attributes, then summarised through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. RESULTS A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being non-empirical, chiefly commentaries or opinions (n = 225, 63.2%). Empirical publications emerged later and becoming more frequent as the pandemic progressed. The United States contributed the most articles (n = 160, 44.9%), though a notable number came from middle-income countries (n = 59, 16.6). Articles were spread across 165 journals, and were of above-average-influence (almost half of the articles were in the top 25% of outputs scores by Altmetric and the average CiteScore across articles was 4.22). The network analysis of author supplied keywords identified key topic areas, including specific: mental health disorders; e-health modalities; issues and challenges; and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by system, service, technology, provider and patient factors. CONCLUSIONS COVID-19 has accelerated applications of e-mental health. Sustained adoption of e-mental health will require evidence to support the implementation of the required technologies across system and service infrastructure alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care. CLINICALTRIAL N/A