Protocol for a randomized controlled trial of mindfulness-based stress reduction to improve attentional control in older adults (HealthyAgers trial).

BACKGROUND: Mindfulness meditation is a form of mind-body intervention that has increasing scientific support for its ability to reduce age-related declines in cognitive functioning, improve affective health, and strengthen the neural circuitry supporting improved cognitive and affective health. However, the majority of existent studies have been pilot investigations with small sample sizes, limited follow-up data, and a lack of attention to expectancy effects. Here, we present the study design of a Phase I/II, efficacy trial-HealthyAgers trial-that examines the benefits of a manualized mindfulness-based stress reduction program in improving attentional control and reducing mind-wandering in older adults. METHODS: One hundred fifty older adults (ages 65-85 years) will be randomized into one of two groups: an eight-week mindfulness program or an eight-week, placebo-controlled, lifestyle education program. Behavioral and neuroimaging assessments are conducted before and after the training. Participants are then invited to booster sessions once every three months for a period of 12 months with post-intervention follow-up assessments conducted at 6-months and 12-months. The primary outcomes for the study are behavioral measures of attentional control and mind-wandering. Additional, secondary outcomes include network strength in an a priori defined neuromarker of attentional control, fluid and everyday cognition, emotion regulation strategy use, and markers of inflammation. DISCUSSION: This study will establish the efficacy of a group-based, low-cost mind-body intervention for the inter-related facets of attentional control and mind-wandering in older adults. Strengths of this study include a well-designed, placebo-controlled comparison group, use of web/mobile application to track study adherence, and longitudinal follow-up. TRIAL REGISTRATION: Clinicaltrials.gov (# NCT03626532 ). Registered August 4, 2018.

Taking thinking together forward: a scheme linking paediatric and CAMHS trainees

BackgroundThe concept of joining up services and managing young people’s mental health difficulties has never been more paramount. Covid has thrown us all into a world of uncertainty and this is exacerbated for young people with anxiety, underlying medical or psychiatric needs. At a time when linking people up to work and think together is the most needed, of course it is also the most challenging. Mental health presentations are an increasing part of the paediatric caseload and there is growing evidence that paediatric trainees feel ill-equipped to manage these patients. Equally CAMHS trainees reported they required greater access to seeing children under 5, assessing development and physical health. Only 33% of trainees we surveyed felt that their current training programme enabled them to achieve their curriculum requirements in paediatrics or mental health respectively.ObjectivesWe developed the concept of Thinking Together, to tackle this training gap. The scheme involves pairing paediatric and CAMHS trainees to share clinical encounters to foster a joint way of learning and working together, coming together to look at how we can link training to optimise patient care. CAMHS services are increasingly stretched, raising referral thresholds and making the need for closer working together across disciplines paramount.MethodsA pilot was launched in March 2016 where 30 trainees from CAMHS and Paediatrics were paired for a period of 6 months, attending at least two clinical encounters in each setting. Trainees were encouraged to explore a variety of learning possibilities, including clinics, referral meetings and signposting their partner to other relevant clinical opportunities.In 2018 we extended the scheme in a second phase pilot to four centres across the UK. Feedback from participants involved was equally positive but there were logistical challenges. We reflected on feedback from the initial and second phase pilot and adapted the programme in 2019/2020. We aimed to consolidate the scheme in one centre and include workshops, which allowed focus on a topic relevant to both specialties, in addition to a forum for debrief discussions on challenging cases.ResultsPrior to participating in Thinking Together, 70% stated they had no experience of working in a jointly delivered paediatric/mental health clinic. 93% of participants felt that their patients benefitted from access to jointly delivered clinics. Feedback was very positive and identified that the scheme met training gaps for both specialties. Th adapted version of Thinking Together that we rolled out in 2019–2020 was also met with positive feedback and proved to be particularly beneficial during the pandemic, when trainee pairs could still participate in Thinking Together via virtual workshops.ConclusionsCovid has clearly brought challenges to every aspect of our lives but this is a training model that has been able to adapt in this unprecedented time, by means of virtual workshops and the enthusiasm of the participants to continue to pursue learning opportunities, including joining referral meetings remotely. Thinking Together has evolved into a successful model that we would like to embed in everyday practice.

Unprecedented times – unseen effects on child mental health

BackgroundThe unprecedented times of the Covid-19 pandemic have presented a plethora of new challenges for both users and providers of healthcare. A now well-recognised effect of the pandemic is the devastating impact it is having on the mental health of young people. There have been a notable increase in the number of mental health cases presenting to Paediatric Emergency Departments, and this is a problem predicted to persist for the foreseeable future. Caring for these young people in both Emergency Departments and on General Paediatric wards is a challenge.To ensure that healthcare professionals are well-equipped to care for these young people and their families, it is vital that the multidisciplinary team (MDT) receive relevant training, and feel well-supported themselves. The introduction of in-situ simulations with focus on Child and Adolescent Mental Health, has highlighted effective methods for the management of challenging cases. The collaboration with airline pilots in facilitation of the Human Factors debriefs has contributed to creating an open environment for safe learning.ObjectivesTo encourage training focused on child mental health through in-situ simulation during the time of the pandemic.To focus on Human Factors training through involvement of airline pilots.To encourage MDT contribution through creating a ‘safe learning space’ for participants.MethodsThis was a qualitative study. High fidelity in-situ simulations were performed in real clinical environments, with primed actors. Clinical faculty focused on the technical aspects, whilst uniformed airline pilots provided feedback on Human Factors. To encourage participation from all team members, there was significant emphasis on psychological safety throughout. The key learning points were written up and shared with the wider MDT.Scenario examples:Ligature – management of patient collapsed in the toilet with ligature tied around their neck, with a distressed parent present.De-escalation – patient with an overdose threatening to leave the ward prior to Mental Health assessment.Acute psychosis– de-escalation of agitated patient, necessitating an MDT approach, including the involvement of security.ResultsThe simulations encouraged closer analysis of the technical aspects of managing acute presentations of young people with psychiatric presentations. Moreover, they provided a safe training space for staff to reflect on the difficulties faced, with facilitation from airline pilots, and parallel aviation examples. Key Human Factors themes were identified by the pilots, with particular focus on workload management, when dealing with a distressed patient and also an anxious relative. The feedback from these sessions was unanimously positive, with 100% of participants reporting they would like to participate in more.ConclusionsThe creation of a safe learning environment for the management of challenging mental health presentations has been extremely valuable in the training of the MDT. Continued learning in this way is of particular prominence at this time, in light of the increase in presentations as a result of the pressures of the pandemic. It is important for the training needs of staff to be met, and for them feel safe and well-supported at this challenging time.