The role of multisystemic resilience in fostering critical agency: UK adolescents during the COVID-19 Pandemic.

Critical agency (CA) refers to an individual's feeling of power in relation to social inequalities. Research has demonstrated that high CA is associated with positive adolescent outcomes, however, less is known about what supports are important for its development. Moreover, a large majority of the literature is based on studies from the US and various countries in Africa; although the UK is saturated with inequalities there is little research within a UK context. In this paper we examine (a) the validity of using an existing measure of CA with a sample of UK adolescents and (b) the extent to which resilience supports account for variance in CA. Our analysis identified two distinct factors of CA: justice-oriented and community-oriented. High CA in both factors was explained by resilience supports associated with peer relationships (p < 0.01). Our findings push us towards new relational, ecological ways of understanding adolescent CA. We close by instantiating a translational framework for those devising policies in support of youth resilience and CA. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-023-04578-1.

Patient Satisfaction With Medical and Social Concerns Addressed During Telemedicine Visits.

Purpose The use of telemedicine dramatically increased during the COVID-19 pandemic. Assessing patient satisfaction with this mode of healthcare delivery is an important metric of success as it is broadly implemented across various settings. Of additional importance are the ways social determinants of health impact health outcomes, with the first step in determining the scale of this impact being the identification of contributing factors. This study assesses patient satisfaction with the medical and social aspects of the care they receive via telemedicine at a university-affiliated primary care training clinic in Detroit, Michigan. Methods A survey was designed to assess patient satisfaction with the technical aspects of the visit, the visit itself, and with the social determinants screening tool used. During July 2020, 167 patients who had at least one telemedicine visit with a primary care physician from the clinic in the preceding months were contacted to assess their impression of the service provided. The responses were used to evaluate patient satisfaction with the comprehensive care provided via the telemedicine visit. Results Of the 167 patients contacted, 79 (47%) completed the survey. Respondents' age ranged from 18-74 years, with 66% identifying as female and 34% as male. For many, this was their first experience with telemedicine. The vast majority expressed comfort in sharing details about their health concerns via telemedicine, with only 3% reporting they were "uncomfortable." More than half of the patients (60%) felt some level of comfort with telemedicine after their first encounter; 14% stated that they were still uncomfortable, and 26% were neutral. Most of the patients (88%) asserted their willingness to participate in future telemedicine visits. Just under two-thirds (63%) of participants "strongly agreed" that concerns related to their social determinants of health were addressed, and 59% "strongly agreed" that the resources provided by their physician were helpful.  Conclusion This survey evaluates multiple dimensions of patient satisfaction with their physician using technology to deliver a telemedicine visit instead of an in-office visit. Telemedicine was well received, with high satisfaction for addressing medical and social concerns. The results of this study support the use of telemedicine to assess social determinants of health in an underserved minoritized patient population and will help physicians optimize future interactions with patients through telemedicine.

The inhibitors and enablers of emerging adult COVID-19 mitigation compliance in a township context

Young adults are often scapegoated for not complying with COVID-19 mitigation strategies. While studies have investigated what predicts this population's compliance and non-compliance, they have largely excluded the insights of African young people living in South African townships. Given this, it is unclear what places young adult South African township dwellers at risk for not complying with physical distancing, face masking and handwashing, or what enables resilience to those risks. To remedy this uncertainty, the current article reports a secondary analysis of transcripts (n=119) that document telephonic interviews in June and October 2020 with 24 emerging adults (average age: 20 years) who participated in the Resilient Youth in Stressed Environments (RYSE) study. The secondary analysis, which was inductively thematic, pointed to compliance being threatened by forgetfulness;preventive measures conflicting with personal/collective style;and structural constraints. Resilience to these compliance risks lay in young people's capacity to regulate their behaviour and in the immediate social ecology's capacity to co-regulate young people's health behaviours. These findings discourage health interventions that are focused on the individual. More optimal public health initiatives will be responsive to the risks and resilience-enablers associated with young people and the social, institutional, and physical ecologies to which young people are connected.

Child protective services during COVID-19 and doubly marginalized children: International perspectives.

BACKGROUND: Alongside deficits in children's wellbeing, the COVID-19 pandemic has created an elevated risk for child maltreatment and challenges for child protective services worldwide. Therefore, some children might be doubly marginalized, as prior inequalities become exacerbated and new risk factors arise. OBJECTIVE: To provide initial insight into international researchers' identification of children who might have been overlooked or excluded from services during the pandemic. PARTICIPANTS AND SETTING: This study was part of an international collaboration involving researchers from Brazil, Canada, Colombia, Israel, South Africa, Uganda, the UK and the USA. Researchers from each country provided a written narrative in response to the three research questions in focus, which integrated the available data from their countries. METHOD: Three main questions were explored: 1) Who are the children that were doubly marginalized? 2) What possible mechanisms may be at the root? and 3) In what ways were children doubly marginalized? The international scholars provided information regarding the three questions. A thematic analysis was employed using the intersectional theoretical framework to highlight the impact of children's various identities. RESULTS: The analysis yielded three domains: (1) five categories of doubly marginalized children at increased risk of maltreatment, (2) mechanisms of neglect consisting of unplanned, discriminatory and inadequate actions, and (3) children were doubly marginalized through exclusion in policy and practice and the challenges faced by belonging to vulnerable groups. CONCLUSION: The COVID-19 pandemic can be used as a case study to illustrate the protection of children from maltreatment during worldwide crises. Findings generated the understanding that child protective systems worldwide must adhere to an intersectionality framework to protect all children and promote quality child protection services.

Resilience to COVID-19-related stressors: Insights from emerging adults in a South African township.

There is widespread recognition that stressors related to Coronavirus Disease 2019 (COVID-19) jeopardize the development of emerging adults, more particularly those living in disadvantaged communities. What is less well understood is what might support emerging adult resilience to COVID-19-related stressors. In response, this article reports a 5-week qualitative study with 24 emerging adults (average age: 20) living in a South African township. Using digital diaries and repeated individual interviews, young people shared their lived experiences of later (i.e., month 4 and 7) lockdown-related challenges (i.e., contagion fears; livelihood threats; lives-on-hold) and how they managed these challenges. An inductive thematic analysis showed that personal and collective compliance, generous ways-of-being, and tolerance-facilitators enabled emerging adult resilience to said challenges. Importantly, these resilience-enablers drew on resources associated with multiple systems and reflected the situational and cultural context of the township in question. In short, supporting emerging adult resilience to COVID-19-related stressors will require contextually aligned, multisystemic responses.

Delivering interprofessional patient safety education using storytelling, a real-life medication error, and synchronous online platform.

INTRODUCTION: Interprofessional education (IPE) about patient safety positively impacts safety and reduces errors but is challenging to deliver. We aimed to determine if a synchronous virtual IPE program using storytelling and interactive learning impacted student perceptions about patient safety. METHODS: An IPE patient safety program involving medical and pharmacy students was synchronously delivered virtually due to the COVID-19 pandemic. The program was framed using storytelling about a medication error told by a family member. Post-program survey data, exploring participants' perspectives on the program, collected between July 2020 and November 2020 was retrospectively reviewed. Quantitative results were grouped by the five components of the program. Responses within each category were averaged to generate a summary measure of each student's experience. Qualitative feedback from two survey questions was evaluated. RESULTS: There were 236 (96.7% of participants) completed surveys included in the analysis. High proportions of participants responded favorably across all five components of the survey. Qualitative responses were largely positive, with themes of increased empathy, behavior, and attitude change, and meaning making. CONCLUSION: An interactive IPE patient safety program using storytelling about a real-life medication error to frame activities and utilizing a virtual platform was a favorable and impactful method to educate students.

Teaching Telemedicine in the COVID-19 Era: a National Survey of Internal Medicine Clerkship Directors.

BACKGROUND: Prior to the COVID-19 pandemic, telemedicine (TM) experiences in undergraduate medical education were uncommon. When students' clinical experiences were interrupted due to the pandemic, TM education provided opportunities for students to participate in clinical care while adhering to social distancing guidelines. OBJECTIVE: To assess the prevalence of TM experiences in the internal medicine (IM) core clerkship experience prior to the COVID-19 pandemic, during interruption in clinical clerkships, and following the return to in-person activities at US medical schools. DESIGN: The Clerkship Directors in Internal Medicine (CDIM) survey is a national, annually recurring thematic survey of IM core clerkship directors. The 2020 survey focused on effects of the COVID-19 pandemic, including a section about TM. The survey was fielded online from August through October 2020. PARTICIPANTS: A total of 137 core clinical medicine clerkship directors at Liaison Committee on Medical Education fully accredited US/US territory-based medical schools. MAIN MEASURES: A 10-item thematic survey section assessing student participation in TM and assessment of TM-related competencies. KEY RESULTS: The response rate was 73.7% (101/137 medical schools). No respondents reported TM curricular experiences prior to the pandemic. During clinical interruption, 39.3% of respondents reported TM experiences in the IM clerkship, whereas 24.7% reported such experiences occurring at the time they completed the survey. A higher percentage of clerkships with an ambulatory component reported TM to be an important competency compared to those without an ambulatory component. CONCLUSIONS: The extent to which TM was used in the IM clinical clerkship, and across clinical clerkships, increased substantially when medical students were removed from in-person clinical duties as a response to COVID-19. When students returned to in-person clinical duties, experiences in TM continued, suggesting the continued value of TM as part of the formal education of students during the medicine clerkship. Curricula and faculty development will be needed to support TM education.

Instagram as a Window to Societal Perspective on Mental Health, Gender, and Race: Observational Pilot Study.

BACKGROUND: Gender and race are known to impact attitudes toward mental health topics and help-seeking behavior. Men and minorities are more likely to cite stigma as a reason for not seeking help for mental health concerns, which is of particular relevance given the high rate of suicide in men and challenges of historic proportion currently facing minority communities. Instagram provides a platform to discuss mental health, though a lack of male and minority representation may further alienate these populations. OBJECTIVE: We aimed to investigate whether men and nonwhite individuals are underrepresented in Instagram photos tagged with #mentalhealth (compared to photos tagged with #health) to better understand how gender and race-based representations are manifested on this popular social media platform and discuss the implications. METHODS: Three investigators of different genders and racial backgrounds met on nine different days via teleconference to analyze a total of 215 publicly available Instagram photos tagged with #mentalhealth and 215 with #health. These photos were generated using Instagram's search function, and search results were sorted by most recently published at the time of data collection. For each photo, the three investigators recorded their observations about the gender (male versus female) and race (white versus nonwhite versus racially unclassifiable) of subjects featured in the photo, which they did not discuss with other investigators. Chi-squared analysis was performed on each investigator's data set to compare the frequency of male versus female and white versus nonwhite subjects identified in each hashtag category. Kappa interrater agreement was calculated for each investigator pair, category (gender or race), and hashtag. RESULTS: All three investigators observed significantly more female as compared to male subjects in photos tagged with #mentalhealth (X2=14.4, P<.001 for all investigators) while observing no significant difference between numbers of male and female subjects in photos tagged with #health (X2=1.533, P=.22; X2=1.241, P=.27; X2=0.096, P=.76). All three investigators identified significantly more white than nonwhite subjects in photos tagged with both #health and #mentalhealth (X2 values range from 11.912 to 98.927, P<.001 for all). Kappa interrater agreement revealed almost perfect agreement for gender (kappa=0.908-0.992) with the agreement for race ranging from 0.614 to 0.822, depending on hashtag and rater pair. CONCLUSIONS: Women are featured more frequently than men in Instagram photos tagged with #mentalhealth. The topic of #health, meanwhile, is not gendered this way. Low visibility of mental health among men may both represent and exacerbate existing stigma and barriers to care. White subjects are featured significantly more frequently than nonwhite subjects in photos tagged with both #mentalhealth and #health. Directed interventions using the Instagram platform may be indicated to increase the visibility of underrepresented groups and break the cycle of stigma.

Understanding the Impact of COVID-19 on Physician Moms.

OBJECTIVE: This study evaluates the personal and professional experiences of physician mothers during the coronavirus disease 2019 (COVID-19) pandemic and the impact of the pandemic on the lives of physician mothers. METHODS: Using social media to reach a broad range of physicians, a convenience sample of physician mothers completed an on-line survey posted between April 27 and May 11. Members were encouraged to repost on social media and share with personal contacts resulting in a passive snowball sampling effect. RESULTS: A total of 2709 physician mothers from 48 states, Puerto Rico, and 19 countries representing more than 25 medical specialties completed the survey. Most were between 30 and 39 y of age, 67% self-identified as white, 17% as Asian, 4% as African American. Most had been working for 11-16 y. A total of 91% had a spouse/partner of the opposite sex. Over half were practicing in an area they identified as high COVID-19 density, while 50% had personally cared for a person with COVID-19. Physician mothers were most concerned about exposing their children to COVID-19 and about the morale and safety of their staff. CONCLUSIONS: This is one of the first studies to explore the personal and professional challenges facing physician mothers during a pandemic. Physician mothers were most concerned about exposing their families to COVID-19. Mothers continued to work and at times increased their work, despite having domestic, childcare, and schooling responsibilities.

Child maltreatment in the time of the COVID-19 pandemic: A proposed global framework on research, policy and practice.

BACKGROUND: Child protection is and will be drastically impacted by the COVID-19 pandemic. Comprehending this new reality and identifying research, practice and policy paths are urgent needs. OBJECTIVE: The current paper aims to suggest a framework for risk and protective factors that need to be considered in child protection in its various domains of research, policy, and practice during and after the COVID-19 pandemic. STRATEGY: From an international collaboration involving researchers and child protection professionals from eight countries, the current paper examines various factors that were identified as playing an important role in the child protection system. THE INITIAL SUGGESTED FRAMEWORK: Through the use of an ecological framework, the current paper points to risk and protective factors that need further exploration. Key conclusions point to the urgent need to address the protection of children in this time of a worldwide pandemic. Discussion of risk and protective factors is significantly influenced by the societal context of various countries, which emphasizes the importance of international collaboration in protecting children, especially in the time of a worldwide pandemic. CONCLUSION: The COVID-19 pandemic has stressed the urgent need to advance both theory and practice in order to ensure children's rights to safety and security during any pandemic. The suggested framework has the potential to advance these efforts so that children will be better protected from maltreatment amidst a pandemic in the future.

'When will I be free': Lessons from COVID-19 for Child Protection in South Africa.

BACKGROUND: COVID-19 has highlighted and amplified structural inequalities; drawing attention to issues of racism, poverty, xenophobia as well as arguably ineffective government policies and procedures. In South Africa, the pandemic and the resultant national lockdown have highlighted the shortcomings in the protection and care of children. Children in alternative care are particularly at risk as a result of disrupted and uncoordinated service delivery. OBJECTIVE: The aim of this study was to explore the experiences and impact of the pandemic and the resulting social isolation on the wellbeing and protection of children living in a residential care facility. METHODS AND PARTICIPANTS: We used qualitative, participatory approaches - specifically draw-and-write methods - to engage with 32 children (average age = 13.5 years) living in a residential care facility in Gauteng. FINDINGS: Children in care demonstrated an awareness of the socio-economic difficulties facing communities in South Africa, and shared deep concerns about the safety, well-being and welfare of parents and siblings. Although they expressed frustration at the lack of contact with family members, they acknowledged the resources they had access to in a residential care facility, which enabled them to cope and which ensured their safety. DISCUSSION AND CONCLUSION: We focus our discussion on the necessity of a systemic response to child welfare, including a coordinated approach by policy makers, government departments and child welfare systems to address the structural factors at the root of inequality and inadequate, unacceptable care. This response is essential not only during COVID-19 but also in pre- and post-pandemic context.

Child safety, protection, and safeguarding in the time of COVID-19 in Great Britain: Proposing a conceptual framework.

BACKGROUND: Great Britain has the highest coronavirus death rate in Europe. While the pandemic clearly poses a risk to the lives and wellbeing of vulnerable groups, necessary public health measures taken to delay or limit the spread of the virus have led to distinctive challenges for prevention, family support, court processes, placement and alternative care. The pandemic has also come about at a time when statutory changes to partnerships have led to a reduction in the importance of educational professional representation in the new formulation in England and Wales. OBJECTIVES: In this discussion paper, we propose a novel and pragmatic conceptual framework during this challenging time. PARTICIPANTS: We consulted with 8 education professionals and 4 field-based student social workers. SETTING: Bodies responsible for safeguarding have been working quickly to develop new approaches to fulfilling their responsibilities, for example through online home visits and case conferences. However, some communities have been highlighted as experiencing particular challenges because of the pandemic and its impacts. Protection of vulnerable children is increasingly dependent on individualised - and often pathologising - practice with a lack of emphasis on the importance of the social. Holistic consideration of the child is side-lined. RESULTS: Our framework comprises two phases: pandemic and aspirational. CONCLUSION: The framework illuminates the importance of interconnected sectors and multi-agency working, the need for resilient and adaptable support systems, and the need to promote the importance of children's rights and voices to be heard above the noise of the pandemic.

Engaging Third-Year Medical Students on Their Internal Medicine Clerkship in Telehealth During COVID-19.

PURPOSE: Due to the coronavirus disease-19 (COVID-19) global pandemic, the Association of American Medical Colleges (AAMC) recommended that medical students be removed from contact with patients testing positive or patients under suspicion (PUIs) for COVID-19. As a result of Detroit being a highly affected area, the Wayne State University (WSU) medical students assigned to hospital clerkships during this time were essentially prevented from performing any direct patient care activities. A model for the Internal Medicine (IM) clerkship was developed incorporating a clinical telehealth component, in order to create a safe environment for students to continue to perform meaningful patient care. OBJECTIVES: To model a curriculum whereby students have a diverse patient care experience while increasing their skill and confidence in the performance of telehealth, as measured by self-report in a required pre- and post-clerkship assessment. Participant population: Twenty, third-year medical students at the end of their academic year, assigned to the IM clerkship at the Detroit Medical Center. METHODS: Students were instructed to complete the American College of Physicians (ACP) module on telehealth, given an orientation via the Zoom online platform by clinical faculty, and placed on a weekly telehealth clinic schedule, precepted by residents and attendings in IM. Survey data was collected covering students' knowledge, skills, and attitudes surrounding telehealth at the beginning of the rotation. A mid-clerkship feedback session was held with the clerkship director, and the resultant qualitative data was assessed for themes to be compared against the baseline assessment. Determination of incremental change between pre- and post-assessment reports will be evaluated at the completion of the clerkship, with that data forthcoming. RESULTS: Baseline survey revealed that 90% of students believed the telemedicine experience would be a valuable addition to their IM clerkship. Most were confident that, with training, they could effectively complete a telemedicine visit and 80% felt that telehealth would play an important role in their future careers. Students were pleased with the telemedicine visit logistics and with their role in actively assisting patients with the Zoom online platform. Despite initial anxiety over effectively communicating with patients prior to beginning the telemedicine experience, students demonstrated a common trend towards comfort with that aspect of the visit. Students were impressed with the amount of guidance given by resident and attending physicians in expressing empathy via a virtual platform. Overall, students were pleased with the variety of cases seen and the prompt feedback they received from resident and attending physicians after the telemedicine encounters. At the midpoint assessment, students expressed satisfaction with the overall experience and appreciated the opportunity to continue interacting with patients despite the limitations the pandemic imposed. CONCLUSIONS: Little is formally taught about telehealth in either medical school or medical residency, and integration into a formal curriculum is rare. The AAMC is underway with the development of competencies for telehealth, and, once released, the teaching of this format will become an expectation. We successfully developed a robust model in which medical students not only actively participated in, but also actively delivered, telehealth care to our patients.