Engaging Stakeholders to Improve Care for Adults with Complex Health and Social Needs during a Public Health Emergency

A public health emergency such as the COVID-19 pandemic exacerbates the already challenging environment facing adults with complex health and social needs (ACHSN) and the systems of care that support them. Between September 2020 and April 2021, 51 participants representing six different stakeholder groups were engaged using interviews, asynchronous Delphi surveys, and a virtual stakeholder meeting to learn from their perspectives about the greatest needs and possible solutions affecting ACHSN populations during the COVID-19 pandemic and to develop a prioritized research agenda to improve care for ACHSN populations. Mental health and financial concerns were strongly and consistently endorsed as the most important issues. Future research priorities identified included both macro systems research such as testing alternative state-level models of payment for physical and mental health care and research that could be conducted at a local level (such as identifying needs for patient care navigation services and testing models of care navigation).

Facilitator reflections on online delivery of simulation-based mental health education during COVID-19

Purpose: During COVID-19, Maudsley Simulation successfully pivoted to fully online delivery of simulation-based education (SBE) in mental health. In migrating digitally, the simulation faculty experienced a range of new phenomena and challenges. The authors' experiences may be transferable to other specialities and for other educator groups. By sharing the authors' experiences, this study aims to support others adapt to online SBE. Design/methodology/approach: This piece represents the authors' collective reflections on the challenges of adapting their facilitation skills to the online environment. It also offers various suggestions on how to improve the learner experience in view of these challenges. Findings: Beyond merely platform orientation and operating procedure familiarisation, the team gained insights into ensuring optimal learning, engagement and participant experience during online deliveries. Delivery of online SBE brings several potential barriers to psychological safety and these warrant careful consideration by experienced simulationists. Practical implications: Optimising participant engagement and psychological safety remain key considerations despite this novel medium. Facilitators must be willing to adapt accordingly to begin delivering high-quality online SBE. Originality/value: From their experience, facilitators must reframe their debriefing expectations and adjust how they engage participants and manage group dynamics given the inherently different nature of this new learning environment.

Dementia Analytics Research User Group (DARUG) - A Model for meaningful stakeholder engagement in dementia research

BACKGROUND: The importance of involving stakeholders in research is widely recognised but few studies provide details to implementation in practice. The use of real-time technology involving patients, carers and professionals in project design, monitoring, delivery and reporting could maximise contribution. Stakeholder engagement was included as part of a Dementia Analytics Research User Group project which applied machine learning to the Trinity-Ulster-Department of Agriculture (TUDA) data set, identifying clinical and lifestyle factors associated with cognitive health in 5000 community-dwelling older Irish adults.

Enhancing the capacity of the mental health and substance use health workforce to meet population needs: insights from a facilitated virtual policy dialogue.

BACKGROUND: Timely knowledge mobilization has become increasingly critical during the COVID-19 pandemic and complicated by the need to establish or maintain lines of communication between researchers and decision-makers virtually. Our recent pan-Canadian research study on the mental health and substance use health (MHSUH) workforce during the pandemic identified key policy barriers impacting this essential workforce. To bridge the evidence-policy gap in addressing these barriers, we held a facilitated virtual policy dialogue. This paper discusses the insights generated at this virtual policy dialogue and highlights how this integrated knowledge mobilization strategy can help drive evidence-based policy in an increasingly digital world. METHODS: We held a 3-hour virtual policy dialogue with 46 stakeholders and policy decision-makers as the final phase in our year-long mixed-methods research study. The event was part of our integrated knowledge mobilization strategy and was designed to generate stakeholder-driven policy implications and priority actions based on our research findings. The data collected from the virtual policy dialogue included transcripts from the small-group breakout rooms and main sessions, reflective field notes and the final report from the external facilitator. Coded data were thematically analysed to inform our understanding of the prioritization of the policy implications and action items. RESULTS: Facilitated virtual policy dialogues generate rich qualitative insights that guide community-informed knowledge mobilization strategies and promote evidence-informed policy. Our policy dialogue identified actionable policy recommendations with equity as a cross-cutting theme. Adapting policy dialogues to virtual formats and including technology-assisted facilitation can offer advantages for equitable stakeholder participation, allow for deeper analysis and help build consensus regarding evidence-based policy priorities. CONCLUSIONS: Our facilitated virtual policy dialogue was a key knowledge mobilization strategy for our research on the capacity of the Canadian MHSUH workforce to respond to the COVID-19 pandemic. Our policy dialogue allowed us to engage a diverse group of MHSUH workforce stakeholders in a meaningful action-oriented way, provided an avenue to get feedback on our research findings, and generated prioritized action items that incorporated the knowledge and experience of these MHSUH workforce stakeholders.

Digital participatory workshops with patients and health professionals to develop an intervention for the management of polypharmacy: results from a mixed-methods evaluation and methodological conclusions.

BACKGROUND: In the COVID-19 pandemic, numerous researchers postponed their patient and public involvement (PPI) activities. This was mainly due to assumptions on patients' willingness and skills to participate digitally. In fact, digital PPI workshops differ from in-person meetings as some forms of non-verbal cues and body language may be missing and technical barriers may exist. Within our project HYPERION-TransCare we adapted our PPI workshop series for intervention development to a digital format and assessed whether these digital workshops were feasible for patients, health care professionals and researchers. METHODS: We used a digital meeting tool that included communication via audio, video and chat. Discussions were documented simultaneously on a digital white board. Technical support was provided via phone and chat during the workshops and with a technical introduction workshop in advance. The workshop evaluation encompassed observation protocols, participants' feedback via chat after each workshop on their chance to speak and the usability of the digital tools, and telephone interviews on patients' and health professionals' experiences after the end of the workshop series. RESULTS: Observation protocols showed an active role of moderators in verbally encouraging every participant to get involved. Technical challenges occurred, but were in most cases immediately addressed and solved. Participants median rating of their chance to speak and the usability of the digital tool was "very good". In the evaluation interviews participants reported a change of perspective and mutual understanding as a main benefit from the PPI workshops and described the atmosphere as inclusive and on equal footing. Benefits of the digital format such as overcoming geographical distance, saving time and combining workshop participation with professional or childcare obligations were reported. Technical support was stressed as a pre-condition for getting actively involved in digital PPI. CONCLUSIONS: Digital formats using different didactic and documentation techniques, accompanied by technical support, can foster active patient and public involvement. The advantages of digital PPI formats such as geographical flexibility and saving time for participants as well as the opportunity to prepare and hold workshops in geographically stretched research teams persists beyond the pandemic and may in some cases outweigh the advantages of in-person communication.

Digital patient and public involvement (PPI) activities differ from in-person meetings. For example, some forms of non-verbal cues and body language are limited and technical barriers may exist. Therefore, some research teams were hesitant to switch to a digital PPI format during the COVID-19 pandemic and postponed their PPI activities.In this paper, we aim to describe, how we adapted a PPI workshop series to a digital format, how patients and health care professionals experienced these digital workshops, and which conclusions we have drawn for future digital PPI activities. The workshop evaluation encompassed workshop observation protocols, participants' feedback via chat on their chance to speak and the feasibility of the digital tools, and telephone interviews on participants' experiences.The study results showed that moderators had an active role in verbally encouraging every participant to get involved. Technical challenges occurred, but were in most cases immediately addressed and solved. Most participants rated their chance to speak and the feasibility of the digital format as "very good". They described the atmosphere as inclusive and on equal footing without hierarchy between different stakeholder groups. Participants reported benefits of the digital format such as overcoming geographical distance, saving time and combining workshop participation with professional or childcare obligations. They stressed technical support as a condition for getting actively involved in digital PPI.We conclude that some advantages of digital PPI may persist beyond the pandemic. Therefore, we encourage research teams to discuss the question of digital or in-person PPI with the involved patients and health professionals and decide on a case-by-case basis.

Social Work After Tehan: Reframing the Scope of Practice

This article describes the recent changes to Australian higher education funding in relation to social work education and practice in order to analyse the frames that situate their implementation. It documents various stakeholder responses to the proposed changes, demonstrating ways in which social work's scope of practice is susceptible to reframing by external forces. The analysis of stakeholder framings of social work in the unfolding chronology illustrates this vulnerability, identifying the alliances and compromises that underpinned the efforts to mitigate impacts of the proposed changes. This analysis reveals the need for social work to articulate its unique role across both sector and disciplinary boundaries, as both an academic discipline and a practice-based profession. IMPLICATIONS Recent changes to funding Australian higher education challenged the viability of social work education, with significant fee increases and reductions in Commonwealth contribution proposed. Advocacy in defence of social work education reframing social work as a branch of allied health succeeded, but no certainty regarding future funding arrangements for social work education was achieved. While the alliance with health did offer a protective frame for social work education funding, this was achieved at the cost of broader alliances within the human services sector.

Participatory Approach to Wetland Governance: The Case of The Memorandum of Understanding of the Sečovlje Salina Nature Park

Wetlands are defined as dynamic ecosystems that combine the characteristics of aquatic and terrestrial ecosystems and are important from ecological as well as social and economic perspectives. In response to the intense degradation and alteration of wetlands, communities have developed various management strategies. One of the ways to achieve more effective participatory wetland management is to introduce the concept of a Wetland Contract, a voluntary agreement that ensures sustainable management and development of wetlands. This study on the Sečovlje Salina Nature Park in Slovenia follows the methodology of the preparation (legal framework, scientific description and stakeholder analysis) and implementation (organization of Territorial Labs, scenario planning and development) stages of the Wetland Contract concept. Of approximately 200 potential stakeholders, 34 participated in the Territorial Labs, and 16 stakeholders signed the less binding type of Wetland Contract, called the Memorandum of Understanding. The Memorandum of Understanding and its implementation process, which included systematic cross-sectoral participation, successfully overcame conflicts between stakeholders with different interests. The methodology used has shown great potential for further applications in wetlands of common interest.

Using the PEPPA framework to develop the nurse practitioner role in emergency care: Critical reflections

In this article, we describe and critically reflect on how the PEPPA framework, a Participatory Evidence-based Patient-focused Process for Advanced Practice Nursing, was used to develop a new model of care including the nurse practitioner (NP) role in an emergency department in Norway, where the role is in its infancy. While there is limited earlier research on the applicability of the PEPPA framework, it was here found to be useful. Supported by the framework, we mapped the current model of care, identified stakeholders and participants, determined the need for a new model of care, identified priority problems and goals, and defined the new model of care and the NP role. The PEPPA framework is recommended to develop new models of care including the NP role. Nonetheless, the process has not been straightforward. It is noted that to communicate and establish the new role in a setting as demanding as an emergency department takes time. Support from the management team is essential to succeed in developing and establishing new models of care and new nursing roles, such as the nurse practitioner role.

Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy.

BACKGROUND: Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users' needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care. OBJECTIVE: Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms. METHODS: Participating health care organizations included the following: Open Arms-Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation's National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention. RESULTS: Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted. CONCLUSIONS: Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care.

Discussing around a virtual fire: Citizen engagement in a shared Decision-Making conference.

An online conference was organized to promote the Interprofessional Shared Decision-Making model and maximize its dissemination among stakeholders (citizens, health care providers, administrative staffs, policy makers, academics) in Canada. The goal was to enhance knowledge of and engagement in shared decision-making in a patient-oriented research, since shared decision-making has been hampered by reduced face-to-face contact, fear of infection, and overworked health professionals due to the COVID-19 pandemic. Therefore, we share a summary of what has been done to engage citizens in shared decision-making and to inform the interprofessional community about active citizen engagement in an online conference.

From sandbox to pandemic: Agile reform of Canadian drug regulation.

Public health urgency for emerging COVID-19 treatments and vaccines challenges regulators worldwide to ensure safety and efficacy while expediting approval. In Canada, legislative amendments by 2019 Omnibus Bill C-97 created a new "agile" licensing framework known as the "Advanced Therapeutic Pathway" (ATPathway) and modernized the regulation of clinical trials of drugs, vaccines, and medical devices. Bill C-97's amendments are worthy of attention in Canada and globally, as health product regulation bends to COVID-19. The amendments follow reforms elsewhere to accommodate health product innovation, however, the Canadian ATPathway is broader and more flexible than its counterparts in other jurisdictions. In addition, Bill C-97 informed Canada's COVID-19 response in important ways, particularly in relation to clinical trials. The measures adopted by the drug regulatory authority, Health Canada (HC) during COVID-19 may become the new norm in Canadian regulatory practice insofar as they help achieve the amendments introduced by Bill C-97. Finally, despite government rhetoric of transparency, the agenda-setting, formulation, and implementation of the amendments have occurred with little opportunity for scrutiny or public engagement.