Using implementation science in youth mental health workforce development: Adapting to the COVID-19 pandemic in Australia

Aims: Globally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organization with a mission to reduce the impact of mental ill-health on young people, families and society, and one of only a few known research and clinical centres with a dedicated Knowledge Translation division. This paper provides a case study of the workforce development team within Orygen Knowledge Translation, outlining how implementation science informs their work and how the division has adapted its model of service support in the face of COVID-19. Method(s): Process data on training and resources developed and delivered by the workforce development team at Orygen over the period 2017-2021 was collated and synthesized with team reflections about the adaptations made by team in response to the COVID-19 pandemic. Results and Conclusion(s): Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. The COVID-19 pandemic facilitated profound and rapid changes to service delivery and development in Australian youth mental health. Implementation science offers flexible models to support a changing system.

COVID-19-related consultation-liaison (CL) mental health services in general hospitals: Results of an international survey

Aims: The COVID-19 pandemic presented new difficulties for integrated healthcare worldwide. Our study aims to highlight developing needs for cooperation while describing structures and practices of consultation liaison (CL) services established during pandemic across Europe. Method(s): The cross-sectional survey used an ONLINE self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies cooperating in EAPM, and heads of CL services from June to October 2021 Results: 259 hospital CL services took part in the study (28.0% response rate). 222 (85.7%) of these services reported providing COVID-19-related mental health care (COVIDpsyCare). Among them, 192 services (86.5%) reported the development of specialized COVID-psyCare co-operation arrangements. 135 services (50.8%) provided specific COVID-psyCare for patients, 85 (38.2%) for relatives, and 171 (77.0%) for staff, with 56.3%, 14.6%, and 23.7% of time resources invested for these groups, respectively. Interventions for hospital staff, commonly related to the liaison function of CL services, were rated as being the most helpful. Regarding newly emerging demands, 129 (58.1%) CL services stated a need for communication and support among themselves concerning COVID-psyCare, and 142 (64.0%) suggested certain adjustments or enhancements that they thought were crucial for the future. Conclusion(s): Specific structure to provide COVID mental health care for patients, their relatives, or staff were implemented in over 80% of the participating CL services. Resources were primarily allocated for patient care, and staff assistance was mostly achieved through the implementation of specialized interventions. COVID psyCare's development calls for further intra- and interinstitutional cooperation.Copyright © 2023

Young people with complex emerging mental health problems: Packages of care and peri-pandemic experiences

The PRODIGY trial found that for young people with complex emerging mental health problems in the UK (N = 270), Social Recovery Therapy did not confer additional benefits above and beyond treatment as usual. Treatment as usual in the trial was, however, surprisingly comprehensive. A study was conducted to evaluate the provision of 'packages' of standard youth mental health care, and the association of provision with trial outcomes. In a subsequent study individuals who participated in the PRODIGY trial (N = 13) were interviewed about their experiences during the COVID-19 pandemic. The restrictions imposed by the COVID-19 pandemic have had significant and wide-ranging impacts on young people due to social isolation, disruption to education and employment opportunities, and young people with pre-existing mental health difficulties were considered to have been disproportionality affected. The results of this study indicated a reciprocal relationship between participants' mental health and their response to the pandemic. Participants told stories of both how the pandemic exacerbated their difficulties, but equally told stories of how their long-standing experiences of managing adversity supported them to cope during pandemic-related social restrictions.

Connection, desperation and disillusionment: Exploring student wellbeing at a university in South Africa during the COVID-19 pandemic

University students' mental health and wellbeing has been a global public health issue of increasing concern in recent years, with a growing body of empirical evidence suggesting university students are a 'very high-risk population' for mental disorders and psychological distress. Pre-existing mental health challenges among university students have consequently been compounded by the global COVID-19 pandemic. A sample of 20 students registered in the education faculty at a large urban university in South Africa participated in a Photovoice study. The research required them to capture three photos or images of their experiences of wellbeing during the pandemic. The findings showed that students experienced mental health concerns and disillusionment with higher education. Their wellbeing was associated with a sense of connection with themselves, their peers and the campus space, and the cultivation of resilience.

Everybody hurts - What can physical health professionals learn about how mental health professionals support their own emotional resilience and mental health?

The physical aspects of ultrasonography, difficult posture with prolonged pressure exertion, have been extensively researched and addressed with advances in machine ergonomics, operator awareness of posture and positioning and workplace tools to identify musculoskeletal problems. The mental stresses are less well recognized and have only recently started getting investigated. Ultrasonography is a mentally challenging activity requiring long periods of intense concentration, empathy and communication of complex and often difficult information to patients and clinicians, all of which carries an emotional toll. Practitioners are also under increasing time and caseload pressures exacerbated by COVID recovery and chronic fatigue from two years of pandemic. A survey of UK obstetric sonographers showed 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively).1 While many Trusts provide training to support physical health, few radiology departments educate their staff on emotional resilience or offer regular support to either promote or maintain mental wellbeing. Training, when available, is often focused on the receiver and not on the impact of vicarious traumas experienced as a result of repeatedly discovering/delivering difficult outcomes to patients on a regular and prolonged basis. Few health professionals are face-to-face with their patient at point of significant discovery whether that information is imparted to the patient or not. Mental health professionals have adopted a traumainformed stance into their working practices. This has not only informed the direct clinical work with patients but is also evident in the way the workforce is supported by the trust. Regular supervision, reflective practice and debriefs are required and monitored by the trust, based on research in clinical psychology to inform best practice. Some of these practices could be applied to physical health professionals to address some of the emotional burdens experienced as part of day-to-day delivery of care.

User centred design of Orygen virtual worlds: The next generation of telehealth for youth mental health care

Background: Rapid uptake of telehealth during the COVID-19 pandemic has opened a gateway to improving access to mental health care. However, existing platforms are not fit-for-purpose, resulting in poor treatment engagement. Virtual worlds (VW) are an innovative technology whereby users can meet and interact in real time using personally tailored avatars within 3D virtual environments. VWs may improve engagement and access to youth mental health care by offering a fun and interactive social space, with customizable features capable of supporting delivery of psychosocial treatment. The aim of this study was to develop a purpose-built VW designed to support delivery of youth mental health care. Method(s): A user centred design framework was employed to develop a prototype of Orygen Virtual Worlds (OVW) across 8 sessions with 8 young people with lived experience. Sessions progressed from basic concept validation, through to persona and journey mapping, and finishing with several user testing sessions to iteratively develop the prototype. Result(s): End users (young people) were overall very positive about the potential for VWs to supplement youth mental health services. Iterative feedback and testing identified core features needed to ensure the platform was usable, safe and capable of delivering effective individual, group and peer interventions. Conclusion(s): This presentation will showcase the development of this innovative new platform for delivering engaging, accessible and effective youth mental health care for hard-to-reach youth. Results will be discussed in context of the unique development approach informed by user centred design principles and implementation science.

Global Mental Health: Where We Are and Where We Are Going.

PURPOSE OF REVIEW: To summarize recent findings in global mental health along several domains including socioeconomic determinants, inequities, funding, and inclusion in global mental health research and practice. RECENT FINDINGS: Mental illness continues to disproportionately impact vulnerable populations and treatment coverage continues to be low globally. Advances in integrating mental health care and adopting task-shifting are accompanied by implementation challenges. The mental health impact of recent global events such as the COVID-19 pandemic, geo-political events, and environmental change is likely to persist and require coordinated care approaches for those in need of psychosocial support. Inequities also exist in funding for global mental health and there has been gradual progress in terms of building local capacity for mental health care programs and research. Lastly, there is an increasing effort to include people with lived experiences of mental health in research and policy shaping efforts. The field of global mental health will likely continue to be informed by evidence and perspectives originating increasingly from low- and middle-income countries along with ongoing global events and centering of relevant stakeholders.

Involuntary psychiatric treatment during the COVID-19 pandemic. An international qualitative study.

Background: During the COVID-19 pandemic, studies report that in the first few months of the lockdown there was a decrease in requests for mandatory psychiatric treatment, while, in contrast, following the second wave, the number of cases increased. This study investigates the use of compulsory psychiatric treatments internationally in the first and subsequent phases of the pandemic. Methods: Sixteen key people were interviewed: eight mental health care professionals and eight scholars in Italy, Greece, China and Chile. Participants were asked to discuss their experience of the motivations, diagnoses and management of patients undergoing an involuntary psychiatric hospitalization. Results: The analysis through Grounded Theory highlighted four themes: (a) the culture of psychiatric care services, (b) the effect of the pandemic on involuntary hospitalizations, (c) exceptional management of hospitalization, and (d) policies and suggestions for more inclusive mental health treatments. Conclusion: During the first wave, respondents reported a decrease in the use of involuntary treatments, while a gradual increase was seen in the following months. Italy extended compulsory psychiatric treatment to a group of new users, including young people and adolescents with acute crises; in other contexts, the main users are chronic psychiatric patients.

ADDRESSING THE PROBLEM

Schools should focus on the following key areas: 1 Mental health staff Staffing schools with mental health specialists, including psychologists and licensed independent clinical social workers, will be helpful. Increased training is also important for school-based health center staff who have access to consultative support from mental health professionals. 2Telehealth The COVID-19 pandemic hastened the expansion of telehealth services, particularly in the area of mental health. Pediatricians should ask families whether any changes in behaviors or development should be supported by services outside of school. 4 Cross-sector partnerships The United Health Foundation is supporting an innovative partnership at Children's National Hospital in Washington, DC, between a pediatric primary care medical home, pediatric mobile medical services, schools, early childhood development centers, and other community organizations.7 School absenteeism can be an early markerfor children's untreated medical and behavioral issues as well as family stressors.

A final review: How are our children doing right now?

In caring for our pediatric patients, we will continue to live with the fact that the disruptions have not been uniformly felt, with increased impact on Black and Brown children and those living in poverty;additionally, levels of access to routine pediatric health services have varied throughout the pandemic.1 For all children, though, we have to make up much lost time when it comes to physical, mental, and academic concerns, as well as socialization issues. Because schools provide another resource for identifying and addressing mental health concerns, the complete or partial shift to virtual learning likely compounded the mental health crisis. According to one study, "the prevalence of depression and anxiety symptoms during the COVID-19 pandemic has doubled, compared with prepan-demic estimates. Early childhood: A profound degree of development takes place from birth to 5 years of life. Because of the pandemic, children 5 years and younger have spent all or a significant portion of their lives in social isolation alongside parents or caregivers.

How pediatricians can help mitigate the mental health crisis

Just as traumatic or stressful events and experiences can increase the risk, strong and supportive relationships and institutions can offset or mitigate that risk. [...]if mental health conditions do develop, early and ongoing recognition and treatment can decrease associated morbidity.2 4 The 2019-2020 National Survey of Children's Health showed that 23% of children aged 3 to 17 years have a reported mental, emotional, developmental, or behavioral (MEDB) problem, with prevalence unevenly distributed by geographic area and social determinants of health: Beginning in April 2020, the proportion of mental health-related visits in pediatric emergency departments increased significantly for both children and adolescents.8 A 2021 report from the Child Mind Institute, "The Impact of the COVID-19 Pandemic on Children's Mental Health: What We Know So Far," highlights the disproportionate negative impact on vulnerable children: those with preexisting mental health problems, especially those with limited access to treatment, racial minorities experiencing racism in the health care system and beyond, LGBTQ+ children, and families living with economic uncertainty or food insecurity.4 Skill-building resources To mitigate the level of need that has created the current crisis, it is particularly important that emerging mental health symptoms be recognized and addressed early within the pediatric medical home before they escalate to the level of crisis. [...]the AAP has developed a mental health toolkit for pediatricians that includes materials, real- world cases, tools for screening, video examples of skills, and an algorithm serving as a cognitive map for how to approach mental health concerns in an outpatient office setting.9 Another resource, The REACH Institute, offers live and online evidence-based training courses for pediatricians on identification and treatment of mental health issues, including screening, medication management, cognitive behavioral therapy, and a host of other topics, all patient-centered and designed to be feasible in an outpatient office setting.10 (For more on The REACH Institute and pediatrician training, see "Guiding principles in managing pediatric mental health issues," page 18.) Address the economic and social barriers that contribute to poor mental health foryoung people,families, and caregivers. 6 Increase timely data collection and research to identify and respond to youth mental health needs more rapidly.

Increasing Access to a Diverse Mental Health Workforce through Emergency Reciprocity Licensure

New Jersey's COVID-19 Temporary Emergency Reciprocity Licensure Program provided temporary licenses to more than 31000 out-of-state healthcare practitioners, over a quarter of whom were mental health providers. As the need for mental health care accelerated during the pandemic, especially among health disparity populations, expanding mental health provider pools may be a critical tool to increase access to care. In January 2021, we surveyed New Jersey's temporary licensees. We analyzed over 4500 mental health provider responses to examine the impact of the temporary licensure program on access to mental health care overall and on enhancing a diverse mental health workforce. Over 3700 respondents used their temporary license to provide mental health care to New Jersey patients. About 7% of respondents self-identified as Hispanic, 12% Black, 6% Asian, 1% American Indian or Alaska Native, and 0% (more than 5) Native Hawaiian or other Pacific Islander. They treated about 30100 New Jersey patients, 40% of whom were new to the provider, and 81% delivered care exclusively using telehealth. Respondents conversed with patients in at least 13 languages. About 53% served at least one patient from an underserved racial/ethnic minority group. Our findings suggest that temporary out-of-state mental health providers helped enhance mental health care continuity and access. Copyright 2023 Federation of State Medical Boards. All Rights Reserved.

The impact of COVID-19 on access to mental health services and the use of teletherapy as an alternative form of treatment

The aim of this research study is to determine the impact of COVID-19 on access related to mental health services and also explain the use of teletherapy as an alternative form of treatment. This research study is based on secondary research data analysis to determine the research study data collected from websites related to the ratios of COVID-19 also that mental health services. Determine the research study used E-views software, and the generated result included descriptive statistics, correlations, the dickey fuller test analysis, the histogram, and state, also that explain the variance and test of equality between them. The overall result shows COVID-19 shows a direct impact on mental health services;teletherapy directly links with mental health services. Benefits make teletherapy the best online therapy session for overcoming various types of depression and mental illness in patients. Also, teletherapy is an alternative form of mental health service that is mostly provided to people affected due to the pandemic conditions of the coronavirus.Copyright © 2022, Universidade de Sao Paulo. Museu de Zoologia. All rights reserved.

HERMENEUTICS PROMOTES PERSON-CENTERED MENTAL HEALTH IN PANDEMIC TIMES

Background: COVID 19 affects not only patients' physical health but also mental well-being. Objective: To explore how hermeneutics, i.e., the theory and practice of interpretation, promotes person-centered mental health during the COVID-19 pandemic. Method: An excerpt of a dialogue between a patient with depression and his psychiatrist was used to illustrate how hermeneutics promotes person-centered mental health. Results: The case study, reviewed through the perspective of hermeneutics, showed that the patient needs a personal narrative to voice his COVID-19-related physical worries as well as associated psychosocial difficulties, mental health distress, and spiritual concerns. Discussion: A multi-layered personal narrative, informed by hermeneutics, ensures mental health needs are not overlooked/neglected in individuals affectedby COVID-19. Conclusion: Hermeneutics, when properly and clinically applied, promotes person-centered mental health in pandemic times.

Disruptions in Health Care among Mwccs Participants during the Covid-19 Pandemic

Background: The COVID-19 pandemic resulted in disruptions to health care services. Vulnerable populations, including people living with HIV (PLHIV), may have experienced unique challenges when accessing medical care. The objective of this study was to evaluate the impact of social disruptions on health care visits among Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study (MWCCS) participants. Method(s): A survey collecting data on missed health care visits and social disruptions (i.e., disruptions in employment, childcare, financial support, housing, and health insurance) during the pandemic was administered via telephone to MWCCS participants 1-3 times from March and September 2020. Logistic regression models adjusted for sociodemographics and HIV-status were used to test the association between social disruptions and three medical care interruption outcomes (i.e., missed healthcare appointment, interruption of mental health care, and interruption of substance use care). Result(s): Surveys (n=10,076) were conducted among 2238 PLHIV (61% women) and 1427 people living without HIV (PLWoH) (41% women). Overall, 42% of participants reported disruptions in health care with no significant difference by HIV status. Among participants receiving mental health care services and substance use treatment, 52% and 36% reported interruptions of care, respectively. Participants reporting >= 2 social disruptions were more likely to report missed health care appointments (adjusted odds ratio [aOR]: 1.81, 95% confidence interval [CI]: 1.54-2.13), and interruptions in mental health care [aOR: 2.42, 95%CI: 1.85-3.17) or substance use treatment (aOR: 1.97, 95%CI: 1.26-3.09), compared to those reporting no disruptions. Participants who were unemployed were more likely to miss health care appointments (aOR:1.46, 95% CI: 1.25-1.71) and report disruptions in mental health care (aOR: 2.02, 95% CI: 1.54-2.66) compared to those who were employed. PLHIV reporting >= 2 social disruptions were at increased risk for missed health care appointments (aOR 1.92, 95%CI: 1.56-2.36) and disruptions in mental health care (aOR: 2.54, 95%CI: 1.83-3.53 (Table 1). Conclusion(s): Social disruptions as a result of the COVID-19 pandemic have adversely impacted the receipt of health care among PLHIV and PLWoH, including the receipt of treatment for mental health and substance abuse. Providing childcare, financial support, housing, and health insurance may reduce disruptions in care and improve health outcomes.

Cystic fibrosis mental health research priorities: Qualitative content analysis of cystic fibrosis community and provider survey

Background: Mental health is among the top three research priorities of the CF community [1]. In 2020-21, the Cystic Fibrosis Foundation Mental Health Research Prioritization Working Group met to designate areas of focus for CF mental health research [2]. To elicit broad input to inform this work, a mixed-methods study was conducted. In June 2020, a 22-item survey was sent via email and social media to CF health care providers, people with CF, family caregivers, and other CF community members. We aimed to analyze qualitative content to add depth to quantitative findings. Method(s): Three hundred fifty-two providers and 693 community members completed the survey, which included three open-ended questions: Q1) When thinking about research topics specific to mental health, where are the current gaps in knowledge that should be prioritized for future research? Q2) Is there anything else regarding mental health and the needs of the community you would like to share? Q3) Considering the impacts of the COVID-19 pandemic, are there additional mental health topics that are (Figure Presented) Figure 1.: Cystic fibrosis (CF) mental health research priorities of all respondents according to frequency. Overarching top-line categories and general codes for open-ended survey responses of CF health care providers, people with CF, family caregivers, and other CF community members not covered by the survey questions? Reponses containing more than one main idea were subdivided into topic-specific codable items. For Q1 and Q2, a codebook guided hierarchical placement of each item into an overarching top-line category with corresponding general code and, if applicable, one or more specific codes and populations or settings. A simplified process designated only one major theme per item for Q3. Three teams of one CF researcher and two CF community members coded the first 20% of their assigned items by consensus and then worked in pairs to independently double code the remaining 80%. Two-sided t-tests were adjusted with the Bonferroni correction using a significance level of less than 0.1. Result(s): One thousand three hundred ninety-one provider items and 1638 community items were coded for Q1 and Q2, and 565 provider and 323 community items were coded for Q3. Strong inter-rater agreement was obtained across coding dyads (71-90%). For Q1 and Q2, the most common top-line priorities were mental health conditions;living with CF;screening, assessment, and intervention;systems-level barriers and facilitators;and effects of modulators (Figure 1). Strong agreement was found in the ranking of top priorities by community members and providers, although providers were significantly more likely to mention effects of modulators;screening, assessment, and intervention;and substance misuse, and community members were significantly more likely to mention stress and trauma. Respondents also noted concerns captured by a wide range of specific codes (e.g., access to mental health care, role and life changes, family relationships), populations (e.g., children), and settings (e.g., inpatient). For Q3, isolation and anxiety emerged as the top COVID-19 concerns, with isolation more salient forcommunity members and anxiety for providers. Conclusion(s): Qualitative analysis of a large survey of multiple stakeholders provided input on top research priorities for CF mental health. This information facilitated consideration of diverse perspectives to identify gaps and select areas of focus for future researchCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Transgender Women Baseline Profile in Transcitar: Transspecific Cohort in Argentina

Background: Transgender women (TGW) are among the population most affected by the HIV epidemic in Argentina, despite a progressive legal framework. TransCITAR is a trans-specific cohort in Argentina that aims to assess physical and mental health among transgender and non-binary people (TGNBP). We present baseline characteristics of TGW. Method(s): TGW attending a trans-friendly clinic to receive HIV/STIs prevention/ treatment, mental health care and/or gender-affirming hormone therapy (GHT) were invited to participate. Semiannual visits including clinical assessments, laboratory tests, and psychosocial interviews were performed. Oral PrEP was offered as part of a combined prevention strategy since September 2021. Result(s): Between September/2019 and August/2022, 500 TGNBP were enrolled, 416 were TGW (median age: 30 years, IQR 25-37). High social vulnerability was observed (Table 1). Regarding trans-specific characteristics, 49.8% reported industrial silicone injections and 36.8% were receiving GHT. 76.9% were sex workers. Baseline STIs prevalence were: HIV 42.3% (10.2% diagnosed at enrolment), syphilis 40% (defined as positive nontreponemal test VDRL with titers of at least 1/8), past HBV 18.5%, chronic HBV 3.8%, HCV antibody positive 2.6%. Only 57% presented HBV protective antibodies titers (HBVsAb>=10UI/ml), 8 TGW were on PreP. For those with HIV, median CD4+ cell count was 602 cells/mm3 (IQR 378-933), 66.5% were on ART at enrolment (53.6% were virally suppressed) and 14.8% initiated at baseline. During 36 months of follow up, 4 TGW died (one AIDS-related and one COVID-19-related). Bivariate analyses showed that a positive HIV diagnosis was independently associated with migration, low level of education, unstable housing, silicone injecion and sex work, while was negatively associated with being on GHT. In multivariable logistic regression, only sociodemographic variables remain associated: migrant (aOR=.487, 95% CI=.304-.768);incomplete high school (aOR=.463, 95% CI=.300=.714);unstable housing (aOR=.614, 95% CI=.401- .940);and sex work (aOR=.324, 95% CI=.177-.593). Conclusion(s): TGW from TransCITAR presented poor health outcomes: high prevalence of HIV/syphilis, high proportion with incomplete/no HBV vaccine and high levels of depression and violence. A comprehensive approach to care and addressing social determinants of health is pivotal to reduce HIV burden in this population.

Social worker to therapist: Adaptation of role while addressing inequities in mental health care

Background: 2020 was a year of transformation in cystic fibrosis (CF) care. Many adults with CF started elexacaftor/tezacaftor/ivacaftor while COVID- 19 was unfolding. Occurring almost simultaneously, these two events created a dramatic shift in the disease landscape. Hospital admissions plummeted, and physical health improved. Clinic appointments turned virtual, and people with CF sheltered at home for months. These changes created opportunities for CF team members to adapt roles to meet evolving needs. Social work hours devoted to inpatient care, end of life, and discharge planning could be reallocated to other areas. Although many patients improved from a physical standpoint, mental health problems increased. Between 2020 and 2022, demand for mental health services increased exponentially, creating a national mental health crisis, but inequities in insurance coverage existed between physical and mental health care. Finding a mental health provider became an almost impossible task. This author sought to address insurance inequity and increased demand for mental health services by offering cognitive behavioral therapy (CBT) sessions to adults with CF to optimize their health andwellbeing. CBT is considered an evidence-based approach for most mental health problems. Method(s): Eight adults at the Stanford Adult CF Center were referred for CBT with social work from August 2021 to April 2022. Referrals were based on mental health crisis, mental health screenings, insurance barriers, and availability of mental health providers. Therapy sessions were offered via telehealth as part of the multidisciplinary care at the CF center. Patients were not billed for the sessions. The number of sessions was variable, with a mean of 10.5 sessions per patient. The frequency and content of sessions were tailored to patients' unique needs. Referrals were accepted on a continuous basis, space available. Mental health problems included anxiety, depression, alcohol use disorder, trauma, and gender dysphoria Results: All eight patients receiving CBT demonstrated significant improvement in mental health symptoms, as evidenced by a mean reduction in Patient Health Questionnaire-9 score of 3 and General Anxiety Disorder-7 score of 3.3. (Six of 8 patients were screened before and after therapy.) Other measures of improvement were patient selfreport as documented in therapy notes, sessions being tapered or discontinued as goals were met, and reduction in or stoppage of psychotropic medications. Conclusion(s): Mental health is a vital component of health and should be properly addressed as part of CF care. Although mental health care in CF has come a long way, patients continue to lack proper access to trained providers, especially those with expertise in CBT and CF. Given the current mental health crisis and shortage of therapists to meet newdemands, there are serious implications for long-term health outcomes for people with CF. As more studies are published demonstrating the effectiveness of CBT and other forms of therapy in the CF population, CF providers can adapt roles to implement new interventions in addressing mental health problems as part of CF care rather than referring patients to community providers who often are poorly positioned to meet their needs. The Stanford CF program will continue to use social work role to provide mental health servicesCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

A Feasibility Study of LORETA Z-Score Neurofeedback Training in Adults with Schizophrenia-Spectrum Disorder Experiencing Treatment-Resistant Auditory Verbal Hallucinations

Introduction: The incomplete effectiveness of interventions demands new ways to help people diagnosed with schizophrenia who experience auditory verbal hallucinations (SZ-AVH). We aimed to perform a feasibility study of low-resolution electromagnetic tomography analysis (LORETA) neurofeedback with people exhibiting treatment-resistant SZ-AVH. Method(s): We examined changes in resting-state quantitative electroencephalogram (qEEG) in four people with SZ-AVH (three male, one female) after LORETA Z-score neurofeedback training. Result(s): The study design had to be amended due to a national COVID-19 lockdown. Neurofeedback was well tolerated and no participants dropped out. Recruitment was the main feasibility issue. Barriers included a lack of knowledge of neurofeedback by patients and mental health teams, as well as the travel and time commitment involved. For the only patient who completed all 20 sessions, elevated frontal, central, and temporal theta absolute power measured at baseline normalized after treatment, but decreased temporal delta and an increase in coherence for all frequency bands were also found. Conclusion(s): Two key lessons were drawn for the feasibility of trials of EEG neurofeedback in this population. First, significant effort is needed to educate mental health professionals and patients about neurofeedback. Second, the equipment employed for neurofeedback training needs to be physically based at a site where patients routinely attend.Copyright © 2022. Amico et al.