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2.
J Psychiatr Pract ; 27(4): 245-253, 2021 07 28.
Article in English | MEDLINE | ID: covidwho-1348094

ABSTRACT

Telehealth has been rapidly deployed in the environment of the Coronavirus 2019 (COVID-19) pandemic to help meet critical mental health needs. As systems of care use telehealth during the pandemic and evaluate the future of telehealth services beyond the crisis, a quality and safety framework may be useful in weighing important considerations for using telehealth to provide psychiatric and behavioral health services within special populations. Examining access to care, privacy, diversity, inclusivity, and sustainability of telehealth to meet behavioral and psychiatric care needs in geriatric and disadvantaged youth populations can help highlight key considerations for health care organizations in an increasingly electronic health care landscape.


Subject(s)
COVID-19 , Mental Health Services , Patient Safety , Psychiatry , Quality Improvement , Telemedicine , Adolescent , Aged , COVID-19/epidemiology , Humans , Mental Health Services/standards , Mental Health Services/trends , Psychiatry/standards , Psychiatry/trends , SARS-CoV-2 , Telemedicine/standards , Telemedicine/trends
4.
J Child Adolesc Psychopharmacol ; 31(7): 457-463, 2021 09.
Article in English | MEDLINE | ID: covidwho-1317895

ABSTRACT

Objectives: Our goal was to develop an open access nationally disseminated online curriculum for use in graduate and continuing medical education on the topic of pediatric telepsychiatry to enhance the uptake of telepsychiatry among child psychiatry training programs and improve access to mental health care for youth and families. Methods: Following Kern's 6-stage model of curriculum development, we identified a core problem, conducted a needs assessment, developed broad goals and measurable objectives in a competency-based model, and developed educational content and methods. The curriculum was reviewed by experts and feedback incorporated. Given the urgent need for such a curriculum due to the COVID-19 pandemic, the curriculum was immediately posted on the American Academy of Child and Adolescent Psychiatry and American Association of Directors of Psychiatric Residency Training websites. Further evaluation will be conducted over the next year. Results: The curriculum covers the six areas of core competence adapted for pediatric telepsychiatry and includes teaching content and resources, evaluation tools, and information about other resources. Conclusion: This online curriculum is available online and provides an important resource and set of standards for pediatric telepsychiatry training. Its online format allows for ongoing revision as the telepsychiatry landscape changes.


Subject(s)
Adolescent Psychiatry/education , COVID-19 , Child Psychiatry/education , Curriculum/trends , Education, Medical, Continuing , Education, Medical, Graduate , Access to Information , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Education/methods , Education/organization & administration , Education, Medical, Continuing/methods , Education, Medical, Continuing/organization & administration , Education, Medical, Graduate/methods , Education, Medical, Graduate/organization & administration , Health Services Accessibility , Humans , Mental Health Services/standards , Mental Health Services/trends , Organizational Innovation , Organizational Objectives , SARS-CoV-2 , Telemedicine/methods
5.
BMC Fam Pract ; 22(1): 143, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1295441

ABSTRACT

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated/organization & administration , Mental Health Services , Patient Care Team/organization & administration , Primary Health Care , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Female , Focus Groups , Health Services Needs and Demand , Humans , Male , Mental Health/trends , Mental Health Services/standards , Mental Health Services/supply & distribution , Ontario/epidemiology , Practice Patterns, Physicians'/trends , Primary Health Care/methods , Primary Health Care/trends , Quality Improvement/organization & administration , SARS-CoV-2 , Telemedicine/methods , Telemedicine/statistics & numerical data
6.
J Marital Fam Ther ; 47(3): 551-565, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1169822

ABSTRACT

As a response to the COVID-19 global crisis, many in the couple/marital and family therapy (CMFT) professional community quickly met the challenge of providing services to clients via telebehavioral health (TBH) services. As this public health emergency endures, family therapists must continue to engage in TBH practice professionally and ethically. The rapid adoption of TBH with minimal training and experience during this public health emergency can result in crises for both individual therapists as well as for the profession in implementing electronic record-keeping, conducting virtual sessions, and communicating online with various clinical populations. The risk of insufficient training and supervision create a challenge to new and experienced family therapists. This article summarizes the work done by the profession thus far to respond to this public health emergency and presents a roadmap of recommendations for navigating those challenges into the future and offers ideas about how to sustain quality TBH practice.


Subject(s)
Couples Therapy , Family Therapy , Guidelines as Topic , Health Personnel , Mental Health Services , Professional Practice , Telemedicine , Couples Therapy/organization & administration , Couples Therapy/standards , Family Therapy/organization & administration , Family Therapy/standards , Guidelines as Topic/standards , Health Personnel/education , Health Personnel/standards , Humans , Mental Health Services/organization & administration , Mental Health Services/standards , Professional Practice/organization & administration , Professional Practice/standards , Telemedicine/organization & administration , Telemedicine/standards
7.
Psychiatriki ; 32(2): 165-166, 2021 Jul 10.
Article in Greek, English | MEDLINE | ID: covidwho-1148407

ABSTRACT

The current coronavirus pandemic (COVID-19) has led mental health systems to uncertainty regarding safe continuation of clozapine monitoring protocols. Clozapine is without doubt the only antipsychotic available with repeatedly proven efficacy in treatment resistant schizophrenia.1 Replacing clozapine with an alternative antipsychotic in patients stabilized with clozapine can potentially lead to higher risk of relapse or exacerbation of severity of illness.1 Clozapine, as already known, has a number of side effects, some of which can be serious, thus patients receiving clozapine require ongoing scheduled monitoring. Side effects of clozapine include neutropenia or agranulocytosis, myocarditis, fever, hypersalivation, weight gain and constipation. These side effects can be detected and treated when recognized on time decreasing the possibility of serious consequences making the implementation of an ongoing treatment monitoring protocol for patients on clozapine mandatory.2 Since it was advised for all mental health providers in most countries worldwide to limit non-urgent hospital visits and procedures to reduce the risk of contamination a challenge arose for patients' ability to access health care facilities for their routine clozapine monitoring. Nevertheless, the majority of Mental Health Care Authorities decided to ensure access for all patients on clozapine to their routine monitoring protocol.3,4 To date, no data exist on any potential relationship between antipsychotic use and the risk of contamination with SARS-CoV-2 or the development of severe symptoms of the infection. The literature suggests that patients receiving antipsychotics, especially clozapine, have an increased risk of developing pneumonia, leading to the assumption that patients receiving clozapine are at higher risk to develop COVID-19. 1 Balancing the importance of monitoring continuation against the increased risk for COVID-19, an International Consensus Statement was recently published addressing a monitoring protocol with reduced visits. The Consensus suggested reduced hematologic monitoring frequency of every 3 months with a prescription of 90 days clozapine supply (if safe). The above applies to patients receiving clozapine for at least one year without neutropenia. Τhe risk of neutropenia after 12 months of clozapine treatment falls significantly.4 Based on the above it is suggested to all clozapine clinics to implement a guidance monitoring protocol for all patients on clozapine to ensure safety during the pandemic. Besides hematological monitoring that requires physical contact with healthcare workers it is significant to implement a telemedicine appointment in frequent intervals to monitor symptoms of infection, symptoms of cardiovascular diseases and constipation. Patient should also be advised to regularly monitor one's blood pressure and pulses and ideally be educated on how by a member of the staff. If a patient is detected with any symptoms related to the above an emergency appointment for evaluation should be planned. Overall, since both the consequences and the duration of the pandemic are unknown, mental health services must work jointly to implement a clozapine monitoring plan to ensure safe continuation in such a vulnerable population.


Subject(s)
COVID-19 , Clozapine , Drug Monitoring , Drug-Related Side Effects and Adverse Reactions/prevention & control , Mental Health Services , Risk Management/trends , Schizophrenia/drug therapy , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , COVID-19/epidemiology , COVID-19/prevention & control , Clozapine/administration & dosage , Clozapine/adverse effects , Drug Monitoring/methods , Drug Monitoring/standards , Health Services Accessibility/standards , Health Services Needs and Demand , Humans , Infection Control/methods , Mental Health Services/organization & administration , Mental Health Services/standards , Organizational Innovation , SARS-CoV-2 , Schizophrenia/epidemiology
8.
J Nerv Ment Dis ; 209(2): 144-146, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1132663

ABSTRACT

ABSTRACT: To date, there is lack of specific effective treatment or vaccine for the SARS-CoV-2, and clinical and laboratory research is still ongoing to find successful drugs. Therefore, prevention to be infected through social distancing and isolation is the most effective way. However, all the other physical and mental illnesses continue to exist, if possible even more burdened by the emergency situation and social distancing. The COVID-19 pandemic, especially in many low- and middle-income countries, has caused a deeper gap in seeking psychiatric help. In this scenario, telepsychiatry could play a decisive role in implementing clinical care for frail patients and ensuring continuous mental care. Therefore, we felt the urge to write this article to express our hope that the old health care system at this time of crisis, as we know it, can offer the chance to implement pervasive care technologies that perfectly fit current psychiatric needs.


Subject(s)
COVID-19/prevention & control , Developing Countries , Health Services Accessibility , Mental Disorders/therapy , Mental Health Services , Telemedicine , Continuity of Patient Care/standards , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Humans , Mental Health Services/organization & administration , Mental Health Services/standards , Mobile Applications , Psychiatry/organization & administration , Psychiatry/standards , Telemedicine/organization & administration , Telemedicine/standards
13.
Am Psychol ; 76(3): 409-426, 2021 04.
Article in English | MEDLINE | ID: covidwho-1065803

ABSTRACT

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
Behavioral Symptoms , COVID-19 , Delivery of Health Care , Mental Disorders , Mental Health Services , Psychology, Clinical , Suicide , Adolescent , Adult , Aged , Behavioral Symptoms/etiology , Behavioral Symptoms/psychology , Behavioral Symptoms/therapy , Child , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Delivery of Health Care/trends , Humans , Mental Disorders/etiology , Mental Disorders/psychology , Mental Disorders/therapy , Mental Health Services/organization & administration , Mental Health Services/standards , Mental Health Services/trends , Middle Aged , Suicide/psychology , Young Adult
14.
J Nerv Ment Dis ; 209(1): 49-53, 2021 01.
Article in English | MEDLINE | ID: covidwho-1066475

ABSTRACT

The novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of telehealth and telemedicine for individuals with SMI supporting the feasibility/acceptability of mobile interventions, and the more limited evidence-based telemedicine practices for this population. We provide anecdotal reflections on the opportunities and challenges for telemedicine drawn from our daily experiences providing services and overseeing systems for this population during the pandemic. We conclude by proposing that a continued, more prominent role for telemedicine in the care of individuals with SMI be sustained in the post-coronavirus landscape, offering future directions for policy, technical assistance, training, and research to bring about this change.


Subject(s)
Attitude of Health Personnel , COVID-19 , Community Health Services , Health Services Accessibility , Mental Disorders/therapy , Mental Health Services , Patient Acceptance of Health Care , Telemedicine , Community Health Services/economics , Community Health Services/organization & administration , Community Health Services/standards , Health Services Accessibility/economics , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Humans , Mental Health Services/economics , Mental Health Services/organization & administration , Mental Health Services/standards , Telemedicine/economics , Telemedicine/organization & administration , Telemedicine/standards
15.
Psychiatr Serv ; 72(1): 86-88, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1060599

ABSTRACT

To address the global mental health crisis exacerbated by the COVID-19 pandemic, an urgent need has emerged to transform the accessibility, efficiency, and quality of mental health care. The next suite of efforts to transform mental health care must foster the implementation of "learning organizations," that is, organizations that continuously improve patient-centered care through ongoing data collection. The concept of learning organizations is highly regarded, but the key features of such organizations, particularly those providing mental health care, are less well defined. Using telepsychiatry care as an example, the authors of this Open Forum concretely describe the key building blocks for operationalizing a learning organization in mental health care to set a research agenda for services transformation.


Subject(s)
Data Collection , Health Services Research/organization & administration , Mental Health Services/organization & administration , Patient-Centered Care/organization & administration , Psychiatry/organization & administration , Quality Improvement/organization & administration , Telemedicine/organization & administration , COVID-19 , Data Collection/standards , Health Services Research/standards , Humans , Implementation Science , Mental Health Services/standards , Organizations , Patient-Centered Care/standards , Psychiatry/standards , Quality Improvement/standards , Stakeholder Participation , Telemedicine/standards
16.
Psychiatr Serv ; 72(1): 89-90, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1059792

ABSTRACT

COVID-19 has affected many people worldwide. Beyond the physical symptoms brought on by this virus, it has adversely affected those without the illness through isolation, social distancing, and changes in job and housing security. Clinicians are trying to address the mental health needs of millions of strained Americans with and without COVID-19 and are operating without a systematic strategy. Informed by the authors' experiences during the pandemic, this Open Forum attempts to answer two questions: What are the specific considerations in working with economically compromised Hispanic/Latino and Black/African American populations with mental illness? How can mental health providers and researchers best help?


Subject(s)
COVID-19 , Mental Disorders/therapy , Mental Health Services/organization & administration , Socioeconomic Factors , African Americans , Humans , Medically Underserved Area , Mental Health Services/standards , New York City , Vulnerable Populations
17.
Psychiatr Serv ; 72(1): 100-103, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1059742

ABSTRACT

Because of the COVID-19 pandemic, many mental health care services have been shifted from face-to-face to virtual interactions. Several health policy changes have influenced telehealth uptake during this time, including changes in technology, Internet connectivity, prescriptions, and reimbursement for services. These changes have been implemented for the duration of the pandemic, and it is unclear if all, some, or none of these new or amended policies will be retained after the pandemic has ended. Accordingly, in the wake of changing policies, mental health care providers will need to make decisions about the future of their telehealth programs. This article briefly reviews telehealth policy changes due to the COVID-19 pandemic and highlights what providers should consider for future delivery and implementation of their telehealth programs.


Subject(s)
COVID-19 , Drug Prescriptions , Insurance, Health , Mental Health Services , Telemedicine , Continuity of Patient Care , Drug Prescriptions/standards , Humans , Insurance, Health/legislation & jurisprudence , Insurance, Health/organization & administration , Insurance, Health/standards , Insurance, Health, Reimbursement/legislation & jurisprudence , Insurance, Health, Reimbursement/standards , Mental Health Services/legislation & jurisprudence , Mental Health Services/organization & administration , Mental Health Services/standards , Telemedicine/legislation & jurisprudence , Telemedicine/organization & administration , Telemedicine/standards , United States
18.
Ann Clin Psychiatry ; 33(1): 27-34, 2021 02.
Article in English | MEDLINE | ID: covidwho-1059657

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic brought many challenges to patient care delivery. The need for social distancing and relaxing of federal and state telemental health regulations paved the way for widespread adoption of direct-to-consumer (DTC) ambulatory mental health video visits. METHODS: We present cases that demonstrate the use of video visits across 6 clinical areas, each serving a unique population of patients, in a large behavioral health system. The benefits and limitations of this modality are illustrated in children, adults, and older adults with mood disorders, anxiety disorders, intellectual disability, substance use disorders, neurocognitive disorders, and schizophrenia. RESULTS: Although telephone visits were acceptable and necessary to serve some patients, there are many advantages to video visits in providing best patient care. Education and support for telemental health-delivered to both patients and clinicians-is critical to the success of the DTC model. CONCLUSIONS: DTC telemental health is a widespread clinical tool used during the COVID-19 pandemic. Because this model has many strengths and advantages compared with traditional telemental health delivered in a clinic, regulators and insurers should be open to its continued use postpandemic when clinically appropriate.


Subject(s)
COVID-19 , Mental Disorders/therapy , Mental Health Services , Telemedicine , Adolescent , Adult , Aged , Child , Female , Humans , Male , Mental Health Services/organization & administration , Mental Health Services/standards , Middle Aged , Telemedicine/organization & administration , Telemedicine/standards , Telephone , Videoconferencing , Young Adult
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