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This chapter focuses on how faculty teaching online graduate courses needed to modify teaching practices and make adjustments and accommodations in response to student needs during the COVID-19 pandemic. Although the online platform did not need to change, student stressors significantly increased. This was particularly true in the Educational Leadership Department at New Jersey City University (NJCU), located in the most diverse city in the United States and in the epicenter of the pandemic. Most students were impacted directly by the pandemic with many becoming ill and losing loved ones. As a graduate program focusing on developing leadership skills, our student body is comprised of working professionals in the field of education. In addition to having to manage personal stressors, students who are educators and administrators in the K-12 and community college setting also had to shift teaching, learning, and supportive services from face-to-face to remote environments in a matter of days or weeks. Examples of how we gained an understanding of our student needs and responded to these needs are provided. © Springer Nature Switzerland AG 2021. All rights reserved.
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Background: Older female caregivers of persons with AD/ADRD are under-represented, under-reported, and understudied. Purpose: This qualitative study aimed to understand how COVID-19 affects older female caregivers' lived experience, ongoing capacity, and willingness to provide care for their loved one(s) with AD/ADRD. Specific Aims: Aim 1: Explicate older female caregivers' lived experience in the context of caring for family members with AD/ADRD during COVID-19. Aim 2: Elucidate how COVID-19 affected older female caregivers' relationships with their family members with AD/ADRD. Method: 172 units of meaning were extracted from 327 pages of transcripts and 972 minutes of interviews with urban (n = 10) and rural caregivers (n = 10). Thematic analysis was then conducted. Results: Respondents, recruited with purposive and snowball sampling, saw hastened AD/ADRD progression in their family member(s) attributed to social isolation. For many, long-term placement was not an option for financial reasons. Respondents providing full-time caregiving depended heavily on their care recipients' financial resources for basic living expenses, reporting placement in long-term care would leave them at risk of homelessness. Black caregivers expressed an "unspoken" cultural taboo about placement. For all, caregiver disability was the only impetus for placement. Respondents in rural communities more often reported faith-based gratefulness, moments of joy, relational harmony resulting from "being stuck together", and less availability of resources allowing virtual support. Urban caregivers reported more social isolation, less awareness of resources, more intentional family member distancing, and higher pandemic-related distress. Implications: These findings have broad economic, social, policy, research, and practice implications.
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Background/Significance: Severe depression, psychosis, and catatonia are prevalent conditions on inpatient medical-surgical services and frequently drive psychiatric consultation. These syndromes are more common in patients with SMI, who are often socioeconomically disadvantaged. ECT can be a rate limiting and urgently indicated therapy in the treatment of these conditions. Transfer to inpatient psychiatry for the purposes of providing ECT can be difficult due to medical-surgical instability. ECT is at baseline a scarce resource in many institutions. Access to ECT for patients outside the inpatient psychiatric service is limited and requires the cooperation of multiple services. Barriers to the provision of ECT on the medical-surgical floors include navigation of a typically full ECT schedule, anesthesia availability, the portability of ECT equipment, and, more recently, restrictions imposed by the COVID-19 pandemic, which necessitates further precautions for procedures requiring anesthesia. We describe a quality improvement intervention designed to assess the needs for and delivery of urgent / emergent ECT referrals in the general hospital. Methods: We convened a group of stakeholders including representatives from medicine, surgery, anesthesia, nursing, and psychiatry to identify the current practices related to care of patients with neuropsychiatric illness who are medically and/or surgically unstable for transfer to inpatient psychiatry and who require urgent/emergent ECT. Goals of this project included education about prevalence, diagnosis, and associated morbidity of catatonia, the role of ECT in catatonia and related psychiatric conditions, and identification of barriers and solutions to providing timely access to ECT. Results: Stakeholders identified the emergent need for ECT and proposed either the creation of an on-call emergency ECT service akin to other on call services such as interventional radiology, dialysis, and surgical subspecialties, and/or the designation of a daily ECT emergency add-on slot. The barriers to intervention and proposed solutions were addressed by stakeholder group participants. Discussion: Neuropsychiatric conditions, including catatonia, can complicate and/or be driven by underlying medical-surgical illness. These patients can become too sick to transfer to inpatient psychiatry. More time on the medical and/or surgical units results in a positive feedback loop of worsening illness, further delaying transfer to inpatient psychiatry. By creating an on-call / designated add-on system for the provision of emergent ECT, we aim to reduce the overall morbidity associated with these conditions. Conclusion/Implications: Improving access to ECT services for medically-surgically ill patients with severe psychiatric comorbidities via an emergency ECT service allows for earlier treatment of these conditions and can improve patient outcomes. References: 1. Lloyd JR, Silverman ER, Kugler JL, Cooper JJ. Electroconvulsive Therapy for Patients with Catatonia: Current Perspectives. Neuropsychiatr Dis Treat. 2020;16:2191-2208. Published 2020 Sep 25. 2. Ramakrishnan VS, Kim YK, Yung W, Mayur P. ECT in the time of the COVID-19 pandemic. Australas Psychiatry. 2020;28(5):527-529.
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Background/Significance: Primary care settings are often the first point of contact for psychiatric diagnosis, treatment, and referral – and primary care clinicians manage many psychiatric illnesses in the community. Integrated and collaborative care models have grown in response to the recognized need for psychiatric services in the primary care setting. Despite increased psychiatric presence, access to mental health services remains a challenge for patients and primary care providers. This challenge is particularly notable in racially diverse and socioeconomically disadvantaged patient populations and is further exacerbated by the COVID-19 pandemic, which disproportionately affects these groups. We describe an initiative to improve equity and access to mental health services among racially diverse and socioeconomically disadvantaged patients in a primary care clinic affiliated with an academic teaching hospital. Methods: We convened a meeting of internal medicine, psychiatry, social work, and administrative stakeholders affiliated with our university-based primary care clinic. This clinic primarily serves low income, racially diverse, and/or immigrant populations. We reviewed provider needs related to mental health referrals and compiled a comprehensive list of local outpatient, partial hospital, inpatient, addiction, and emergency resources. We then created an algorithm to direct providers to the appropriate resources based on the presenting mental health concern. This algorithm has been integrated into the electronic medical record (EMR) for easier access and use. Clinicians were surveyed pre-training and deployment of the algorithm and will be surveyed in follow up to measure its benefits. Results: The majority of primary care providers did not feel confident with psychiatric referral options. The most frequently described reason for psychiatric intervention was for depression and anxiety. Among mental health questions, a majority could be addressed with the assistance of a referral. Discussion: Despite increasing psychiatry presence in primary care, challenges remain in accessing mental health services. The COVID-19 pandemic has exacerbated existing challenges with increased demand for services. Our project builds on an existing integrated care model and introduces a resource that further streamlines mental health referrals. By having this resource available both physically in the clinic and embedded within the EMR, we hope to enhance the ease and efficiency of referral. Conclusion/Implications: A streamlined referral process can further aid in improving access to mental health services within a clinic already using an integrated care model. This is particularly important given the increased need for mental health services in low income, diverse, and immigrant populations hit hard by the COVID-19 pandemic. References: 1. Rothman S, Gunturu S, Korenis P. The mental health impact of the COVID-19 epidemic on immigrants and racial and ethnic minorities. QJM. 2020;113(11):779-782. 2. Jackson-Triche ME, Unützer J, Wells KB. Achieving Mental Health Equity: Collaborative Care. Psychiatr Clin North Am. 2020;43(3):501-510. 3. Lee-Tauler SY, Eun J, Corbett D, Collins PY. A Systematic Review of Interventions to Improve Initiation of Mental Health Care Among Racial-Ethnic Minority Groups. Psychiatr Serv. 2018;69(6):628-647.
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The 2020 Black Lives Matter protests in the United States demanded police reform and legislative action. Data-driven policing is just one technological intervention designed with the hope to tackle police brutality. However, these design interventions are often rooted in the continued racial profiling of poor and socially marginalized communities. Designers and researchers need a Healing Justice framework to circumvent this harm. Healing Justice addresses generational trauma and violence in marginalized communities and is not just a framework for policing but can address maternal mortality rates, COVID-19, medical malpractice, and other trauma issues. In this paper, we apply a Healing Justice framework to co-design activities focused on police brutality. We bridge Healing Justice and design by using an Afrofuturist Feminism framework, arguing that Healing Justice and Afrofuturist feminism frameworks lead to collective, grassroots, and pragmatic designs. © 2022 Owner/Author.
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CSCW, like many other academic communities, is reckoning with its roles, responsibilities, and practices amidst 2020's multiple pandemics of COVID-19, anti-Black racism, and a global economic crisis. Reviewing our work with data and communities demands we address harms from overexposure caused by surveillance or algorithmic bias and from underexposure caused by design that is insufficiently participatory and equitable. This workshop will elicit narratives of good and bad design and data work with communities, apply the lenses of equitable participatory design and data feminism to current CSCW projects and our global context, and develop practical outputs for supporting academics and practitioners in pursuit of democratic and just partnerships. © 2020 Owner/Author.