Going Telemental

2022 ◽  
pp. 125-139
Author(s):  
Shaun Respess
Keyword(s):  
Digital Literacy ◽  
Mental Healthcare ◽  
Telemental Health ◽  
Care Providers ◽  
Privacy Concerns ◽  
Medical Interventions ◽  
Schedule Flexibility ◽  
Reduced Costs ◽  
Traditional Approaches ◽  
Physical Care

Telemental health (TMH) is considered by many to be the future of mental healthcare, with some claiming that these methods should replace more traditional approaches. Early teletherapeutic initiatives demonstrate an immediate set of benefits for patients including improved access to care, reduced costs, better schedule flexibility, greater environmental familiarity, and higher rates of patient engagement. Notable limitations to TMH include enhanced privacy concerns, the variable digital literacy of certain populations/persons, and technological instability. However, other limitations regarding therapeutic relationships, experiences, and settings have gone undertheorized and are not sufficiently represented in the current research. This chapter surveys these considerations and argues that digital medical interventions are unable to effectively replicate the same degree of ‘contact' and ‘intimacy' available in physical care; providers should therefore be cautious in wholly replacing in-person methods or in implementing a standalone paradigm of digital care.

Telemental Health in Africa

2017 ◽  
Author(s):  
Sinclair Wynchank ◽  
Dora Wynchank
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Mental Healthcare ◽  
Cross Cultural ◽  
Healthcare Personnel ◽  
Telemental Health ◽  
African Countries ◽  
Broadcast Media ◽  
Equipment Costs

Although telemental health (TMH) in Africa shares much with TMH in well-resourced nations, significant differences exist. These mainly result from relatively small funds available for all forms of healthcare, inadequate infrastructure, lack of mental healthcare personnel, and cross-cultural difficulties. The majority of individuals with severe mental illness receive no treatment in most African countries. This lack has been alleviated in part by some “North–South” and “South–South” TMH programs, in addition to other locally initiated programs. African TMH has emphasized provision of a wide variety of TMH—education, managing psychotrauma in regions of violent upheavals, and the provision of other TMH services. Novel African telecommunications techniques and means of providing TMH, for example using broadcast media and diasporic mental healthcare personnel, are outlined. So, future African TMH will surely grow because of decreasing equipment costs, but principally because of proven effectiveness and the power of such interventions.

scholarly journals A Four-Component Framework Toward Patient-Centered, Integrated Mental Healthcare in Kenya

2021 ◽  
Vol 9 ◽  
Author(s):  
Manasi Kumar ◽  
Thomas L. Osborn ◽  
Cyrus Mugo ◽  
Hossein Akbarialiabad ◽  
Osman Warfa ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Care Providers ◽  
Professional Training ◽  
Fast Track ◽  
Mental Healthcare ◽  
Clear Understanding ◽  
Care Providers ◽  
Patient Centered ◽  
Fast Tracking

Background: How can we fast-track the global agenda of integrated mental healthcare in low- and middle-income countries (LMICs) such as Kenya? This is a question that has become increasingly important for individuals with lived experiences, policymakers, mental health advocates and health care providers at the local and international levels.Discussion: This narrative synthesis and perspective piece encompasses an overview of mental health care competencies, best practices and capacity building needed to fast track patient responsive services. In that vein we also review key policy developments like UHC to make a case for fast-tracking our four-step framework.Results: While there is an increasingly global impetus for integrated mental healthcare, there is a lack of clarity around what patient-responsive mental healthcare services should look like and how to measure and improve provider readiness appropriately. Here, our collaborative team of local and international experts proposes a simple four-step approach to integrating responsive mental healthcare in Kenya. Our recommended framework prioritizes a clear understanding and demonstration of multidimensional skills by the provider. The four steps are (1) provider sensitization, (2) continuous supervision, (3) continuous professional training, and (4) leadership empowerment.Conclusion: Our proposed framework can provide pointers to embracing patient-centered and provider empowerment focused quality of care improvements. Though elements of our proposed framework are well-known, it has not been sufficiently intertwined and therefore not been integrated. We think in the current times our integrated framework offers an opportunity to “building back better” mental health for all.

scholarly journals Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews (Preprint)

2019 ◽  
Author(s):  
Rosie Dobson ◽  
Pauline Herbst ◽  
Sarah Candy ◽  
Tamzin Brott ◽  
Jeffrey Garrett ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Digital Literacy ◽  
Pulmonary Rehabilitation ◽  
End Users ◽  
Support Program ◽  
Care Providers ◽  
Technology Access ◽  
Cross Sectional Survey ◽  
Respiratory Disorders ◽  
Key Stakeholders

BACKGROUND Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. OBJECTIVE The objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. METHODS A mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. RESULTS Across all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. CONCLUSIONS These formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population.

scholarly journals Readiness to Deliver Person-Focused Care in A Fragile Situation: The Case of Mental Health Services in Lebanon

2020 ◽  
Author(s):  
Aya Noubani ◽  
Karin Diaconu ◽  
Giulia Loffreda ◽  
Shadi Saleh
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Health System ◽  
Health Care Providers ◽  
Mental Healthcare ◽  
Care Providers ◽  
Health Seeking

Abstract Background: Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support (MHPSS) service provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system’s ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model.Methods: A qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon. Results: Findings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one’s livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon’s populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient’s experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care.Conclusion: Mental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to 1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and 2) promote the implementation of integrated person focused care for addressing mental health.

scholarly journals Healthy Birth Practice #1: Let Labor Begin on Its Own

2019 ◽  
Vol 28 (2) ◽  
pp. 68-80 ◽  
Author(s):  
Debby Amis
Keyword(s):  
Obstetric Care ◽  
Labor Induction ◽  
Low Risk ◽  
Professional Organizations ◽  
Current Evidence ◽  
High Tech ◽  
Care Providers ◽  
Medical Interventions ◽  
Nulliparous Women ◽  
Obstetric Care Providers

Current evidence and professional organizations identify letting labor begin on its own as one of the most important strategies for promoting normal, physiologic birth. It also prevents iatrogenic prematurity and the need for high-tech medical interventions required for labor induction. Because the American College of Obstetricians and Gynecologists (ACOG) now states that it is reasonable for obstetric care providers to offer induction at 39 weeks to low-risk nulliparous women, it is more important than ever for childbirth educators to be familiar with best evidence on letting labor begin on its own.

scholarly journals Hospice Care for Veterans: A Community Education Program

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 777-777
Author(s):  
Denise Kresevic ◽  
Barbara Heath ◽  
Muralidhar Pallaki
Keyword(s):  
Vietnam Veterans ◽  
Hospice Care ◽  
Community Education ◽  
Moral Injury ◽  
Telemental Health ◽  
Spiritual Support ◽  
Care Providers ◽  
Continued Education ◽  
Assessment Skills ◽  
The Impact

Abstract The impact of trauma on care at end of life and the social isolation of the COVID-19 pandemic highlighted a critical gap in care of terminally ill veterans. It is estimated that 30% of Vietnam Veterans suffer from PTSD, suicide rates are 49% higher in older veterans than nonveterans, and 41% of veterans surveyed report post traumatic guilt. A survey of non-VA hospice agencies revealed many do not screen for PTSD, but desired training in this area. The VA responded to these challenges implementing an initiative to educate community caregivers on PTSD, suicide, and moral injury with expanded tele mental health services. Several VA sites were supported to participate in training focusing on PTSD, suicide, and moral injury and Telemental health. In Northeast Ohio, from 2019-20, 11 community hospice agencies participated in training, including 283 providers,120 (42%) nurses, 100 (35%) social workers, 29 (10%) volunteers, and 34 (12%) other. A majority of participants post-training (n=160) (84%-94%) reported enhanced knowledge, skills, or attitudes related to resources, education, and communication. Participants rated changes for assessment skills lowest for moral injury (34%), PTSD (41%), and suicide (56%). An analysis of telemental health visits (N=50) revealed that, 56% addressed spiritual support, (22%) family support, (10%) resources/referrals, and (8%) confusion. The majority of telehealth visits were VA initiated (84%), and 10% were hospice initiated Continued education regarding PTSD, suicide, and moral injury assessment skills is still needed for hospice care providers of veterans. These findings support the use of telemental health for care and consultation.

Complementary and Alternative Treatments for Female Sexual Pain (DRAFT)

2018 ◽  
Author(s):  
Susan Kellogg Spadt ◽  
Jennifer Yonaitis Fariello
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Providers ◽  
The United States ◽  
Care Providers ◽  
Medical Interventions ◽  
First Line Therapy ◽  
Sexual Pain ◽  
Female Sexual Pain ◽  
Complementary And Alternative

An estimated 17–19% of women in the United States suffer from chronic sexual pain and dyspareunia of vulvovaginal origin. The majority will see several health care providers in an effort to comprehensively diagnose, evaluate, and decide on a management strategy for the condition. As a result of countless encounters with health care providers, and after trying numerous unsuccessful traditional medical interventions woman can feel frustrated and look to the use of complementary and alternative solutions to “solve their sexual health mystery.” According to the 2007 National Health Interview Survey, an estimated 83 million adults in the United States spent $33.9 billion dollars on complementary and alternative medicine. Complementary therapies, including psychotherapy, physical therapy, and behavioral modification strategies, are becoming increasingly popular for women who are seeking treatment of chronic sexual pain either as a first-line therapy monotherapy or as cotherapies added to traditional medical pharmacotherapy.

Telemental Health in Postdisaster Settings

2017 ◽  
Author(s):  
Eugene F. Augusterfer ◽  
Richard F. Mollica ◽  
James Lavelle
Keyword(s):  
Disaster Response ◽  
Mental Health Problems ◽  
Primary Care Providers ◽  
Telemental Health ◽  
Care Providers ◽  
Time Zone ◽  
Middle Income ◽  
Great Satisfaction ◽  
Middle Income Countries ◽  
Acute Injuries

Low- and middle-income countries are disproportionately impacted by disasters, and the majority of medical providers in these countries are primary care providers (PCPs). PCPs do a tremendous job saving lives and addressing acute injuries and illnesses, but often are not trained to recognize and treat mental health problems. Telemental health (TMH) should be an important component in supporting those on the front lines of disaster response. Telemedicine and TMH have been deployed in postdisaster settings, but remain underused. A number of challenges must be overcome in the implementation of a comprehensive TMH postdisaster response program: educating providers to work in varied cultures, working through translators, time zone differences, and more. This chapter emphasizes the importance and great satisfaction of disaster response work and the important role of TMH in ensuring the delivery of evidence-based best practices to those in critical need.

Moving Beyond Traditional Decision Support Systems

2017 ◽  
Vol 8 (2) ◽  
pp. 74-87
Author(s):  
Noura Azaiez ◽  
Jalel Akaichi ◽  
Jeffrey Hsu
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Moving Objects ◽  
Temporal Data ◽  
Trajectory Data ◽  
Reduced Costs ◽  
Spatio Temporal ◽  
Traditional Approaches ◽  
Dairy Milk ◽  
Made In

Integrating the concept of mobility into the professional and organizational realm offers the possibility of reducing geographical disparities related to organization services. The advances made in technology, geographic information systems and pervasive systems equipped with global positioning (GPS) technologies have been able to bring about an evolution from classic data approaches towards the modeling of trajectory data resulting from moving activities of moving objects. As such, trajectory data needs first to be loaded into a Data Warehouse for analysis purposes. However, the traditional approaches used are poorly suited to handle spatio-temporal data features and also the decision making tasks related to mobility issues. Because of this mismatch, the authors propose to move beyond traditional approaches and propose a repository that is able to analyse trajectories of moving objects. Improving decision making and extracting pertinent knowledge with reduced costs and time expended are the main goals of this revised analysis approach. Thus, the authors propose an approach in which they employ the Bottom-up approach to modeling a Decision Support System which is designed to support Trajectory Data. As an example to illustrate this approach, the authors use a creamery and dairy milk mobile cistern application to demonstrate the effectiveness of their approach.

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