Hospital-Based Modified Cogmed Working Memory Training for Youth With ADHD

Objective: This study evaluated a modified working memory training program, Cogmed, for ADHD youth. Method: Forty youth were randomized to modified Cogmed training (MCT) or treatment as usual (CON). MCT was delivered in an outpatient mental health clinic in 3 weekly 35-minute sessions with a dedicated coach for 10 weeks. Participants completed assessments at baseline, after the intervention, and again 3 months later. Results: After controlling for baseline, groups were comparable on working memory, academics, and ADHD symptoms. The MCT group was rated by parents and teachers as having fewer executive function challenges and youth endorsed better self-concept compared with the CON group. Conclusions: MCT was associated with some improvement, which could not be attributed to increased working memory capacity and may reflect other facets of the program. Results question the usefulness of Cogmed but highlight considerations for optimizing adherence, engagement, and the therapeutic alliance in interventions for ADHD youth.

Can Text Messages Enhance Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment? A multimethod formative evaluation (Preprint)

BACKGROUND Pathways to mental health services for youth are generally complex, and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text-messages offer a convenient, low-cost option for information-sharing, skill building and potentially activate youth and caregivers to positive behaviours prior to beginning formal therapy. To date, there is little evidence about the feasibility of initiating transdiagnostic text messages during the early stage of youth and caregiver contact with community outpatient mental health services. OBJECTIVE To develop and test the feasibility of implementing two novel text messaging campaigns aimed at youth clients and their caregivers during early stages of engaging with outpatient mental health services. METHODS A multidisciplinary panel of experts developed two sets of 12-message interventions with youth and caregivers prior to deployment. Each text included a link to an external interactive or multimedia resource to extend skill development. Enrolment of youth aged 13 to 18 years, and/or their caregivers,occurred in two early treatment timepoints. At both time points, text-messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in two phases between January and March 2020 and January and May 2021. Enrolment, willingness to persist in using, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. RESULTS A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54% and 44% respectively. Over 1500 text messages were sent in total throughout the study. More than three quarters of youth reported that they learned something new and noticed a change in themselves due to receiving the texts. Eighty-eight percent of youth said they would recommend the texts to others. Youth ranked the most helpful text as the one related to coping with difficult emotions. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts and would recommend them to others. Caregivers perceived diverse levels of value in the text topics with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. CONCLUSIONS Results are preliminary but show brief, core skill-focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers showed promising knowledge and behaviour change with exposure to only 12 messages over 6 weeks. A larger study, with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention.

Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis

Autistic adults often experience barriers to healthcare that can cause their healthcare service use to be unique from other populations. We conducted a systematic review to gather the most recent evidence about how often autistic adults use five important healthcare services (the emergency department, hospitalization, outpatient mental health, preventive services, and primary care) compared to populations of non-autistic adults. We searched six electronic research databases for articles. Our search strategy identified N = 2964 unique articles. Ultimately, we included N = 16 articles in our review. Most included studies (N = 13) were high-quality level 3a studies that compared autistic adults’ service use to a non-autistic population comparison group (N = 11), and examined emergency department use (N = 12). Autistic adults most often had equal or higher use of services than population comparison groups across all healthcare services we examined. Although autistic adults had greater use of primary care and preventive services than comparison groups, frequent emergency department visits and hospitalizations may reflect that these services are not adequately meeting autistic adults’ needs. Future research should identify targets for improving autistic adults’ access to and use of primary care and preventive services, which may ultimately reduce frequent use of the emergency department and hospitalizations. Lay abstract Autistic adults often have complex healthcare needs due to factors like having other health conditions, sensory sensitivities, and limited access to healthcare providers who are trained to provide care for them. All these factors may influence the healthcare services that autistic adults use. In this review, we searched six electronic research databases to gather the most recent evidence about how often autistic adults use five important healthcare services (the emergency department, hospitalization, outpatient mental health, preventive services, and primary care) compared to populations of non-autistic adults. A total of 16 articles were ultimately included in this review. Most articles found that autistic adults had equal or higher use of healthcare services than non-autistic adults. Autistic adults frequently used the emergency department and hospital. This may indicate that routine outpatient care in the community is not meeting their needs. Our findings show the importance of improving care at this level for autistic adults to reduce overuse of the emergency department (in this article referred to as ED) and hospital.

Ny tilnærming for vurdering og planlegging av behandling i poliklinisk psykisk helsevern

Background: Mental health care services are facing challenges due to the increasing number of referrals of patients with multifaceted problems. This study aims to describe the Early Assessment Team (EAT), a novel method of organizing intake assessments for the outpatient mental health service in a community mental health center (CMHC). Method: During the first two years of EAT, 1,034 cases were included in a descriptive quality assurance study. Patient population, method of work, re-referrals and patient satisfaction were evaluated. Results: After contact with EAT, two-thirds of patients were assessed as not in need of further treatment in the outpatient clinic. The assessment was performed during one to three sessions in 90% of cases. Fewer than 20% of cases that were screened out by EAT were re-referred to the CMHC within six months. Patients expressed satisfaction with the service. Implications: The results indicate that intake assessment by an early assessment team may be an alternative in clinical practice, though further controlled studies are needed.

An Analysis of Admissions to a Refugee Child Mental Health Unit in the Context of the COVID-19 Pandemic

Background To examine the admissions to a refugee child outpatient mental health unit in the COVID-19 pandemic and to compare them with the pre-pandemic period. Methods This retrospective observational study, planned through the hospital information system and patient files, included the 1-year number of outpatient unit admissions, sociodemographic, and clinical data. Results Before the COVID-19 pandemic (March 2019–February 2020), a total of 2322 patients (local and refugee) applied to the same unit, and 236 (10.1%) of these patients were refugees. Since the commencement of the COVID-19 pandemic in Turkey (March 2020–February 2021), 1209 patients applied, and 10.4% ( n = 126) of them were refugees. While 19.66 ± 6.31 refugees applied per month in the pre-pandemic period, this number decreased to 10.50 ± 5.31 during the pandemic period ( p = 0.01). During the pandemic period, there was a significant decrease in the number of female refugee patient admissions. In addition, while admissions for external disorders increased significantly during the pandemic period ( x 2 = 13.99, p = 0.001), admissions for internal disorders decreased significantly ( x 2 = 4.54, p = 0.03). Conclusions The decrease in the mental health unit demands with the pandemic may lead to negative consequences in the long term. To determine mental health and psychological needs of patients during the outbreak will greatly contribute to the pandemic management process.

Retrospective cohort study of outpatient mental health visits in children and youth in Canadian military families

LAY SUMMARY This study tried to answer the question “Do children and youth in military families have a greater risk of emotional and behavioural problems than children and youth in the general population?” The authors used routinely collected health data from children and youth in Canadian Armed Forces families who relocated to Ontario, matched to data from children and youth in non-military families. They compared outpatient mental health services use, such as physician visits, and the reasons for those visits, such as depression. They found that children and youth in military families were more likely to visit a physician for specific mental health diagnoses than children and youth in the general population. More programming and resources supporting the mental health and well-being of children and youth in military families may be needed.

Experience of stigmatization in children receiving inpatient and outpatient mental health treatment: a longitudinal study

Mental health-related stigma is poorly understood, and minimal research has focused on the experience of stigma from children’s perspectives. We sought to investigate whether children treated as inpatients and outpatients had different experiences of stigma over time and whether stigma is linked to global functioning cross-sectionally and longitudinally. Children, aged 8–12 years, receiving treatment within a national specialist mental health inpatient unit were matched for age, gender and diagnosis with children receiving outpatient treatment (N = 64). Validated measures of stigma, global functioning and symptom severity were collected at the start of treatment and upon discharge from the ward for inpatients, and a similar timeframe for their individually matched outpatients. Latent change score models and partial correlation coefficients were employed to test our hypotheses. No differences in most aspects of stigma between children treated as inpatients and outpatients were observed, except for personal rejection at baseline and self-stigma at follow-up favouring outpatients. A reduction in stigma was observed in societal devaluation, personal rejection and secrecy for inpatients, and self-stigma and secrecy for outpatients between the two assessments. Societal devaluation declined at a higher rate among inpatients compared to outpatients, albeit reductions in stigma were comparable for all remaining measures. No association was found between the change in stigma and change in global functioning. Future research may offer further insights into the development and maintenance of stigma and identify key targets for anti-stigma interventions to reduce its long-term impact.

A Preliminary Evaluation of the Unified Protocol among Trauma-Exposed Adults with and without PTSD

The purpose of this study was to evaluate whether the Unified Protocol (UP)—a mechanistically transdiagnostic psychological treatment—provides benefit to individuals with a range of trauma histories, psychological difficulties, and diagnostic comorbidity. Using data from a sequential multiple-assignment randomized trial (SMART), this exploratory analysis included a sample of 69 community-recruited adults seeking outpatient mental health treatment. We examined reductions in anxiety and depressive symptoms and changes in aversive and avoidant reactions to intense emotions—the UP’s putative mechanism—first by comparing individuals with and without trauma histories and then specifically among participants with PTSD. Findings suggest that the UP may lead to similar improvements in clinical diagnostic severity, anxiety, and depression among patients with trauma exposure as those without trauma exposure. Roughly half of participants with PTSD demonstrated reductions in PTSD clinical severity, anxiety, depression, and distress aversion, suggesting the UP may be an efficacious treatment for people with PTSD and comorbid conditions.