A Rapid Learning Health System to Support Implementation of Early Intervention Services for Psychosis in Quebec, Canada: Study Protocol

Background: Given the strong evidence for their effectiveness, early intervention services for psychosis (EIS) are being widely implemented. However, heterogeneity in the implementation of essential components, remains an ongoing challenge. Rapid learning health systems (RLHS), that embed data collection in clinical settings for real-time learning and continual quality improvement, can address this challenge. We therefore implemented a RLHS in 11 EIS in Quebec, Canada. This project aims to determine the feasibility and acceptability of implementing a RLHS in EIS, and to assess its impact on compliance with standards for essential EIS components. Methods: Following literature recommendations, the implementation of this RLHS involves six iterative phases: external and internal scan, design, implementation, evaluation, adjustment, and dissemination. Multiple stakeholder groups (service users, families, clinicians, researchers, decision makers, provincial EIS association) are involved in all phases. Meaningful indicators of EIS quality (e.g., satisfaction, timeliness of response to referrals) were selected based on literature review, provincial guidelines, and stakeholder consensus on indicators prioritisation. A digital infrastructure was designed and deployed that comprises (a) a user-friendly interface for routinely collecting data from programs (b) a digital terminal and mobile app to collect feedback from service users and families regarding care received, health, and quality of life (c) data analytic, visualization and reporting functionalities to provide participating programs with real-time feedback on their performance over time, and in relation to standards and to other programs, along with tailored recommendations. Community of practice activities are being conducted that leverage insights from data to build capacity among programs to continually progress towards aligning their practice with standards/best practices. Guided by the RE-AIM framework, we are collecting quantitative and qualitative data on the Reach, Effectiveness Adoption, Implementation and Maintenance of our RLHS. These RE-AIM data will be analyzed to evaluate our RLHS’s impacts. Discussion: This project will yield valuable insights about how a RLHS can be implemented by EIS, along with preliminary evidence for its acceptability, feasibility and impacts on program-level outcomes. Its findings will refine our RLHS further and advance approaches that bring data, stakeholder voices and collaborative learning to improve outcomes and service quality in psychosis. Trial registration: NA

Social Work Training Intervention to Increase Referral Rates for Preventive Psychosis Services: A Randomized Trial

Purpose Social workers are employed in a broad range of community settings, in which they may be able to identify youth with emerging psychotic symptoms and facilitate connection to specialized services. Methods: This randomized controlled trial tested the efficacy of a training intervention for social workers ( N = 959) intended to increase the volume of referrals and rate of successful referrals to specialized early psychosis services. Results: During the 2-year study period, referrals to the early intervention program nearly doubled, t (df = 11) = 5.46, p < 0.001. Additionally, the rate of successful referrals was greater among social workers who received the active training (41.7%) compared to the other referral sources (19.2%), X2 (df = 1, n = 311) = 3.69, p = 0.055. Conclusions: The active training was associated with a marginally greater rate of successful referrals. Overall referrals increased greatly during the training period although this could not be linked to specific participants, suggesting contamination effects may have increased community awareness of early intervention services.

Implementation of Developmental Screening in Early Childhood Education: An Investigation of Process Variables and Acceptability

Many children with developmental delays need early intervention services but do not receive them. Developmental screening provides the impetus for identification of delays and service referrals but is not used consistently across all early childhood education settings. We used an implementation science framework to examine attitudes and engagement in a developmental screening program across three early childcare centers. Teachers demonstrated adequate knowledge of screening following training in the screener and were highly engaged in the screening process. Teachers’ positive attitudes toward screening increased yet perceived barriers to regular use of screening in their practice remained unchanged. Family participation in the screening process varied across centers and suggested a trend between family income and participation. Future research is needed to target pervasive barriers to teachers’ use of screening, such as perceived difficulties in engaging parents in the screening process.

Ka puāwai ngā kōhungahunga turi: a study of the nature and impacts of early intervention for Māori deaf children and their whānau

<p>This research investigates the early experiences of Māori deaf children, documenting whānau (family) perspectives on interactions with early intervention professionals and environmental sources of information, the effects of these on whānau perceptions of deafness, how decisions around communication and language use are arrived at, and how these affect a sense of parental competence. The features of a whānau-centred model of intervention are explored by whānau participants and the researcher in order to provide an understanding of how early intervention services could be more effective from Māori perspectives. Developing age appropriate language, communication skills and social acculturation is a synchronous process which typically occurs within the context of families. The majority of deaf children, however, are born to hearing parents and families with little experience of deaf people from which to develop a subconscious repertoire of skills with which to engage, facilitate and teach language to a deaf child. Early intervention services seek to support deaf children and their families in this process. In New Zealand a family-centred model of early intervention is accepted practice. Māori children are over-represented in deafness diagnostic statistics and their early language and social development takes place within a social context that is configured differently to the prototypical non-Māori family, that is, the whānau. Little is known or documented about the characteristics and efficacy of a family-centred model in relation to Māori deaf children and their whānau. The Māori metaphor of transformative praxis was used to frame a kaupapa Māori approach to case study research. Kete mātauranga (woven baskets of knowledge) were co-constructed between whānau participants, early intervention professionals, and the researcher, using Māori methods of qualitative data collection: kōrero-a-tinana (observations of action and behaviour), kōrero-a-waha (spoken language), kōrero-a-ringaringa (signed language), kōrero-a-tuhituhi (written language). Analysis of the data suggests that whānau perceptions of their deaf child evolve as the child moves through developmental stages and as the whānau encounters different sources of information and experiences relating to deafness. The study shows how the relevance of information, spoken, written, and signed, from early intervention professionals and observational knowledge gained from others with lived experience of deafness, deaf people and their whānau, was interpreted and weighed by participants as they interacted with their own deaf child in everyday social contexts. Participants' aspirations for their deaf children centred on a holistic perspective of wellbeing and development, the whānau providing the foundational context from which this developed. Recognising that their deaf child was situated at the borders of multiple cultural and linguistic groups, through either familial or social connection, whānau aspirations centred on the child’s active social and linguistic participation within these groups. Initial encounters with professionals focused on medical perspectives of hearing loss, positing deafness as a medical concern remedied through routine technical and medical interventions. However, as the child entered developmental stages, whereby language acquisition and the social acculturation process began, whānau started to relate to their deaf child in more social terms, and required more social and linguistic support to ensure participation in various home and educational contexts. Early intervention services were seen by some participants to constrain, or conflict with, their social-cultural aspirations for the child, through a focus on acquisition of spoken English and facilitating participation in mainstream educational contexts. Whānau expressed frustration at the compromise they endured as a consequence and wished for a model of support that engaged with whānau aspirations and relational styles more effectively. Potential features of a whānau-centred model of early intervention were composed by the researcher and whānau participants during a wānanga (forum) held as a part of the research. The features identified utilised the tradition of raranga (weaving) as a metaphor with which to frame relational and participatory components of a whānau-centred early intervention model for Māori deaf children.</p>

Ka puāwai ngā kōhungahunga turi: a study of the nature and impacts of early intervention for Māori deaf children and their whānau

<p>This research investigates the early experiences of Māori deaf children, documenting whānau (family) perspectives on interactions with early intervention professionals and environmental sources of information, the effects of these on whānau perceptions of deafness, how decisions around communication and language use are arrived at, and how these affect a sense of parental competence. The features of a whānau-centred model of intervention are explored by whānau participants and the researcher in order to provide an understanding of how early intervention services could be more effective from Māori perspectives. Developing age appropriate language, communication skills and social acculturation is a synchronous process which typically occurs within the context of families. The majority of deaf children, however, are born to hearing parents and families with little experience of deaf people from which to develop a subconscious repertoire of skills with which to engage, facilitate and teach language to a deaf child. Early intervention services seek to support deaf children and their families in this process. In New Zealand a family-centred model of early intervention is accepted practice. Māori children are over-represented in deafness diagnostic statistics and their early language and social development takes place within a social context that is configured differently to the prototypical non-Māori family, that is, the whānau. Little is known or documented about the characteristics and efficacy of a family-centred model in relation to Māori deaf children and their whānau. The Māori metaphor of transformative praxis was used to frame a kaupapa Māori approach to case study research. Kete mātauranga (woven baskets of knowledge) were co-constructed between whānau participants, early intervention professionals, and the researcher, using Māori methods of qualitative data collection: kōrero-a-tinana (observations of action and behaviour), kōrero-a-waha (spoken language), kōrero-a-ringaringa (signed language), kōrero-a-tuhituhi (written language). Analysis of the data suggests that whānau perceptions of their deaf child evolve as the child moves through developmental stages and as the whānau encounters different sources of information and experiences relating to deafness. The study shows how the relevance of information, spoken, written, and signed, from early intervention professionals and observational knowledge gained from others with lived experience of deafness, deaf people and their whānau, was interpreted and weighed by participants as they interacted with their own deaf child in everyday social contexts. Participants' aspirations for their deaf children centred on a holistic perspective of wellbeing and development, the whānau providing the foundational context from which this developed. Recognising that their deaf child was situated at the borders of multiple cultural and linguistic groups, through either familial or social connection, whānau aspirations centred on the child’s active social and linguistic participation within these groups. Initial encounters with professionals focused on medical perspectives of hearing loss, positing deafness as a medical concern remedied through routine technical and medical interventions. However, as the child entered developmental stages, whereby language acquisition and the social acculturation process began, whānau started to relate to their deaf child in more social terms, and required more social and linguistic support to ensure participation in various home and educational contexts. Early intervention services were seen by some participants to constrain, or conflict with, their social-cultural aspirations for the child, through a focus on acquisition of spoken English and facilitating participation in mainstream educational contexts. Whānau expressed frustration at the compromise they endured as a consequence and wished for a model of support that engaged with whānau aspirations and relational styles more effectively. Potential features of a whānau-centred model of early intervention were composed by the researcher and whānau participants during a wānanga (forum) held as a part of the research. The features identified utilised the tradition of raranga (weaving) as a metaphor with which to frame relational and participatory components of a whānau-centred early intervention model for Māori deaf children.</p>

Early Intervention Services During the COVID-19 Pandemic in Spain: Toward a Model of Family-Centered Practices

Early intervention services (EIS) worked hard to continue serving children and their families during the COVID-19 lockdown, using online applications. This study aimed to determine families’ and professionals’ perceptions of the functioning of the early intervention (EI) model in Spain during the pandemic. The study sample comprised two subsamples: 81 families of children attended at an EIS (72 mothers and 9 fathers) and 213 professionals recruited from EIS. The survey was conducted online several weeks after the end of the strict lockdown in Spain. Descriptive statistics of the questionnaire answered by families and professionals were compiled, comparisons were made between the families’ and the professionals’ responses, and the relationships with several sociodemographic variables were analyzed. The results indicated that parents who cared for their children and were fully responsible for housework, parents who had used telematic tools before the lockdown, and younger professionals had a more positive perception of the EI model and the incorporation of family-centered practices (FCP) during the pandemic. The results also showed statistically significant differences in some items between parents and professionals: for example, professionals perceived more advantages than families during the lockdown, quoting the greater participation of families in the intervention and a greater focus on families’ needs. The data obtained from professionals suggested a more positive attitude toward FCP: however, the results show that they continued to adopt a directive role in the intervention, a position that is at odds with the tenets of FCP. There is a clear need for more training if a paradigm shift to FCP is to be achieved. Families’ and caregivers’ perceptions of telerehabilitation, and their adherence to telerehabilitation programs, are discussed. The implications of this study with regard to guiding future telematic interventions and family support are also considered.

International Telepractice for Therapy and Training: Auditory Verbal UK's Perspective

Purpose The aim of this clinical focus article is to discuss Auditory Verbal UK's (AVUK) training program for prospective listening and spoken language specialist certified auditory verbal (AV) therapists delivered globally via telepractice. Since 2015, AVUK has delivered training via telepractice to 18 countries. Consideration is given to the barriers and challenges of training across geographical and cultural boundaries, including access to technology, cultural and linguistic difference of families and trainees, and the differing global states of audiological practice for early intervention. Some possible solutions are offered. Although there have been calls for international consensus on early intervention, the reality of provision across Europe differs especially in the wake of COVID-19. From a global perspective, audiology and early intervention services differ considerably. Some countries are not up-to-date with the latest hearing technology and do not have access to tuning for cochlear implants or the technology required for families to attend therapy via telepractice. Conclusions With appropriate technology, telepractice is a viable means of providing training in AV therapy. It builds communities across geographical areas, breaking down boundaries and facilitating global collaboration. Although considerable differences remain in both service provision and access to services across different countries, the passion of trainees worldwide and the good will of the AV community in supporting our colleagues give reason for optimism going forward.