Key elements of an evidence-based clinical psychology service within adult critical care

The COVID-19 pandemic has generated renewed interest in the psychological rehabilitation needs of patients admitted to intensive care units. While the availability of embedded practitioner psychologists within adult critical care teams remains inconsistent, post numbers have increased in response to the clinical needs of the pandemic. As psychology services within adult critical care become more widely established, models for service provision will be required. We describe our experience of developing a model for the delivery of a clinical psychology service within critical care in a District General Hospital with specialist tertiary surgical and cancer services. The current paper describes a service design that is firmly rooted in psychological theory and the broader clinical health psychology evidence base. We hope that our learning will be helpful to others.

Pessoas em situação de rua em Manaus e o direito à saúde: um estudo sobre adesão ao tratamento em HIV

RESUMO No Brasil os estudos sobre o tratamento de saúde com soro-positivos ainda é incipiente, sobretudo no que diz respeito ao processo de adesão ao tratamento que ainda é um fator que tem limitado o sucesso no tratamento antiretroviral. Alguns estudos apontam que a não-adesão é um desafio e uma ameaça para a saúde, tanto individual quanto para a Saúde Pública. Sabe-se ainda que, na perspectiva do paciente, a adesão traz inúmeros benefícios ao tratamento dentre eles destaca-se: a redução do risco de falha virológica, aumenta a sobrevida do paciente, reduz o risco de progressão para AIDS e principalmente a melhora na qualidade de vida. Como está o acompanhamento e a adesão ao tratamento em Manaus e como as pessoas aderem a este serviço, é um dos objetivos da pesquisa aqui apresentada. Os procedimentos metodológicos se basearão nos métodos qualitativos e quantitativos e tratando-se de uma pesquisa descritiva, a metodologia utilizada para coleta de dados, objetivou descrever as características da população soro-positiva atendida nos SAES de Manaus e pela Equipe de Consultório na Rua. Como principais resultados baseados na análise dos dados feita a partir dos dados disponíveis pelo SAE /AHF de 2020 e tomando por base o acompanhamento do Serviço de psicologia e Serviço social, há uma adesão bastante significativa dos pacientes ao tratamento antirretroviral em 85% dos 903 pacientes em acompanhamento. Em relação aos pacientes em situação de rua atendidos pela Equipe de Consultório na Rua (CNAR), foram acompanhados 07 pacientes nos últimos 6 anos, dentre os quais 01 foi à óbito devido às complicações com comorbidades como a tuberculose, 01 está em tratamento e os demais não foram mais encontrados pela equipe. ABSTRACT In Brazil, studies on health care treatment with sero-positive individuals is still incipient, especially regarding the treatment adherence process that is still a factor that has limited the success in antiretroviral treatment. Some studies point out that non-adherence is a challenge and a threat to health, both individual and public health. It is also known that, from the patient's perspective, adherence brings several benefits to the treatment, among which we highlight: reduced risk of virologic failure, increased patient survival, reduced risk of progression to AIDS, and especially improved quality of life. How is the monitoring and adherence to treatment in Manaus and how people adhere to this service, is one of the objectives of the research presented here. The methodological procedures will be based on qualitative and quantitative methods and being a descriptive research, the methodology used for data collection, aimed to describe the characteristics of the HIV-positive population assisted in the SAES of Manaus and by the Street Clinic Team. As main results based on data analysis made from the data available by the SAE /AHF of 2020 and based on the monitoring of the Psychology Service and Social Service, there is a very significant adherence of patients to antiretroviral treatment in 85% of 903 patients in monitoring. Regarding the homeless patients assisted by the Street Clinic Team (CNAR), 07 patients were followed in the last 6 years, among which 01 died due to complications with comorbidities such as tuberculosis, 01 is under treatment and the others were no longer found by the team.

Waiting list eradication in serious mental illness (SMI) “secondary care” psychology: addressing an NHS blind spot

AimsThe poster focuses on the reduction, and eventual eradication, of waiting times within a community-based NHS psychology service in the North East of England. The poster aims to demonstrate the effectiveness of strategies implemented within a secondary care psychology service whilst examining patterns of help-seeking behaviour and treatment compliance in those waiting for therapy, and also the care needs of this cohort following a wait for services.BackgroundSecondary care waiting lists for psychological therapy, as highlighted by a recent British Medical Association audit, remain a so-called ‘blind-spot’ in mental health care provision and a national problem. Tackling waiting lists within this sector has been stated as a priority within the Five Year Forward View, however “core ingredients” of waiting list eradication methodologies and the components leading to such, have yet to be disseminated.MethodA historical audit and follow-up of clinical data were utilised to gather and analyse data of 208 individuals who were seen by the psychology service between October 2014 and March 2016.ResultNo significant differences were found between individuals who successfully completed therapy compared to those who disengaged in regard to demographic or epidemiological variables, or mental health service input. Despite lengthy waiting times of up to 3.69 years, waiting time did not significantly impact whether someone engaged with psychological services. Any form of input from psychological services led to a significant reduction in distress, as measured by the CORE-OM. No individuals who completed therapy were re-referred for psychological input at 12-month follow-up.ConclusionIf imposed appropriately over a suitable time-frame evidence-based, effective and efficient needs-led psychological input can be provided whilst eradicating a waiting list and still remaining flexible, formulation-based and person-centred.

Clinical Psychology Services for Patients Hospitalized Due to COVID-19 During the Pandemic in Northern Italy: From Isolation to Rehabilitation

The objective of this paper is to describe the organization and modality of provision of clinical psychology services for those patients who had to be hospitalized due to COVID-19 during the pandemic in Northern Italy. The IRCCS Policlinico San Donato hospital in Milan was converted into a COVID-19 center in March 2020, and all the staff, including the Clinical Psychology Service Team, were diverted to assist these patients. A description is given of how the service was organized and the modalities which were utilized to assist the patients. Following the pertinent ministerial decrees, guidelines, and relevant literature, the patients were followed up through telehealth (via phone, smartphone, or tablet with audio or audio-visual calls). A COVID-19 rehabilitation unit was later opened in April 2020, where all patients were seen and followed up by the Clinical Psychology team, the last patient being discharged at the end of June. Details are given about the type of services provided during the hospitalization at the different points in time. At admittance and subsequent isolation, patients indicated by the medical and nursing staff, and those who specifically requested it, were given psychological support. Patients transferred to the COVID-19 rehabilitation unit were all evaluated for anxiety, depression, posttraumatic stress disorder, and sleep disorders both on admission and at discharge when possible.

Establishing a clinical psychology team within the orthognathic service: A triad model of orthodontic, maxillofacial and psychological care

The importance of psychological support for orthognathic patients has taken an increasing precedence over recent years and is embedded in orthognathic commissioning guidelines. Furthermore, attention towards mental health-related conditions and their management is of prime importance and continues to be a key area of focus within healthcare settings. With this in mind, this paper aims to outline our experience of establishing a need for and subsequently securing funding to establish a clinical psychology service within an existing orthognathic service in the NHS. The information outlined may be of benefit to orthognathic teams seeking to secure such psychological support within their respective units.

Evaluating Sport Psychology Service Delivery for Elite USA Track and Field Athletes: Findings and Recommendations

In preparation for the 2020–2024 Olympic cycle, members of the USA Track and Field sport psychology (SP) subcommittee investigated the SP service provision needs and preferences of 88 elite Olympic-level athletes. A mixed-methods needs analysis was employed, which consisted of surveys, interviews, and a focus group, to help understand current SP usage and shape future SP services for USA Track and Field. Findings highlighted a lack of knowledge and exposure to SP services and a desire for increased contact with SP professionals among athletes, exposing gaps and room for improvement in service delivery. Athletes cited flexibility in terms of service delivery mode and shared common core preferences for mental training, including help managing stress, pressure, emotions, and other challenges of competition and training. The results are discussed in relation to strengthening the effectiveness of service provision through increasing visibility, accessibility, and education regarding the benefits of SP services.