use of portraiture to foster humanistic care

It has been said that a picture says a thousand words, that art should speak for itself. Within the social sciences, there is recognition that images are not merely illustrations, but “texts” that can be read, studied and interpreted in different ways: they are visual narratives. When we look at a work of art, we respond with our own thoughts, feelings and ideas about what it communicates. When we look at a portrait specifically, we are not just looking at a picture of an individual, we are looking at a picture of someone being looked at. It is a visual record of an interaction, as much as a likeness of the person. The artist-sitter relationship has much in common with the doctor patient relationship involving trust, attention, and an openness to ambiguity and creativity. As clinicians that are tired and feeling overwhelmed, we may objectify patients. Engaging with art can help hone our skills to consistently see the whole person. It provides freedom to sit with ambiguity and maintain curiosity and can help us become more flexible in our thinking, to hold multiple possibilities in mind at the same time. Viewing art in a group provides opportunities to understand and appreciate others’ perspectives. Drawing on multiple portraiture projects related to pediatric epilepsy, youth mental health and dementia, this presentation will provide constructive ways in which portraiture can be used to foster humanistic, patient centred care, and to understand the power of distributed cognition.

Coordination of sustainable financing for evidence-based youth mental health treatments: protocol for development and evaluation of the fiscal mapping process

Background Sustained delivery of evidence-based treatments (EBTs) is essential to addressing the public health and economic impacts of youth mental health problems, but is complicated by the limited and fragmented funding available to youth mental health service agencies (hereafter, “service agencies”). Strategic planning tools are needed that can guide these service agencies in their coordination of sustainable funding for EBTs. This protocol describes a mixed-methods research project designed to (1) develop and (2) evaluate our novel fiscal mapping process that guides strategic planning efforts to finance the sustainment of EBTs in youth mental health services. Method Participants will be 48 expert stakeholder participants, including representatives from ten service agencies and their partners from funding agencies (various public and private sources) and intermediary organizations (which provide guidance and support on the delivery of specific EBTs). Aim 1 is to develop the fiscal mapping process: a multi-step, structured tool that guides service agencies in selecting the optimal combination of strategies for financing their EBT sustainment efforts. We will adapt the fiscal mapping process from an established intervention mapping process and will incorporate an existing compilation of 23 financing strategies. We will then engage participants in a modified Delphi exercise to achieve consensus on the fiscal mapping process steps and gather information that can inform the selection of strategies. Aim 2 is to evaluate preliminary impacts of the fiscal mapping process on service agencies’ EBT sustainment capacities (i.e., structures and processes that support sustainment) and outcomes (e.g., intentions to sustain). The ten agencies will pilot test the fiscal mapping process. We will evaluate how the fiscal mapping process impacts EBT sustainment capacities and outcomes using a comparative case study approach, incorporating data from focus groups and document review. After pilot testing, the stakeholder participants will conceptualize the process and outcomes of fiscal mapping in a participatory modeling exercise to help inform future use and evaluation of the tool. Discussion This project will generate the fiscal mapping process, which will facilitate the coordination of an array of financing strategies to sustain EBTs in community youth mental health services. This tool will promote the sustainment of youth-focused EBTs.