The COVID PIVOT - Re-orienting Child and Youth Mental Health Care in the Light of Pandemic Restrictions

Effectiveness of videoconference-delivered psychotherapy for children, adolescents, and their parents: A meta-analysis of randomized controlled trials

IntroductionOver the last years, videoconference-delivered psychotherapy (VCP) has been more commonly used in clinical practice. This meta-analysis is the first to evaluate the effectiveness of VCP for children and adolescents with a mental disorder and their parents.MethodsA systematic literature search was performed to identify randomized controlled trials (RCTs) that compared the effectiveness of VCP for youths with a mental disorder to a control condition. Twelve studies were included. Two reviewers independently extracted data and rated study quality.ResultsEffect size estimates for measures of children's symptoms of mental disorders were large for comparison between VCP and waitlist (posttreatment: Hedges's g = -1.26, k = 5) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = 0.00, k = 6; follow-up: g = -0.05, k = 3). Similarly, effect size estimates for measures of children's functional impairments were large for comparison between VCP and waitlist (posttreatment: g = -1.10, k = 3) and negligible for comparisons between VCP and in-person treatment (posttreatment: g = -0.23, k = 3; follow-up: g = 0.04, k = 2). VCP more effectively reduced symptoms in children with an internalizing disorder (g = -0.88, k = 5) compared to externalizing disorders (g = 0.25, k = 2) or tic disorders (g = -0.08, k = 3).DiscussionThe results provide preliminary evidence that VCP is an effective treatment for youths with a mental disorder and their parents. VCP was equally effective as in-person treatment in reducing children's symptoms and functional impairments. Limitations include the limited number of RCTs and incomplete reporting of methodological features.

The trend of once-off versus follow-up Medicare-reimbursed psychiatric consultations and increased telehealth availability: an interrupted time series analysis

Objective The Australian Medicare Benefits Schedule (MBS) telehealth items were expanded in March 2020 and consolidated in January 2022. We aim to describe the trend of the ratio of MBS psychiatric video items for once-off assessments to follow-up sessions and examine the effect of telehealth consolidation. Methods Psychiatric once-off item to follow-up item ratios in face-to-face (F2F) and video modes were computed from state and territory-level monthly Medicare data (January 2016-December 2023). We performed a multilevel interrupted times series analysis (ITSA) of once-off video consultations with telehealth consolidation as the intervention, followed by subgroup analyses by age groups. Finally, in the young adult group (25-44years), we performed a multiple-group ITSA comparing video once-off to follow-up ratios between genders. Results The once-off to follow-up ratio for video items after telehealth consolidation greatly increased compared with F2F items, with rapid growth in once-off assessments. Sustained high video once-off assessment usage occurred in the youth (15-24years) and young adult (25-44years) groups, while other age groups showed declines following the initial rise. The male group showed a greater initial increase in the video once-off to follow-up ratio among young adults but the ratio continued to rise only in the female group. Conclusions The evolving trends of reimbursed telepsychiatry consultations require further examination given their potential implications concerning service quality, health equity, health attitudes and behaviours, and healthcare costs.

Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists

INTRODUCTION

Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing.

METHODS

Caregivers (parents) and psychotherapists of n  =  228 patients (4-20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1).

RESULTS

At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists' ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r < .35).

CONCLUSION

The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639).

Embedding Technology-Assisted Parenting Interventions in Real-World Settings to Empower Parents of Children With Adverse Childhood Experiences: Co-Design Study

BACKGROUND

Adverse childhood experiences are strongly associated with mental disorders in young people. Parenting interventions are available through community health settings and can intervene with adverse childhood experiences that are within a parent's capacity to modify. Technology can minimize common barriers associated with engaging in face-to-face parenting interventions. However, families experiencing adversity face unique barriers to engaging with technology-assisted parenting interventions. Formative research using co-design methodology to provide a deep contextual understanding of these barriers can help overcome unique barriers and ensure these families can capitalize on the benefits of technology-assisted parenting interventions.

OBJECTIVE

This study aims to innovate the parenting support delivered by a community health and social service with technology by adapting an existing, evidence-based, technology-assisted parenting intervention.

METHODS

Staff (n=3) participated in dialogues (n=2) and co-design workshops (n=8) exploring needs and preferences for a technology-assisted parenting intervention and iteratively developing a prototype intervention (Parenting Resilient Kids [PaRK]-Lite). Parents (n=3) received PaRK-Lite and participated in qualitative interviews to provide feedback on their experience and PaRK-Lite's design.

RESULTS

PaRK-Lite's hybrid design leverages simple and familiar modes of technology (podcasts) to deliver intervention content and embeds reflective practice into service provision (microcoaching) to enhance parents' empowerment and reduce service dependency. A training session, manuals, session plans, and templates were also developed to support the delivery of microcoaching. Feedback data from parents overall indicated that PaRK-Lite met their needs, suggesting that service providers can play a key role in the early phases of service innovation for parents.

CONCLUSIONS

The co-designed technology-assisted parenting intervention aims to offer both parents and clinicians a novel and engaging resource for intervening with maladaptive parenting, contributing to efforts to respond to childhood adversity and improve child mental health. Future research in the field of human-computer interaction and health service design can consider our findings in creating engaging interventions that have a positive impact on the well-being of children and families.

The Coronavirus Pandemic and Mental Health Presentations of Young Children

Children under the age of four are emotionally vulnerable to global disasters, such as the COVID-19 pandemic given the lack of socialization opportunities and coping mechanisms, and susceptibility to heightened caregiver stress. Currently, the extent to which the pandemic impacted the mental health of clinically referred young children is unknown. To evaluate how children's mental health outcomes were impacted during the pandemic, interRAI Early Years assessments (N = 1343) were obtained from 11 agencies across the Province of Ontario, during pre-pandemic and pandemic timepoints. Findings demonstrated that the number of completed assessments declined during the pandemic. Further, children's emotional concerns differed before and during the pandemic, whereby children exhibited greater emotional dysregulation during the pandemic. However, there were no significant differences when examining caregiver distress, parenting strengths, child distractibility/inattention or behavioural issues. Implications for young children and their families, clinicians, and policy makers are discussed.

Mental health care measures and innovations to cope with COVID-19: an integrative review

This integrative review aims to identify the mental health care measures that were produced during the COVID-19 pandemic. This research was conducted on three databases (SciELO, PubMed, and LILACS) with the following descriptors in Portuguese, English, and Spanish: "SAÚDE MENTAL" or "SALUD MENTAL" or "MENTAL HEALTH" AND "COVID-19" from 2020 to 2021. In total, 3,451 articles were found, 43 of which were analyzed. Most measures were digital, stemmed from public institutions, focused on the local perspective, and were integrated with the public health care system. This study discusses the models of care in mental health based on measures to cope with the COVID-19 pandemic. It also discusses the Brazilian health care system, reiterating its resilience. In conclusion, digital measures occurred most often. This study suggest the evaluation of the accessibility of this mental health care model for most vulnerable groups. Finally, this research reinforces the importance of the Brazilian health care system for public health and access to information to cope with the COVID-19 pandemic.

Telepsychiatry in Australia: A Scoping Review

Telepsychiatry formed part of the Australian mental health response to COVID-19, but relevant reviews pre- and post-pandemic are sparse. This scoping review aimed to map the literature on telepsychiatry in Australia and identify key research priorities. We searched databases (Medline, PubMed, PsycINFO, Scopus, Web of Science, EBSCO Psychology & Behavioral Sciences Collection, Proquest databases, and Cochrane Central Register of Controlled Trials) and reference lists from January 1990 to December 2022. Keywords included telepsychiatry, videoconferencing, telephone consultation, psychiatry, mental health, and Australia. Two reviewers independently screened titles, abstracts, and full texts. We identified 96 publications, one-third of which appeared since 2020. Extracted data included article types, service types, usage levels, outcome measures, perceptions, and research gaps. Most publications were quantitative studies (n = 43) and narrative reports of services (n = 17). Seventy-six papers reported mostly publicly established services. Videoconferencing alone was the most common mode of telepsychiatry. There was increased use over time, with the emergence of metropolitan telepsychiatry during the pandemic. Few papers used validated outcome measures (n = 5) or conducted economic evaluations (n = 4). Content analysis of the papers identified perceptions of patient (and caregiver) benefits, clinical care, service sustainability, and technology capability/capacity. Benefits such as convenience and cost-saving, clinical care issues, and implementation challenges were mentioned. Research gaps in patient perspectives, outcomes, clinical practice, health economics, usage patterns, and technological issues were identified. There is consistent interest in, and growth of, telepsychiatry in Australia. The identified perception themes might serve as a framework for future research on user perspectives and service integration. Other research areas include usage trends, outcome measures, and economic evaluation.

Receptivity towards Remote Service Delivery among Social Work Clients and Practitioners during COVID Times: A Systematic Review

PURPOSE

This systematic review aims to identify and synthesize the available evidence on the receptivity toward, perceived advantages and challenges of remote service delivery among social work clients and practitioners during the context of COVID-19.

METHOD

Two electronic databases were searched from 2020 to 2022. Identified papers were screened against the established eligibility criteria, yielding 15 papers. Two additional papers were further identified through hand-search. As heterogeneity of studies was high, a narrative synthesis was performed to summarize the overall evidence.

RESULTS

Our review provides evidence that remote service delivery holds the potential to increase access to services among selected client populations as well as promote a sense of empowerment for clients and opportunities for practice enhancement for practitioners.

DISCUSSION & CONCLUSION

The findings from our study highlighted the need for innovative solutions and practical considerations for ongoing remote service, including the careful considerations of social work clients' and practitioners' suitability, the need for provision of training and ongoing support to optimize practitioners' well-being. As the delivery of services transition to face-to-face or remain remote, further research is needed to assess the promise of remote practice in optimizing overall service delivery, while maintaining client-reported satisfaction.

The Provision and Utilization of Telehealth within Academic Mental Health Clinics in North America during the COVID-19 Pandemic

Objective

To document the experience of 14 academic child and adolescent psychiatry programs in transitioning to and managing telehealth services during the COVID-19 pandemic. The goal was to understand how programs adopted and sustained telehealth during the pandemic. Telehealth was defined as services delivered via videoconferencing and telephony.

Method

In this descriptive study, faculty from 14 programs completed online surveys about the use of both telehealth and in-person services from February 2020 to June 2021. Survey questions addressed telehealth practices (e.g., policies, support resources), monthly service utilization, telehealth modality (videoconferencing vs. telephony), and missed appointments.

Results

Programs varied in the proportion of appointments delivered by telehealth prior to the pandemic (February 2020; 0-27%). By May 2020 all programs were providing a majority of visits via telehealth (64-100%). In June 2021, all programs continued to provide services via telehealth (41% to 100%) and reported that they would continue to do so moving forward. Programs addressed many challenges to telehealth provision during the study period, including adding interpreter services, technological support for providers and patients, and formalizing safety and training requirements.

Conclusion

Academic child and adolescent psychiatry programs provided outpatient services primarily via telehealth throughout the COVID-19 pandemic and reported that they planned to continue utilizing telehealth in combination with in-person services moving forward. Academic programs should therefore address logistical, technological, and financial barriers to the sustained use of telehealth.

Global priorities for improving access to mental health services for adolescents in the post-pandemic world

Although several mental health conditions have their onset during adolescence, a very small proportion of adolescents receive adequate evidence-based interventions. There are both demand and supply-side barriers to accessing mental healthcare. The problem has been further exacerbated by the COVID-19 pandemic, which disrupted the general life, health care services, and mental health of children, adolescents, and young adults across the globe. Despite multiple implementation challenges, interventions delivered in school settings and using digital health technologies can improve access to mental health care for adolescents, especially given the reverberations of the COVID era. While designing adolescent mental health programs, special emphasis needs to be on equity and trying to reach out to adolescents who need services the most.

Changes in Children and Youth's Mental Health Presentations during COVID-19: A Study of Primary Care Practices in Northern Ontario, Canada

Recent research suggests that children and youth are at increased risk of anxiety and depression due to the indirect effects of the COVID-19 pandemic. In Canada, children and youths may face additional hurdles in accessing mental health services in rural areas due to socioeconomic disadvantages and healthcare provider shortages worsened by the pandemic. Our study aimed to assess changes in primary healthcare utilization related to depression and anxiety among children and youth aged 10-25 years in Northern Ontario, Canada. We analyzed de-identified electronic medical record data to assess primary healthcare visits and prescriptions for depression and anxiety among children and youth aged 10-25 years. We used provider billing data and reasons for visits and antidepressant/antianxiety prescriptions compared with 21 months pre-pandemic (1 June 2018 to 28 February 2020) and 21 months during the pandemic (1 April 2020 to 31 December 2021). Our interrupted time series analysis showed an average increase in visits by 2.52 per 10,000 person-months and in prescriptions by 6.69 per 10,000 person-months across all ages and sexes. Females aged 10 to 14 years were found to have the greatest relative change in visits across all age-sex groups. The greatest relative increases in antianxiety and antidepression prescriptions occurred among females and males aged 10 to 14 years, respectively. These findings indicate that there were increased anxiety and depression presentations in primary healthcare among children and youths living in northern and rural settings during the COVID-19 pandemic. The increased primary healthcare presentations of anxiety and depression by children and youths suggest that additional mental health resources should be allocated to northern rural primary healthcare to support the increased demand. Adequate mental health professionals, accessible services, and clinical recommendations tailored to northern rural populations and care settings are crucial.

Determinants of psychotherapists' attitudes to online psychotherapy

Introduction

Online psychotherapy is a form of work that is becoming more and more popular. Public health problems, such as COVID-19, forced mental health professionals and patients to incorporate new methodologies such as the use of electronic media and internet to provide follow-up, treatment and also supervision. The aim of this study was to investigate which factors shape the therapists' attitudes toward online psychotherapy during a pandemic taking into account: (1) attitudes toward the COVID-19 pandemic (fear of contagion, pandemic fatigue, etc.), (2) personal characteristics of the psychotherapists (age, gender, feeling of efficacy, anxiety, depression, etc.), and (3) characteristics of the psychotherapeutic practice (guideline procedure, client age group, professional experience, etc).

Materials and methods

Study participants were 177 psychotherapists from four European countries: Poland (n = 48), Germany (n = 44), Sweden (n = 49), and Portugal (n = 36). Data were collected by means of an individual online survey through the original questionnaire and the standardized scales: a modified version of the Attitudes toward Psychological Online Interventions Scale (APOI), Fear of Contagion by COVID-19 Scale (FCS COVID-19), Pandemic Fatigue Scale (PFS), Hospital Anxiety and Depression Scale (HADS), Social Support Questionnaire (F-SozU K-14), and the Sense of Efficiency Test (SET).

Results

Determinants that impacted psychotherapists' attitudes toward online therapy were: COVID-19 belief in prevention-keeping distance and hand disinfection, pandemic behavioral fatigue, previous online therapy experience (including voice call), working with youth and adults. Our study showed that belief in the sense of prevention in the form of taking care of hand disinfection before the session, pandemic behavioral fatigue and experience in working with adults were significant predictors of negative attitudes of therapists toward online psychological interventions. On the other hand, belief in the sense of prevention in the form of keeping distance during the session had a positive effect on general attitudes toward therapy conducted via the internet.

Discussion

The online therapy boom during the COVID-19 pandemic has spawned a powerful tool for psychotherapists. More research in this area and training of psychotherapists are needed for online psychological interventions to become an effective therapy format that is accepted by patients and therapists alike.

Youth care in time of COVID-19: Experiences of professionals and adolescent clients with telehealth

Measures aimed at preventing the COVID-19 virus from spreading restricted all aspects of public life, including possibilities for meeting in-person. Youth care professionals were forced to turn to telehealth tools, such as video calling and e-health methods, to be able to continue support and treatment of children, adolescents, caregivers, and families. This study consists of two qualitative interview studies on the experiences with and transition to telehealth during COVID-19: (1) interviews with youth care professionals (N = 20), and (2) interviews with adolescents who used mental health care support (N = 14). We specifically asked participants about five themes which were selected based on pre-COVID literature on telehealth: (1) tools (i.e., which programs are being used), (2) privacy, (3) methods (i.e., what was the same and what was different compared to in-person sessions), (4) relationship/therapeutic alliance, and (5) effectiveness (i.e., what was their impression of effectiveness of telehealth). The majority of professionals reported that they had very little to no experience with telehealth prior to the pandemic. Both professionals and adolescent clients mentioned benefits and limitations of telehealth. On several themes professionals and adolescent clients mentioned similar barriers in the transition to telehealth during COVID such as limitations of the available hard- and software (theme 1: tools); forced changes in the content and methods of the sessions (theme 3: methods); and difficulties with non-verbal communication (theme 4: alliance). However, whereas most professionals expressed the intention to keep using several aspects of telehealth after restrictions due to COVID are lifted, most adolescent clients expressed they see telehealth as a temporary solution and prefer meeting professionals in person. Their experiences and the barriers and enabling aspects they mentioned may provide important insights in the acceptability and usability of telehealth for youth care organizations, youth care professionals, researchers and higher educational training programs.

The impact of COVID-19 on school-age children

The paper examines the impact of the coronavirus disease 2019 (COVID-19) pandemic on school-age children and their families. Changes to their daily lives were examined through the lens of their physical, mental, and emotional well-being. An analysis of current literature was conducted examining the emerging research on the pandemic's effects on families. A case example is provided to offer a narrative snapshot of the many experiences faced by children and families throughout school closures and stay at home orders. The paper concludes with implications for providers and further research with special attention paid to the emergence of telehealth and implications for treatment.

Advantages and disadvantages of teleworking in healthcare institutions during COVID-19: A systematic review

Introduction

The prevalence of COVID-19 as pandemic disease and efforts to control it have caused extensive changes in work methods and the global growth of teleworking, especially in health. This study aimed to investigate the advantages and disadvantages of teleworking in healthcare institutions during the Covid-19 era.

Methods

This systematic review was conducted up to January 1, 2022, by searching the relevant keywords in PubMed, Scopus, Web of Science, and ProQuest databases. Study selection has been conducted based on inclusion and exclusion criteria. Data extraction was done using the data extraction form based on the study objectives.

Results

From all 276 articles retrieved, 14 studies were included in the study. The results show that England had the highest number of articles (6 articles). The advantages of teleworking have ten categories, and the disadvantages have nine categories. The most important benefits of teleworking include facilitating service delivery, increasing satisfaction, supporting healthcare providers, and reducing costs. The most important disadvantages of using teleworking have been the lack of facilities and support, the lack of technology acceptance, and reduced interactions between healthcare providers.

Conclusion

Although teleworking was a suitable solution for some problems in healthcare institutions during COVID-19, it is also associated with obstacles. It is recommended that managers make policies and guidelines to use appropriate technologies, provide facilities, and have continuous support and increased interactions between healthcare providers and patients.

Using Implementation Science to Inform Workforce and Service Development in Youth Mental Health: An Australian Case Study

Globally, mental illness and substance use disorders are the leading cause of disability and disease burden for young people. Orygen is an Australian youth mental health organisation with a mission to reduce the impact of mental ill health on young people, families and society, through research, clinical services, advocacy, and the design and delivery of youth mental health workforce and service development initiatives. Orygen is one of only a few known research and clinical centres with a dedicated knowledge translation division, which concentrates on growing the capacity of the systems, services, and professionals who support young people experiencing mental ill health. This paper provides a case study of the workforce development team within the Orygen knowledge translation, outlining how implementation science informs their work and how the division has adapted its model in the face of COVID-19. Since 2017, the team has delivered training to more than 4000 youth mental health workers across Australia, on the topics of trauma, psychosis, mood and anxiety disorders, brief interventions, cognition and other areas of youth mental health. The COVID-19 pandemic generated abrupt and dramatic changes to the delivery of workforce and service development initiatives in Australia due to significant restrictions to travel and in-person events. It also placed major delivery demands on youth mental health services. This paper outlines how the team at Orygen adapted their approach to youth mental health workforce development in response to COVID-19, offering reflections and future directions for implementation science that can support flexible models of support in a changing system.

Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review

BACKGROUND

Telemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed.

OBJECTIVE

This rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms.

METHODS

Rapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including "gray literature," to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups.

RESULTS

A total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed.

CONCLUSIONS

Service user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings.

TRIAL REGISTRATION

International Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910.

Cognitive-behavioral teletherapy for children and adolescents with mental disorders and their families during the COVID-19 pandemic: a survey on acceptance and satisfaction

BACKGROUND

The COVID-19 pandemic is challenging for health care systems around the world. Teletherapy (psychotherapy conducted via videoconference) for children and adolescents offers a promising opportunity not only to provide treatment during social distancing restrictions but also to reduce treatment barriers that might prevent families from seeking care independent of the pandemic. Therefore, it is highly important to examine the implementation and especially the acceptance of and satisfaction with teletherapy.

METHODS

Therapists of 561 patients and parents of 227 patients (total 643 patients) aged 3-20 years treated at a university outpatient unit rated their experiences with teletherapy.

RESULTS

Following the outbreak of COVID-19, 73% of the patients switched from face-to-face treatment to teletherapy. Both therapists and parents were mainly satisfied with teletherapy and did not report negative impacts on treatment satisfaction or the therapeutic relationship. Stress from COVID-19, age, gender, duration of treatment, psychosocial functioning, and psychopathology were associated with satisfaction, but correlations were low. Sixty-six percent of parents and 53% of therapists intended to use teletherapy in the future.

CONCLUSIONS

Teletherapy during the COVID-19 pandemic was well accepted by both parents and therapists. Certain patient characteristics were related to satisfaction. Trial registration The study was retrospectively registered in the German Clinical Trials Register (DRKS00028639).

Foster care during the COVID-19 pandemic: A qualitative analysis of caregiver and professional experiences

BACKGROUND

Research is needed to facilitate better understanding of how different groups have been impacted by COVID-19, especially those in already strained service systems such as foster care. These inquiries will support further response, recovery and preparedness efforts.

OBJECTIVE

This qualitative study addressed how professionals and caregivers in foster care described being affected by COVID-19 in order to support future research and planning for foster care systems in this pandemic context.

PARTICIPANTS AND SETTING

A sample of foster parents and foster care professionals (N = 357) from a mostly rural, southeastern state in the U.S. participated in the study.

METHODS

Qualitative analysis was conducted of 357 open-ended responses regarding the impact of COVID-19 from a survey distributed in August 2020.

RESULTS

The coding process resulted in the identification of 15 distinct themes: Isolation & Loss of Social Support, Work Changes/Stressors, School Issues, Childcare Issues, No Impact/Positive Changes, Financial Problems, Fear of Contagion, Negative Child Welfare Impacts, Mental Health Problems/Stress, Loss of Faith/Trust & Societal Frustrations, Health & Mental Healthcare Access Issues, PPE & Testing Issues, Grief & Loss, and Marital Problems. Secondary impacts rather than direct physiologic effects of the virus were primarily reported.

CONCLUSIONS

This study underscores the various challenges facing foster care systems, and how the pandemic context is exacerbating many of these issues. Further research is needed to ensure the implementation of adequately complex and nuanced responses that target needs and avoid creating further problems for foster care.

The Use of Information and Communication Technologies in Family Support across Europe: A Narrative Review

The COVID-19 pandemic has accelerated the use of information and communication technology (ICT) to deliver parenting and mental health support services to families. This narrative review illustrates the diverse ways in which ICT is being used across Europe to provide family support to different populations. We distinguish between the use of ICT in professional-led and peer-led support and provide implementation examples from across Europe. We discuss the potential advantages and disadvantages of different ways of using ICT in family support and the main developments and challenges for the field more generally, guiding decision-making as to how to use ICT in family support, as well as critical reflections and future research on its merit.

Social Work Practice During COVID-19: Client Needs and Boundary Challenges

While information and communication technologies (ICTs) permeated social work practice long before the onset of COVID-19, the abrupt need to close non-essential workplaces resulted in an unparalleled incorporation of digital technology into practice across the globe. The onset of COVID-19 occurred during phase two of research in which we were investigating social workers' informal use of ICT with clients. Prior to COVID-19, we were conducting interviews with practitioners and clients from four agencies serving diverse client populations in a large city in Canada. With the onset of COVID-19, we adapted to the COVID-19 context and amended the questions to investigate ICT use during the pandemic. In addition, with ethics approval, we conducted second interviews with practitioners interviewed prior to COVID-19 with a revised guide to address the pandemic context; and we continued to recruit and interview practitioners and clients using an amended interview guide incorporating pandemic-related questions. The sample comprised 27 practitioners and 22 clients. Eleven practitioners participated in interviews prior to and during COVID-19. Analysis of transcribed interviews revealed that the COVID-19 context had led to a paradigm shift in practitioners' ICT use, with two key themes identified: (1) boundary challenges and (2) clients' diverging ICT needs. We discuss these themes and present implications for policy and practice in a post-COVID-19 world.

Pivoting in the pandemic: a qualitative study of child and adolescent psychiatrists in the times of COVID-19

OBJECTIVES

We examined the personal and professional impacts of the COVID-19 pandemic on the development, practice, and shifting values of child and adolescent psychiatrists (CAP), in order to inform how the field may move forward post-pandemic.

METHODS

We conducted individual semi-structured interviews of child and adolescent psychiatrists (n = 24) practicing in the United States. Participants were selected as a diverse purposive sample of active members of the American Academy of Child and Adolescent Psychiatry (AACAP). We analyzed anonymized transcripts through iterative coding using thematic analysis aided by NVivo software.

RESULTS

We identified three main thematic domains within participants' response to the pandemic, which have engendered a reevaluation of and a recommitment to the aims of each clinician and the field of CAP more broadly. These domains, paired with representative questions, include: (1) Unsettling, or "who have we been?" (identifying discontents such as daily inefficiencies and intraprofessional loss of trust); (2) Adaptation, or "who are we now?" (exploring affordances and limitations of virtual work, and the evolution of personal and professional identity); and (3) Reimagination, or "who will we become?" (renewing a commitment to psychiatry as advocacy). Even as we identified a collective agreement toward the need for implementing change, just what needs to change, and how that change will be realized, remain contested.

CONCLUSION

These three thematic domains, augmented by a national confrontation with race and equity, have engendered a field-wide reckoning with known inequities. They have reinvigorated collective responses and calls to action. The divergent mindsets to change and leadership have provided an aperture for what values and practices the field might instill in its next generation of practitioners.