Rapid Adoption and Implementation of Telehealth Group Psychotherapy During COVID 19: Practical Strategies and Recommendations

The therapeutic alliance during remotely delivered therapy: A Delphi study with health professionals

OBJECTIVES

Delivering psychological therapy via videoconferencing and telephone is now commonplace across mental health services, but many therapists remain concerned about the impact on the therapeutic alliance. This study aimed to establish consensus amongst psychological therapists regarding the factors involved in establishing and maintaining the therapeutic alliance during remote therapy interventions.

METHODS

Psychological therapists from a range of professional backgrounds were invited to complete a three-Round Delphi survey online. Round 1 generated qualitative data which was used to develop a list of statements relating to key factors in establishing and maintaining alliance in therapy delivered over the telephone or videoconferencing. Participants were invited to rate their level of agreement with these statements in Rounds 2 and 3.

RESULTS

Of the 149 participants who completed Round 1, 93 completed Round 2, and 71 participants completed all three Rounds. Following Round 3, a high level of agreement (above 80%) was obtained in relation to 31/63 statements reflecting communication style, contracting, quality and value, environment, emotional differences, effort, and technological aspects of engaging clients in this way. Participants reported similar views for therapies delivered via telephone and videoconferencing.

DISCUSSION

Clinicians who have had to navigate the rapid rise in online delivery of therapy have valuable insights which warrant sharing amongst communities of practicing therapists and those in training. Identifying factors which therapists agree are important in developing alliances with patients remotely also guides researchers in identifying factors that warrant further investigation through empirical studies.

Lessons Learned from the Rapid Implementation of Telehealth Group Psychotherapy at a Safety-Net Health System in the U.S

There is inadequate availability and access to behavioral health services to meet demand, and this issue amplified during the pandemic, creating a mental health crisis. Group therapy is an effective way to meet this need. The rapid implementation of telehealth group psychotherapy as part of a Primary Care Behavioral Health Integration program in a U.S. safety-net health care setting is described. Implementation lessons are summarized as barriers or facilitators, using thematic analysis of qualitative data from meeting notes. Major facilitators identified include having key staff serve as technology champions, dedicated administrative leadership to operationalize workflows, and communication and collaboration across teams and layers of infrastructure. Major barriers include uncertainty about operational workflows and technological challenges. While group visit volume initially waned, it began to rebound and quantitative analysis of demographic data shows that important underserved populations were reached. Frequent communication, collaboration, and adaptation among teams are critical elements for improving the likelihood of successful telehealth group therapy. It is feasible to expeditiously implement telehealth group psychotherapy in safety-net health care systems with limited resources.

Perceived Barriers and Facilitators of Behavioral-Health Modality Change Adoption During the COVID-19 Pandemic: A Systematic Review

Introduction

During the Coronavirus Disease 2019 pandemic, there was a surge in demand for mental health services worldwide, presenting challenges for healthcare institutions as they navigated changes in policy and safety regulations. In the United States, this resulted in many behavioral health modality changes to remain in compliance with the Center for Disease Control guidelines. A growing body of literature has documented these, yet few explored barriers and facilitators affecting the adoption of these modality delivery changes. The researchers conducted a systematic review using the PRISMA method, focusing on service delivery changes across healthcare systems in the United States from March 2020 to May 2022.

Objective

The study objective was to identify barriers and facilitators affecting the adoption of changes to modality delivery of behavioral health services due to pandemic restrictions.

Methods

This was a systematic review that utilized the PRISMA method. The researchers identified 445 initial articles from eight databases using predetermined keywords and implemented a three-round screening process to select the most pertinent articles for this review. The researchers used a thematic analysis focused on user-related, program-related, technology, and environment-related constructs relevant to engagement with digital mental health interventions, and also addressed provider and administrative-related barriers and facilitators of virtual behavioral health modality changes. Barriers and facilitators were operationalized using the Borghouts Model.

Results

This systematic review revealed several common barriers and facilitators, including underdeveloped technology infrastructure, privacy and confidentiality concerns, poor technology literacy, availability of diverse technology options, provider technology training, and ease of integration into everyday life.

Conclusion

This review provides insights into barriers and facilitators of modality change adoption, which could inform the development and implementation of virtual mental healthcare services and may help optimize the application of these services by improving our understanding and ability to overcome barriers influencing their adoption.

Modality and terminology changes for behavioral health service delivery during the COVID-19 pandemic: a systematic review

Introduction

The COVID-19 pandemic prompted healthcare professionals to implement service delivery adaptations to remain in compliance with safety regulations. Though many adaptations in service delivery were reported throughout the literature, a wide variety of terminology and definitions were used.

Methods

To address this, we conducted a PRISMA review to identify service delivery adaptations across behavioral healthcare services in the United States from March 2020 to May 2022 and to identify variations in terminology used to describe these adaptations. We identified 445 initial articles for our review across eight databases using predetermined keywords. Using a two-round screening process, authors used a team approach to identify the most appropriate articles for this review.

Results

Our results suggested that a total of 14 different terms were used to describe service modality changes, with the most frequent term being telehealth (63%). Each term found in our review and the frequency of use across identified articles is described in detail.

Discussion

Implications of this review such as understanding modality changes during the COVID-19 pandemic and beyond are discussed. Our findings illustrate the importance of standardizing terminology to enhance communication and understanding among professionals.

Feasibility and Acceptability of a Videoconferencing CBT Intervention for Anxiety in People with Parkinson's Disease

OBJECTIVES

In people with Parkinson's disease (PwPD), non-motor symptoms such as anxiety are common and have negative impacts on their quality of life. There are currently few interventions that address anxiety in PwPD, and access to diagnosis and treatment is often limited for those living in rural areas. The aim of this study was to evaluate the feasibility and acceptability of a telehealth videoconferencing CBT intervention for anxiety in PwPD.

METHODS

A pre- and post-test feasibility study (N = 10) was conducted and evaluated utilizing the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance).

RESULTS

Lack of access to the internet and videoconferencing technology were identified as barriers to participation. Physical health issues also impacted recruitment and retention. Non-completers were significantly older and less likely to have a carer involved in the intervention. Clinician adoption of the intervention was low while participant acceptability of videoconferencing technology varied and required carer support.

CONCLUSIONS

Providing access to technology and support to overcome technological issues, as well as telehealth training for clinicians, are recommended in future studies to improve recruitment, retention, and implementation.

CLINICAL IMPLICATIONS

Identification of barriers and facilitators provides future studies with the knowledge to tailorize their program to better suit PwPD.

Videoconferencing psychotherapy from a psychodynamic point of view. A qualitative analysis

There is a growing interest in delivering videoconferencing psychotherapy (VCP) due to the enormous impact of the COVID-19 pandemic on our lives since the beginning of severe restrictions worldwide in March 2020. Scientific literature has provided interesting results about the transition to remote sessions and its implications, considering different psychotherapy orientations. Less is known about whether and how VCP affects psychodynamic psychotherapeutic approaches and reports on remote work with severe and complex mental health problems such as severe personality disorders are still scarce. The aim of the study was to examine the experiences of psychodynamic psychotherapists, mainly delivering Transference-Focused Psychotherapy (TFP), with the transition and delivery of VCP during the first wave of the COVID-19 pandemic. Four hundred seventy-nine licensed psychotherapists completed an online survey during the peak of the pandemic. Survey data were analyzed using qualitative analysis. Results are presented and discussed concerning advantages and disadvantages regarding the access to psychotherapy, the specificity of the online video setting, bodily aspects, the quality of the therapeutic relationship, the therapeutic process including technical aspects and therapist's experience. Furthermore, we analyzed and discussed the statements concerning transference and countertransference reactions differentiating between high-level borderline and neurotic patients and low-level borderline patients. Our results support the importance to identify patients who potentially benefit from VCP. Further research including more prospective randomized controlled trials are needed to investigate the therapeutic implications of the findings.

Improving measurement-based care implementation in adult ambulatory psychiatry: a virtual focus group interview with multidisciplinary healthcare professionals

BACKGROUND

Measurement-Based Care (MBC) is an evidence-based practice shown to enhance patient care. Despite being efficacious, MBC is not commonly used in practice. While barriers and facilitators of MBC implementation have been described in the literature, the type of clinicians and populations studied vary widely, even within the same practice setting. The current study aims to improve MBC implementation in adult ambulatory psychiatry by conducting focus group interviews while utilizing a novel virtual brainwriting premortem method.

METHODS

Semi-structured focus group interviews were conducted with clinicians (n = 18) and staff (n = 7) to identify their current attitudes, facilitators, and barriers of MBC implementation in their healthcare setting. Virtual video-conferencing software was used to conduct focus groups, and based on transcribed verbatin, emergent barriers/facilitators and four themes were identified. Mixed methods approach was utilized for this study. Specifically, qualitative data was aggregated and re-coded separately by three doctoral-level coders. Quantitative analyses were conducted from a follow-up questionnaire surveying clinician attitudes and satisfaction with MBC.

RESULTS

The clinician and staff focus groups resulted in 291 and 91 unique codes, respectively. While clinicians identified a similar number of barriers (40.9%) and facilitators (44.3%), staff identified more barriers (67%) than facilitators (24.7%) for MBC. Four themes emerged from the analysis; (1) a description of current status/neutral opinion on MBC; (2) positive themes that include benefits of MBC, facilitators, enablers, or reasons on why they conduct MBC in their practice, (3) negative themes that include barriers or issues that hinder them from incorporating MBC into their practice, and (4) requests and suggestions for future MBC implementation. Both participant groups raised more negative themes highlighting critical challenges to MBC implementation than positive themes. The follow-up questionnaire regarding MBC attitudes showed the areas that clinicians emphasized the most and the least in their clinical practice.

CONCLUSION

The virtual brainwriting premortem focus groups provided critical information on the shortcomings and strengths of MBC in adult ambulatory psychiatry. Our findings underscore implementation challenges in healthcare settings and provide insight for both research and clinical practice in mental health fields. The barriers and facilitators identified in this study can inform future training to increase sustainability and better integrate MBC with positive downstream outcomes in patient care.

Telehealth Psychoeducational Groups With Latinx College Students: Findings From Focus Groups

The literatures examining psychoeducational groups and telehealth services have demonstrated positive results but less is known about the efficacy of psychoeducational telehealth groups. This study examines the perspectives of 105 Latinx college students who participated in an 8-session psychoeducational group via a telehealth platform during the COVID-19 pandemic. The research questions included (a) What was the experience of these Latinx college students participating in telehealth psychoeducational groups? and (b) What were the potential perceived advantages and disadvantages of implementing telehealth psychoeducational groups? Postintervention, a total of 16 focus groups were convened with a total of 105 Latinx college students (average number of participants per group = 6). Interviews were coded using conventional qualitative analysis and yielded four main themes: (1) group cohesion, which involved group members feeling that they were connected and that the group was a safe space; (2) group leaders, which involved leaders' preparation and knowledge and their ability to foster a safe environment); (3) cultural issues, which involved cultural values and acculturative and first-generation stress.; and (4) telehealth implementation, wherein participants described advantages and disadvantages of the telehealth approach. We discuss study limitations and directions for future research.

The Usability, Feasibility, Acceptability, and Efficacy of Digital Mental Health Services in the COVID-19 Pandemic: Scoping Review, Systematic Review, and Meta-analysis

BACKGROUND

After the rapid spread of the novel SARS-CoV-2, the short-term and long-term mental health impacts of the pandemic on the public, in particular on susceptible individuals, have been reported worldwide. Although digital mental health services expand accessibility while removing many barriers to in-person therapy, their usability, feasibility, acceptability, and efficacy require continued monitoring during the initial phase of the pandemic and its aftermath.

OBJECTIVE

In this study, we aimed to understand what mental health services are offered, whether they are practical or acceptable, and to what extent digital mental health services are effective in response to the COVID-19 pandemic across high-income and low- and middle-income countries.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline. We implemented searches in PubMed (MEDLINE), Embase, PsycINFO, and Cochrane databases for studies that were published between December 2019 and November 2021 and that involved the use of digital mental health services. Two review authors screened, assessed, and extracted studies independently. The protocol was registered on the International Prospective Register of Systematic Reviews.

RESULTS

This review identified 7506 articles through database searching. In total, 65 (0.9%) studies from 18 countries with 67,884 participants were eligible for the scoping review. Of the 65 studies, 16 (24.6%) were included in the meta-analysis. A total of 15 (23.1%) studies measured the usability; 31 (47.7%) studies evaluated the feasibility; 29 (44.6%) studies assessed the acceptability; and 51 (78.5%) studies assessed the efficacy. Web-based programs (21/65, 32.3%), videoconferencing platforms (16/65, 24.6%), smartphone apps (14/65, 21.5%), and SMS text messaging (5/65, 7.7%) were the main techniques. Psychotherapy (44/65, 67.7%) followed by psychoeducation (6/65, 9.2%) and psychological support (5/65, 7.7%) were commonly used. The results of the meta-analysis showed that digital mental health interventions were associated with a small reduction in depressive symptoms (standardized mean difference=-0.49; 95% CI -0.74 to -0.24; P<.001) and a moderate reduction in anxiety symptoms (standardized mean difference=-0.66; 95% CI -1.23 to -1.0; P=.02) significantly.

CONCLUSIONS

The findings suggest that digital mental health interventions may be practical and helpful for the general population, at-risk individuals, and patients with preexisting mental disorders across high-income and middle-income countries. An expanded research agenda is needed to apply different strategies for addressing diverse psychological needs and develop integrated mental health services in the post-COVID-19 era.

TRIAL REGISTRATION

PROSPERO CRD42022307695; https://tinyurl.com/2jcuwjym.

Implementation strategies for telemental health: a systematic review

BACKGROUND

The COVID-19 pandemic resulted in a rapid shift from traditional face-to-face care provision towards delivering mental health care remotely through telecommunications, often referred to as telemental health care. However, the manner and extent of telemental health implementation have varied considerably across settings and areas, and substantial barriers are encountered. There is, therefore, a need to identify what works best for service users and staff and establish the key mechanisms for efficient integration into routine care.

OBJECTIVE

We aimed to identify investigations of pre-planned strategies reported in the literature intended to achieve or improve effective and sustained implementation of telemental health approaches (including video calls, telephone calls, text messaging platforms or a combination of any of these approaches with face-to-face care), and to evaluate how different strategies influence implementation outcomes.

METHODS

A systematic review was conducted, with five databases searched for any relevant literature published between January 2010 and July 2021. Studies were eligible if they took place in specialist mental health services and focused on pre-planned strategies to achieve or improve the delivery of mental health care through remote communication between mental health professionals or between mental health professionals and service users, family members, unpaid carers, or peer supporters. All included studies were quality-assessed. Data were synthesised using the Expert Recommendations for Implementing Change (ERIC) compilation of implementation strategies and the taxonomy of implementation outcomes.

RESULTS

A total of 14 studies were identified as meeting the inclusion criteria from a total of 14,294 records of which 338 were assessed at full text. All ERIC implementation strategies were used by at least one study, the most commonly reported being 'Train and educate stakeholders'. All studies reported using a combination of several implementation strategies, with the mean number of strategies used per study of 3.5 (range 2-6), many of which were reported to result in an improvement in implementation over time. Few studies specifically investigated a single implementation strategy and its associated outcomes, making conclusions regarding the most beneficial strategy difficult to draw.

CONCLUSIONS

Using a combination of implementation strategies appears to be a helpful method of supporting the implementation of telemental health. Further research is needed to test the impact of specific implementation strategies on implementation outcomes.

Psychological Status of the Participants in Alzheimer's Prevention Initiative Autosomal Dominant Alzheimer's Disease Colombia

BACKGROUND

The SARS-CoV2 global pandemic impacted participants in the Alzheimer's Prevention Initiative (API) Autosomal Dominant Alzheimer's Disease (ADAD) clinical trial, who faced three stressors: 1) fear of developing dementia; 2) concerns about missing treatment; and 3) risk of SARS-CoV2 infection.

OBJECTIVE

To describe the frequency of psychological disorders among the participants of the API ADAD Colombia clinical study, treated by a holistic mental health team during the COVID-19 pandemic. The extent of use of mental health team services was explored considering different risk factors, and users and non-users of these services were compared.

METHODS

Participants had free and optional access to psychology and psychiatry services, outside of the study protocol. Descriptive statistics was used to analyze the frequency of the mental health difficulties. A multivariable logistic regression model has been used to assess associations with using this program.

RESULTS

66 participants were treated by the Mental Health Team from March 1, 2020, to December 31, 2020. Before and after the start of the pandemic, the most common psychological problems were anxiety (36.4% before, 63.6% after) and depression (34.8% before, 37.9% after). 70% of users assisted by psychology and 81.6% of those assisted by psychiatry felt that the services were useful for them. Female sex, depression, and anxiety before the pandemic were positively associated with being assisted by either psychology or psychiatry, while the association with hyperlipidemia was negative.

CONCLUSIONS

A holistic mental health program, carried out in the context of a study, could mitigate psychopathology during pandemics such as COVID-19.

The Implementation of Measurement-Based Care in the Context of Telemedicine: Qualitative Study

BACKGROUND

The Measurement Based Care in Mental Health Initiative launched by the Department of Veterans Affairs in 2016 is an example of an evidence-based practice that uses patient-reported outcome measures (PROMs) to improve patient outcomes. The acceptance of measurement-based care (MBC) among Veterans Affairs providers is relatively high. However, there are barriers to MBC for telehealth providers. Health information technologies might afford opportunities to address some of the barriers related to the uptake of MBC.

OBJECTIVE

This paper reports on an implementation effort to integrate MBC into mental health care telehealth practice using eHealth solutions.

METHODS

Qualitative data were generated from 22 semistructured interviews with psychiatrists (n=4), psychologists (n=3), social workers (n=3), nurses (n=6), a pharmacist (n=1), and administrative staff (n=5) who provide telemental health care through a community-based outpatient clinic in the rural Midwestern United States. The interviews were conducted during the pilot phase of an implementation initiative to increase the adoption of MBC by revising clinic workflows to integrate the use of eHealth technologies. Data were analyzed using thematic analysis.

RESULTS

Time burden and workflow issues were the most common barrier to provider adoption of MBC; sharing and reviewing pencil-and-paper measures and results in the same room was no longer possible in novel telehealth workflows necessitated by the COVID-19 pandemic. Providers voiced concerns about how long it would take to collect, adequately score, interpret, share, and document the PROMs during the telehealth visit. Concerns about time might also correspond to a gap in providers' familiarity with these assessments, greater comfort in assessing symptoms through clinical interviews, and being accustomed to using the assessments as screening tools more so than longitudinal outcome measures. Capacities associated with eHealth technologies may address workflow concerns and promote providers' understanding and use of the measures as tracking tools.

CONCLUSIONS

The need to use limited appointment time well was a top priority for telemental health providers. eHealth technologies provided operative supports that protect time in appointments by shifting when and how PROMs are collected. Bolstering providers' familiarity with how to use PROMs in the course of treatment may impact providers' buy-in by encouraging them to reconsider how sharing and acting on PROMs could be time well spent.

The transition to online psychotherapy during the pandemic: a qualitative study on patients' perspectives

The coronavirus disease 2019 (COVID-19) pandemic has substantially increased online psychotherapies due to the impossibility of participating in vis-a-vis settings. In the last years, research about online therapy has been quickly growing. However, until now, few studies investigated patients' perspective about the transition to online psychotherapy and, specifically, no qualitative research in group therapy has been done on this topic. This study aimed to explore the experience of 51 patients (39 group patients and 12 from individual psychotherapies) who continued psychotherapy in the online setting during the COVID-19 outbreak. A structured online questionnaire with open answers investigated the following topics: setting online, effectiveness, psychotherapy relationship, specific dynamics of online psychotherapy. Patients' answers were analysed by means of Consensual Qualitative Research, modified version (CQRM), an inductive method that allows analysing a large sample and relatively brief written answers. The results show the impact of shift to online platforms on patients and explore how easy or difficult it is for them to adapt to therapeutic processes are in online therapy (vs in-person therapy), by highlighting potential barriers and resources to practice implementation. Participants' responses have been arranged into three main domains: setting online, content/effectiveness of online therapy and therapeutic relationship. A fourth domain, specific for online group therapy, collected responses referred to the changes perceived regarding the group dynamics. From the patient's perspective, online therapy is effective and satisfying. Patients perceived a positive quality of therapeutic relationship in online setting, whereas produced more controversial judgments concerned the changes due to the online setting. Finally, patients in group therapy gave more attention and importance in showing and seeing private personal spaces than the ones in individual therapy.

Impact of Online Group Psychoeducation and Support Sessions on Receptivity Towards Digital Mental Health Care During the COVID-19 Pandemic: A Pilot Study

While social distancing was crucial to slow the COVID-19 virus, it also contributed to social isolation and emotional strain. This pilot study evaluated the impact of stand-alone psychoeducational group sessions designed to build social connectedness and space for people to learn about mental health during the pandemic. The study examined if offering the stand-alone group sessions increased uptake of and receptivity to additional mental health services. People had access to free, online group psychoeducational sessions offered by a digital mental health platform company. Sessions were offered to (1) employees who had mental health benefits offered through their employer, and to (2) members of the general public. Session formats included discussions, didactic lectures, and workshops, were facilitated by a mental health provider, and used live video conference technology. Topics included race and identity, stress management, coping with political events, relationship issues, and self-compassion. First-time session registrations were tracked from June 2020 to July 2021 on 6723 participants (3717 benefits-eligible employees and 3006 from the general public). Among the employee subsample, 49.5% attended a group session as their first use of any available service on the platform; 52.5% of these employees sought additional services after their first session. In anonymous post-session surveys of employees and members of the general public, 86% of respondents endorsed knowledge increases, 79.5% reported improved understanding of their mental health, 80.3% endorsed gaining actionable steps to improve mental health, 76.5% said that they would consider group sessions in addition to therapy, and 43.5% said that they would consider group sessions instead of therapy. These results suggest that scalable, brief group psychoeducational sessions are a useful conduit to mental health care and have potential to reach people who may not otherwise access available mental health services.

Overcoming Clinician Technophobia: What We Learned from Our Mass Exposure to Telehealth During the COVID-19 Pandemic

Mental health clinicians have migrated to telehealth during the COVID-19 pandemic and have reported their use of telehealth may be permanent. Understanding how stakeholders overcame hesitancy regarding the use of telehealth can potentially reveal how stakeholders can adopt future clinical technologies. The exposure therapy conceptual framework provides one explanation of how mental health clinicians can face their concerns about technologies that promise to improve clinical outcomes and worker well-being. We review available literature published since the start of the pandemic on the extent to which clinicians migrated to telehealth and their reactions to their transitions. In particular, we review available literature that describes negative attitudes and worries by clinicians as one of many barriers of telehealth implementation. We introduce the perspective that the necessary transition to telehealth at the start of the pandemic functioned as an exposure exercise that changed many clinicians' cognitive and emotional reactions to the use of telehealth technologies. Next, we provide guidance on how clinicians can continue taking an exposure approach to learning emerging technologies that are safe and can benefit all stakeholders. Clinicians can now reflect on how they overcame hesitancy regarding telehealth during the pandemic and identify how to build on that new learning by applying strategies used in exposure therapy. The future of clinical work will increasingly require mental health clinicians to better serve their patient populations and enhance their own well-being by overcoming technophobia, a broad term for any level of hesitancy, reluctance, skepticism, worry, anxiety, or fear of implementing technology.

Online group psychodynamic psychotherapy-The effectiveness and role of attachment-The results of a short study

The role of remote treatment, including psychotherapy, has increased during the COVID-19 pandemic. The results of research in this area are promising, initially pointing to similar effectiveness for online psychotherapy as that of face-to-face psychotherapy. A significantly smaller amount of research has been conducted on online group psychotherapy, in particular, in the psychodynamic paradigm. Many authors have drawn attention to the need to conduct further research, considering specific patient features, for example, personality traits, attachment style, age, and other demographic variables. This study conducted pre- and post-treatment (10 weeks) and a 6-week follow-up, on the effectiveness of online synchronous group psychodynamic psychotherapy (via Zoom) taking into account patients' attachment styles. Four main hypotheses were tested: H1: Patients will obtain a lower score in the attachment's dimensions of anxiety and avoidance; H2: Patients will get a lower level of symptoms and sense of loneliness; H3: Patients will have increased self-esteem; and H4: The anxiety and avoidance dimensions of the attachment will be predictors for the effectiveness of online psychodynamic group psychotherapy. Twenty-two outpatients participated in the study, out of which 18 suffered from neurotic, stress-related, and somatoform disorders (F40-F48), and four suffered from a depressive episode (F32.0, F32.1) according to ICD-10. The results of the pre-treatment test showed a reduction in the global severity of psychiatric symptoms (d = -0.526) and depressive symptoms (d = -0.5), as well as an increase in self-esteem (d = 0.444) and feelings of loneliness (d = 0.46). A change in the attachment dimension, anxiety (d = -0.557) and avoidance (d = -0.526), was also observed. The above results were maintained in the follow-up test conducted after 6 weeks. Additionally, a reduction in the symptoms of social phobia was observed. Attachment dimensions were not a predictor of the effectiveness of psychotherapy, but a decrease in avoidance during therapy was a predictor of increased symptoms of pain. The results of the research are promising in terms of psychiatric symptoms and increased self-esteem. During therapy, there may be a favorable change in attachment dimensions, but this variable was not shown to be a predictor of results. These results suggest that more controlled research is required.

Effects of COVID-19 on Patients in Adult Ambulatory Psychiatry: Using Patient-Rated Outcome Measures and Telemedicine

Introduction:

To examine the effects of coronavirus disease 2019 (COVID-19) on patients in an academic psychiatric ambulatory clinic, data from a measurement-based care (MBC) system were analyzed to evaluate impacts on psychiatric functioning in patients using telemedicine. Psychiatric functioning was evaluated for psychological distress (brief adjustment scale [BASE]-6), depression (patient health questionnaire [PHQ]-9), and anxiety (generalized anxiety disorder [GAD]-7), including initial alcohol (U.S. alcohol use disorders identification test) and substance use (drug abuse screening test-10) screening.

Methods:

This observational study included MBC data collected from November 2019 to March 2021. Patient-Reported Outcome Measures (PROMs) were examined to determine changes in symptomatology over the course of treatment, as well as symptom changes resulting from the pandemic. Patients were included in analyses if they completed at least one PROM in the MBC system.

Results:

A total of 2,145 patients actively participated in the MBC system completing at least one PROM, with engagement ranging from 35.07% to 83.50% depending on demographic factors, where completion rates were significantly different for age, payor status, and diagnostic group. Average baseline scores for new patients varied for the GAD-7, PHQ-9, and BASE-6. Within-person improvements in mental health before and after the pandemic were statistically significant for anxiety, depression, and psychological adjustment.

Discussion:

MBC is a helpful tool in determining treatment progress for patients engaging in telemedicine. This study showed that patients who engaged in psychiatric services incorporating PROMs had improvements in mental health during the COVID-19 pandemic. Additional research is needed exploring whether PROMs might serve as a protective or facilitative factor for those with mental illness during a crisis when in-person visits are not possible.

Lessons Learned From VHA's Rapid Implementation of Virtual Whole Health Peer-Led Groups During the COVID-19 Pandemic: Staff Perspectives

BACKGROUND

Committed to implementing a person-centered, holistic (Whole Health) system of care, the Veterans Health Administration (VHA) developed a peer-led, group-based, multi-session "Taking Charge of My Life and Health" (TCMLH) program wherein Veterans reflect on values, set health and well-being-related goals, and provide mutual support. Prior work has demonstrated the positive impact of these groups. After face-to-face TCMLH groups were disrupted by the COVID-19 pandemic, VHA facilities rapidly implemented virtual (video-based) TCMLH groups.

OBJECTIVE

We sought to understand staff perspectives on the feasibility, challenges, and advantages of conducting TCMLH groups virtually.

METHODS

We completed semi-structured telephone interviews with 35 staff members involved in the implementation of virtual TCMLH groups across 12 VHA facilities and conducted rapid qualitative analysis of the interview transcripts.

RESULTS

Holding TCMLH groups virtually was viewed as feasible. Factors that promoted the implementation included use of standardized technology platforms amenable to delivery of group-based curriculum, availability of technical support, and adjustments in facilitator delivery style. The key drawbacks of the virtual format included difficulty maintaining engagement and barriers to relationship-building among participants. The perceived advantages of the virtual format included the positive influence of being in the home environment on Veterans' reflection, motivation, and self-disclosure, the greater convenience and accessibility of the virtual format, and the virtual group's role as an antidote to isolation during the COVID-19 pandemic.

CONCLUSION

Faced with the disruption caused by the COVID-19 pandemic, VHA pivoted by rapidly implementing virtual TCMLH groups. Staff members involved in implementation noted that delivering TCMLH virtually was feasible and highlighted both challenges and advantages of the virtual format. A virtual group-based program in which participants set and pursue personally meaningful goals related to health and well-being in a supportive environment of their peers is a promising innovation that can be replicated in other health systems.

From Office-Based Treatment to Telehealth: Comparing Clinical Outcomes and Patient Participation in a Psychiatric Intensive Outpatient Program with a Large Transdiagnostic Sample

Introduction: Patient participation and clinical outcomes of a precoronavirus disease 2019 (COVID-19) office-based transdiagnostic psychiatric intensive outpatient program (IOP) were compared with those of telehealth IOP during COVID-19. Materials and Methods: Weeks of enrollment, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessments, and sociodemographic and clinical factors (including group track and diagnosis) were collected during pre-COVID-19 (n = 191) and during COVID-19 (n = 200). Continuous and categorical measures of GAD-7 and PHQ-9 were analyzed; potential sociodemographic and clinical covariates to scores were also explored. Results: There were no statistically significant differences in participation between time periods. Associations were observed between PHQ-9/GAD-7 score improvement and number of assessments. Significant score reductions occurred in both periods, and differences in change scores were not significant. Sociodemographic and clinical factors were not significantly different between time periods. Patients with commercial insurance had significantly higher improvement in both mean and categorical PHQ-9 scores (t = 2.77, p = 0.006; χ² = 10.47, df = 1, p = 0.001) and GAD-7 scores (t = 2.29, p = 0.023; χ² = 8.58, df = 1, p = 0.003) than those with public insurance. Patients with anxiety disorders had significantly greater improvements (F = 4.49, p = 0.004; χ² = 9.15, df = 3, p = 0.027) in GAD-7 during COVID-19. Discussion: Significant improvements in PHQ-9/GAD-7 scores and measures of participation were not significantly different between telehealth and office-based IOP, nor were they greatly influenced by clinical or sociodemographic factors. Further study is needed of possible care disparities for publicly insured patients. Conclusion: Despite some limitations, telehealth IOP appears to be a clinically appropriate option for a diverse sociodemographic and diagnostically heterogeneous psychiatric population.

Virtual World Café Method for Identifying Mental Health Research Priorities: Methodological Case Study

People with lived experience of mental health problems as both consumers and carers can bring significant expertise to the research process. However, the methods used to gather this information and their subsequent results can vary markedly. This paper describes the methods for two virtual World Cafés held to gather data on consumer and carer priorities for mental health research. Several methodological processes and challenges arose during data collection, including the achieved recruitment for each group (n = 4, n = 7) falling significantly short of the target number of 20 participants per group. This led to departures from planned methods (i.e., the use of a single ‘room’, rather than multiple breakout rooms). Despite this, the participants in the virtual World Cafés were able to generate over 200 ideas for research priorities, but not identify agreed-upon priorities. Virtual World Cafés can quickly generate a significant volume of data; however, they may not be as effective at generating consensus.