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Kautz SV, Bosk EA, Mendez A, Pomales H. Strategies and Adaptations to an Integrated Substance Use and Infant Mental Health Treatment Program During COVID-19. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:17-34. [PMID: 37773312 DOI: 10.1007/s10488-023-01300-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/01/2023]
Abstract
The COVID-19 pandemic resulted in increased parenting stress and substance use. At the same time that mental health and social service needs increased, access to services, including among those receiving treatment, decreased due to stay-at-home orders. Few programs were equipped or prepared to translate their interventions to a virtual format at the start of the pandemic. There is a critical need to identify effective adaptations to substance use and family-focused treatment during the COVID-19 pandemic. Effective program adaptations have continued relevance for the expansion of access to family-focused addiction services beyond the pandemic itself, particularly for rural or other hard to reach populations. Seventy-three semi-structured interviews were conducted with the five agencies participating in the implementation of the In-Home Recovery Program (IHRP), an in-home, substance use disorder (SUD) treatment program. Using a rapid analysis approach two coders analyzed interviews for recurring concepts and themes. Facilitators for adapting services included: (1) the introduction of virtual toxicology screens, (2) helping parents access technology, (3) assisting parents with non-identified children to decrease their stress, and (4) anticipating reoccurrences of substances during the pandemic. Barriers to adapting services included: (1) engaging young children in virtual treatment, (2) privacy, and (3) engaging in telehealth with parents experiencing domestic violence or reoccurrence of substances. Findings reveal virtual substance use treatment is possible. Facilitators to adaptation such as providing access to technology and virtual toxicology screens demonstrate the feasibility and acceptability of utilizing telehealth interventions for substance use. Barriers to adaptations were primarily related to the infant mental health component. Telehealth is likely not appropriate for children below the age of five. Individual sessions focusing on caregiving, rather than dyadic treatment may be more suitable to virtual formats.
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Affiliation(s)
- Sarah V Kautz
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, Room 713, New Brunswick, NJ, 08901, USA.
| | - Emily A Bosk
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, Room 713, New Brunswick, NJ, 08901, USA
| | - Alicia Mendez
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, Room 713, New Brunswick, NJ, 08901, USA
| | - Hannah Pomales
- School of Social Work, Rutgers, The State University of New Jersey, 390 George Street, Room 713, New Brunswick, NJ, 08901, USA
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Labella MH, Benito-Gomez M, Margolis ET, Zhang J, Dozier M. Telehealth delivery of modified attachment and biobehavioral catch-up: feasibility, acceptability, and lessons learned. Attach Hum Dev 2023; 25:240-253. [PMID: 36803169 PMCID: PMC10453955 DOI: 10.1080/14616734.2023.2179577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The COVID-19 pandemic necessitated dramatic shifts in the delivery and evaluation of attachment-based home-visiting services. The pandemic disrupted a pilot randomized clinical trial of modified Attachment and Biobehavioral Catch-Up (mABC), an attachment-based intervention adapted for pregnant and peripartum mothers with opioid use disorders. We transitioned from in-person to telehealth delivery of mABC and modified Developmental Education for Families, an active comparison intervention targeting healthy development. Of 40 mothers then enrolled in study interventions, 30 participated in telehealth, completing an average of 4.7 remote sessions each (SD = 3.0; range = 1-11). Following the transition to telehealth, 52.5% of randomized cases and 65.6% of mothers maintaining custody completed study interventions, comparable to pre-pandemic rates. Overall, telehealth delivery was feasible and acceptable, and mABC parents coaches' ability to observe and comment on attachment-relevant parenting behaviors was preserved. Two mABC case studies are presented and lessons learned for future telehealth implementation of attachment-based interventions are discussed. .
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Affiliation(s)
- Madelyn H. Labella
- Department of Psychological Sciences, William & Mary, Williamsburg, VA, USA
| | - Marta Benito-Gomez
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | - Emma T. Margolis
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | - Jingchen Zhang
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | - Mary Dozier
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
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Meadowcroft D, Davis W. Understanding the Effect of the COVID-19 Pandemic on Substance Use Disorder Treatment Facility Operations and Patient Success: Evidence From Mississippi. Subst Abuse 2022; 16:11782218221095872. [PMID: 35592585 PMCID: PMC9112314 DOI: 10.1177/11782218221095872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to disruptions in the provision of care at substance use disorder (SUD) treatment facilities. Stresses associated with the pandemic could also negatively impact treatment outcomes for clients. The aim of this study is to evaluate how SUD treatment facilities in Mississippi changed their operations following the start of the pandemic. The change in client success rates at the facilities is also assessed. METHODS An online survey was completed by 12 SUD treatment facilities in Mississippi between February and May 2021. RESULTS Generally, the facilities' capacity to provide treatment to clientele was moderately affected by the pandemic. Facilities in the sample also adapted a variety of policies to limit the spread of COVID-19. Changes in the services provided by facilities was observed in the survey responses. For client success rates reported by the facilities, there was a decrease in the number of facilities stating that more than 80% of their clients completed treatment across the pre- and post-pandemic periods. However, the number of facilities with more than 80% of their clients successfully finishing treatment has increased in recent months. CONCLUSIONS To continue serving their clientele during the pandemic, facilities enacted COVID-19-related policies and began offering new services such as telehealth. Although client success rates decreased at the beginning of the pandemic, they have returned to pre-pandemic levels in recent months. Our results indicate that SUD treatment facilities and clients have improved in terms of giving and receiving care as the pandemic has progressed.
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Affiliation(s)
- Devon Meadowcroft
- Delta Research and Extension Center,
Mississippi State University, Stoneville, Mississippi, MS, USA
| | - Will Davis
- Department of Agricultural Economics,
Mississippi State University, Starkville, Mississippi, MS, USA
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Samji H, Wu J, Ladak A, Vossen C, Stewart E, Dove N, Long D, Snell G. Review: Mental health impacts of the COVID-19 pandemic on children and youth - a systematic review. Child Adolesc Ment Health 2022; 27:173-189. [PMID: 34455683 PMCID: PMC8653204 DOI: 10.1111/camh.12501] [Citation(s) in RCA: 326] [Impact Index Per Article: 163.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has posed an unprecedented threat to global mental health. Children and adolescents may be more susceptible to mental health impacts related to their vulnerable developmental stage, fear of infection, home confinement, suspension of regular school and extracurricular activities, physical distancing mandates, and larger scale threats such as global financial recessions and associated impacts. Our objective was to review existing evidence of the COVID-19 pandemic's global impact on the mental health of children and adolescents <19 years of age and to identify personal and contextual factors that may enhance risk or confer protection in relation to mental health outcomes. METHODS We conducted a search of peer-reviewed and preprint research published in English from January 1, 2020, to February 22, 2021. We included studies collecting primary data on COVID-19-related mental health impacts on children and adolescents. We graded the strength of included articles using the Oxford Centre for Evidence-Based Medicine rating scheme. RESULTS Our search and review yielded 116 articles presenting data on a total of 127,923 children and adolescents; 50,984 child and adolescent proxy reports (e.g., parents, healthcare practitioners); and >3,000 chart reviews. A high prevalence of COVID-19-related fear was noted among children and adolescents, as well as more depressive and anxious symptoms compared with prepandemic estimates. Older adolescents, girls, and children and adolescents living with neurodiversities and/or chronic physical conditions were more likely to experience negative mental health outcomes. Many studies reported mental health deterioration among children and adolescents due to COVID-19 pandemic control measures. Physical exercise, access to entertainment, positive familial relationships, and social support were associated with better mental health outcomes. CONCLUSIONS This review highlights the urgent need for practitioners and policymakers to attend to and collaborate with children and adolescents, especially those in higher risk subgroups, to mitigate short- and long-term pandemic-associated mental health effects.
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Affiliation(s)
- Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada.,British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Judy Wu
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Amilya Ladak
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Caralyn Vossen
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada.,Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,British Columbia Mental Health and Substance Use Research Institute, Vancouver, BC, Canada
| | - Naomi Dove
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David Long
- Division of Clinical and Behavioural Neurosciences, Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Gaelen Snell
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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El-Khani A, Cartwright K, Maalouf W, Haar K, Zehra N, Çokamay-Yılmaz G, Calam R. Enhancing Teaching Recovery Techniques (TRT) with Parenting Skills: RCT of TRT + Parenting with Trauma-Affected Syrian Refugees in Lebanon Utilising Remote Training with Implications for Insecure Contexts and COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168652. [PMID: 34444403 PMCID: PMC8394916 DOI: 10.3390/ijerph18168652] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/16/2022]
Abstract
Child psychosocial recovery interventions in humanitarian contexts often overlook the significant effect that caregivers can have on improving children’s future trajectory. We enhanced the well-established, evidenced-based child trauma recovery programme Teaching Recovery Techniques (TRT) intervention with parenting sessions, i.e., TRT + Parenting (TRT + P), which aims to improve parent mental health and their ability to support their children’s mental health. We describe the findings of a three-arm randomised controlled trial comparing enhanced TRT + P vs. TRT and waitlist. The primary aim was to test if children in the enhanced arm of the programme show improved child and caregiver mental health. We recruited 119 Syrian refugee children and one of their caregivers in Beqaa Valley in Lebanon. They were randomised to the TRT, TRT + P, or waitlist control group. Data were collected at baseline and 2 weeks and 12 weeks post intervention. Training of facilitators was via remote training from the United Kingdom. Results showed a highly consistent pattern, with children in the enhanced TRT + P group showing the greatest levels of improvement in behavioural and emotional difficulties compared to children in the TRT or waitlist control groups. Caregivers in the TRT + P group also reported significant reductions in depression, anxiety, and stress. Findings indicate that the addition of the evidence-based parenting skills components has the potential to enhance the effects of interventions designed to improve children’s mental health in contexts of trauma, conflict, and displacement. Implications for COVID-19 remote learning are also discussed.
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Affiliation(s)
- Aala El-Khani
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, Division of Operations, United Nations Office on Drugs and Crime (UNODC), Wagramer Strasse 5, A-1400 Vienna, Austria; (W.M.); (K.H.)
- Division of Psychology & Mental Health, University of Manchester, Manchester M13 9WL, UK;
- Correspondence:
| | - Kim Cartwright
- Greater Manchester Mental Health NHS Foundation Trust, Complex Trauma and Resilience Research Unit, Research and Innovation Office, Manchester M13 9WL, UK;
| | - Wadih Maalouf
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, Division of Operations, United Nations Office on Drugs and Crime (UNODC), Wagramer Strasse 5, A-1400 Vienna, Austria; (W.M.); (K.H.)
| | - Karin Haar
- Prevention, Treatment and Rehabilitation Section, Drug Prevention and Health Branch, Division of Operations, United Nations Office on Drugs and Crime (UNODC), Wagramer Strasse 5, A-1400 Vienna, Austria; (W.M.); (K.H.)
| | - Nosheen Zehra
- Global Mental Health and Cultural Psychiatry Research Group, Manchester M13 9PL, UK;
| | | | - Rachel Calam
- Division of Psychology & Mental Health, University of Manchester, Manchester M13 9WL, UK;
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Abstract
The COVID-19 pandemic has created conditions which heighten risk for child abuse. As key players in times of crisis, pediatric emergency medicine providers must be equipped with the tools to recognize, respond to, and mitigate risk of child abuse. An exploration of the scientific literature, stakeholder organization reports and lay press was undertaken to understand the impact of large-scale U.S. crises, including infectious disease, financial downturn, natural disaster, and violence, on child abuse risk and inform prevention strategies. Review of the literature suggests a relationship between crises and child abuse risk, though gaps in the research remain. We outline the role of pediatric emergency medicine providers in partnering with communities in organizing and advocating for systems that better protect children and strengthen families.
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