Patient initiation of information: exploring its role during the mental health intake visit

Questionnaires for the Assessment of Cognitive Function Secondary to Intake Interviews in In-Hospital Work and Development and Evaluation of a Classification Model Using Acoustic Features

The number of people with dementia is increasing each year, and early detection allows for early intervention and treatment. Since conventional screening methods are time-consuming and expensive, a simple and inexpensive screening is expected. We created a standardized intake questionnaire with thirty questions in five categories and used machine learning to categorize older adults with moderate and mild dementia and mild cognitive impairment, based on speech patterns. To evaluate the feasibility of the developed interview items and the accuracy of the classification model based on acoustic features, 29 participants (7 males and 22 females) aged 72 to 91 years were recruited with the approval of the University of Tokyo Hospital. The MMSE results showed that 12 participants had moderate dementia with MMSE scores of 20 or less, 8 participants had mild dementia with MMSE scores between 21 and 23, and 9 participants had MCI with MMSE scores between 24 and 27. As a result, Mel-spectrogram generally outperformed MFCC in terms of accuracy, precision, recall, and F1-score in all classification tasks. The multi-classification using Mel-spectrogram achieved the highest accuracy of 0.932, while the binary classification of moderate dementia and MCI group using MFCC achieved the lowest accuracy of 0.502. The FDR was generally low for all classification tasks, indicating a low rate of false positives. However, the FNR was relatively high in some cases, indicating a higher rate of false negatives.

Assessment of adjunct cognitive functioning through intake interviews integrated with natural language processing models

In this article, we developed an interview framework and natural language processing model for estimating cognitive function, based on an intake interview with psychologists in a hospital setting. The questionnaire consisted of 30 questions in five categories. To evaluate the developed interview items and the accuracy of the natural language processing model, we recruited participants with the approval of the University of Tokyo Hospital and obtained the cooperation of 29 participants (7 men and 22 women) aged 72-91 years. Based on the MMSE results, a multilevel classification model was created to classify the three groups, and a binary classification model to sort the two groups. For each of these models, we tested whether the accuracy would improve when text augmentation was performed. The accuracy in the multi-level classification results for the test data was 0.405 without augmentation and 0.991 with augmentation. The accuracy of the test data in the results of the binary classification without augmentation was 0.488 for the moderate dementia and mild dementia groups, 0.767 for the moderate dementia and MCI groups, and 0.700 for the mild dementia and MCI groups. In contrast, the accuracy of the test data in the augmented binary classification results was 0.972 for moderate dementia and mild dementia groups, 0.996 for moderate dementia and MCI groups, and 0.985 for mild dementia and MCI groups.

Service user experiences of mental health assessments: a systematic review and thematic synthesis of qualitative literature

BACKGROUND

Successive governments have placed service users' experiences at the heart of mental health services delivery and development. However, little is known about service users' experiences of assessments and there is some evidence that assessments can cause harm.

AIMS

To synthesise the qualitative literature on service users' experiences of undergoing mental health service assessments.

METHODS

Literature was systematically searched, screened and extracted, following PRISMA guidelines. Several search strategies were employed, including electronic database searches, handsearching, and forward and backward citation tracking, to identify literature which contained data on service users' experiences of mental health assessments. Thematic synthesis was used to derive a set of themes underpinning these experiences.

RESULTS

Of the 10,137 references screened, 47 were identified as relevant to the review. Two main themes were identified: the importance of humanising assessment processes and experiences of service user agency, with each theme containing four sub-themes.

CONCLUSIONS

Findings highlight key factors determining service user experience. We identify key practice implications, contextualised within the literature on trauma-informed approaches and conclude that trauma-informed approaches may aid understanding and improvement of people's assessment experiences. Further research into the experiences of people from Black and minority ethnic communities is indicated.

Centering the Voice of the Client: On Becoming a Collaborative Practitioner with Low-Income Individuals and Families

Despite current interest in collaborative practices, few investigations document the ways practitioners can facilitate collaboration during in-session interactions. This investigation explores verbatim psychotherapy transcripts to describe and illustrate therapist's communications that facilitate or hinder centering client's voice in work with socioeconomically disadvantaged populations. Four exemplar cases were selected from a large intervention trial aimed at improving shared decision making (SDM) skills of psychotherapists working with low-income clients. The exemplar cases were selected because they showed therapist's different degrees of success in facilitating SDM. Therapist's verbalizations were grouped into five distinct communicative practices that centered or de-centered the voice of clients. Communication practices were examined through the lens of collaborative approaches in family therapy. The analysis suggests that cross-fertilization between SDM and family-oriented collaborative and critical approaches shows promise to illuminate and enhance the challenging road from clinician-led to client-led interactions. This paper also stresses the importance of incorporating relational intersectionality with individuals and families who may not feel entitled to express their expectations or raise questions when interacting with authority figures.

Experiences, opinions and current policies on users' choice and change of the allocated primary mental health professional: a survey among directors of community mental health centers in the Emilia-Romagna region, Italy

Background

The subject of how the initial allocation of the primary mental health professional (PMHP) in community mental health services is made and the frequency and management of users’ requests to choose and/or change their allocated PMHPs has been scarcely investigated. The present paper is aimed at exploring the experiences and opinions of directors of community mental health centers (CMHC) on this topic.

Methods

A cross-sectional survey was conducted. Electronic ad hoc questionnaires with both multiple choice and open-ended questions were e-mailed to the institutional addresses of CMHC directors in the Emilia-Romagna Region (Northern Italy) with the consent of their heads of department and the Ethical Committee. Quantitative data were analysed by means of Microsoft Excel software and STATA 14.2 (College Station, TX), while the qualitative analysis was performed using the Nvivo12 software.

Results

Twenty-eight questionnaires were collected (response rate: 71.8%) that were equally distributed between males and females. For the initial PMHP allocation, casual allocation by “fixed-rota” was commonly performed (39.3%). Moreover, hope for a change of prescription by a different psychiatrist was the most frequent reason for users’ requests to change their PMHP. In two mental health departments only (Parma and Bologna), written guidelines to manage users’ requests of change of PMHP were available. In this context, most participants classified the explored topics as relevant and believed that written policies, especially if shared with users, could be useful.

Conclusions

In Emilia-Romagna CMHCs, neither users nor professionals were generally involved in the initial choice of the PMHP. Further national-level studies should be conducted in order to confirm this finding. Additionally, written and shared guidelines for managing users’ request to choose/change their PHMP may be useful.

Unpacking childhood experiences of abuse: Can clinicians identify their patients' History of Abuse?

Emotional, physical and sexual abuse, have been consistently linked to mental health problems in adults. Previous research found that mental health providers rarely ask their patients about their childhood experiences of abuse. No study to date has examined the convergence of clinicians' and patients' reports of childhood abuse. The current study applied a multi-method, multi-informant approach to explore the concordance between patients' reports of childhood experiences of abuse and clinicians' identification of their patients' history of abuse. Assessment of an independent interviewer was included. A convenience sample of clinicians (N = 80) and their patients (N = 170) in mental health clinics in care-as-usual settings participated in the study. To assess the history of abuse clinicians and patients completed the Clinical Data Form, patients additionally completed the Childhood Trauma Questionnaire. Independent interviewer completed the Familial Experiences Interview. Findings show that across all informants, exposure to emotional abuse was most prevalent, followed by physical abuse and least prevalent was sexual abuse. Additionally, clinicians reported lower prevalence of physical and sexual abuse among their patients as compared with the patient and independent interviewer's reports. Moderate to strong correlations were observed between clinicians, patients and independent interviewer reports of emotional, physical and sexual childhood abuse. Moreover, the severity of the patient's history of abuse was related to greater accuracy in clinicians' reports. Clinicians are advised to collect explicit information regarding childhood abuse through interviews or valid measures. Clinicians should pay special attention when assessing patients with moderate severity of childhood abuse since they are frequently under-identified.

It takes two to self-disclose: Incremental theorists facilitate others' self-disclosure more than do entity theorists

OBJECTIVE

We tested the prediction that incremental theorists are more likely to facilitate others' self-disclosure than are entity theorists.

METHOD

We conducted three studies: (a) a field study that examined client's self-disclosure (N = 122; M_age  = 41.9, 67.8% woman; Israelis) during an intake interview with a professional therapist (N = 38; M_age  = 46.2, 84.20% woman; Israelis), (b) a survey of adults (N = 120; M_age  = 37.14, 57.6% female) who reported self-perceptions and behaviors during conversations and their perceptions of others' self-disclosure. In both studies participants reported their implicit theories, and (c) an experiment (N = 250; M_age  = 28.27, 56.6% female) in which participants whose implicit theories were manipulated reported their opening behaviors during a conversation and their perceptions of others' self-disclosure.

RESULTS

Ones' incremental theory of personality was positively related to another's self-disclosure, to one's opening and disclosure-encouraging behaviors, and was negatively related to one's perceptions of others' self-protection tendency. Furthermore, one's opening behaviors and perceptions of others' self-protection tendencies mediated the effect of one's incremental theory on others' self-disclosure.

CONCLUSION

Those who believe people can grow and change, can influence others to trust their personal information with them, even when the information is negative.

"Why Come for Treatment?" Clients' and Therapists' Accounts of the Presenting Problems When Seeking Mental Health Care

Although identification of main problems is the foundation for treatment planning, limited research has examined reasons for seeking mental health care. We identified reasons for seeking mental health care as reported by clients and therapists upon initial contact with mental health services. We conducted in-depth interviews with clients and their therapists immediately following the intake. We analyzed 117 therapist and 112 client interviews using thematic analysis. Overall interrater reliability among three raters who coded the interviews was high (kappa = 0.72). Our findings suggest that, overall, clients and therapists report similar main area problems that bring clients to care. Emotional distress and other psychiatric symptoms as well as interpersonal problems were most prevalent. Therapists tended to ignore some problem areas that clients highlighted, including physical problems and socioeconomic strains. Raising awareness to potential gaps in perception of main problems that bring clients to care will promote a shared understanding and improve quality of care.

Starting the conversation: Patient initiation of weight-related behavioral counseling during pregnancy

OBJECTIVE

To examine the relationship between patient initiation and weight-related behavioral counseling during pregnancy.

METHODS

We examined audio recordings of prenatal visits between 22 obstetricians and 120 patients for behavioral counseling using the Roter Interaction Analysis System and the 5A's behavioral counseling framework. We used multivariate regression models to examine the relationship between patient initiation and communication outcomes.

RESULTS

Overall, 55% of prenatal visits included any behavioral counseling. Patients initiated counseling episodes 45.5% of these visits. Patients were less verbally dominated by their clinicians in prenatal visits with patient-initiated behavioral counseling episodes (difference in clinician verbal dominance ratio=0.73, 95% CI=0.16-1.30). Patient-initiated counseling episodes included more socioemotional communication relative to those initiated by clinicians (p=0.02). The total duration of counseling was 28s longer (95% CI 0.27-56.0s) and clinicians were more likely to use two or more 5A's strategies (OR=3.61, 95% CI=1.01-12.88) when patients initiated discussions.

CONCLUSIONS

Patient initiation may lead to behavioral counseling that is longer in duration and includes more 5A's strategies, possibly mediated by socioemotional communication.

PRACTICE IMPLICATIONS

Participatory prenatal care communication may lead to more effective counseling that is responsive to women's concerns.

Social Identities of Clients and Therapists During the Mental Health Intake Predict Diagnostic Accuracy

Across countries, common mental disorders are often more prevalent and/or more persistent among disadvantaged members (e.g., ethnic minorities) compared with advantaged group members. Although these disparities constitute a heavy challenge to national health organizations, there is little empirical evidence to help account for the mechanism underlying them. In this study, conducted in clinics across Israel, we investigated processes, rooted in the clinical encounter that may contribute to mental health disparities. We focused on the accuracy of diagnostic decisions, which are likely to substantially impact the client’s prognosis. Therapists’ diagnostic decisions following the initial intake with their client were compared with independent structured diagnostic interview of the client. Results revealed that therapists were twice as likely to misdiagnose mental illness when their client was a member of a disadvantaged (relative to advantaged) group. Implications for the quality of mental health services that members of disadvantaged groups receive are discussed.

The Impact of Qualitative Research on the “Real World”

Knowledge translation (KT) remains an elusive term that has no unified definition in the health or social sciences. The wide scope of what KT is in practice invites creativity in disseminating research findings. In this article, we describe innovative KT initiatives based on different methodologies of qualitative research we conducted in the fields of psycho-oncology and mental health. These include medical and public education, training mental health clinicians, national policy recommendations, and clinical interventions in the health field. As academic researchers, we bear a responsibility to the public we are intended to serve with our qualitative research. We argue that researchers need to take KT seriously and think deeply about not only what we research but also the ways in which we translate that knowledge to make the maximum possible positive impact on the communities we study and serve.

Predictors of mental health care stigma and its association with the therapeutic alliance during the initial intake session

OBJECTIVE

We investigated the association between socio-demographic and clinical variables with mental health care stigma, and the impact of the latter on the quality of the therapeutic alliance measured at intake.

METHOD

Consecutive clients (N = 236) filled questionnaires upon accessing services for a new episode of care. Immediately following the intake, a randomly selected sample of clients and their corresponding therapists (n = 102) completed the Working Alliance Inventory - Bond Scale.

RESULTS

Lower mean years of education and higher emotional distress (both partial r = .17) were significantly associated with higher stigma. Higher care stigma negatively correlated with therapists' ratings of the therapeutic alliance during the intake (partial r = -.22), but not with those of clients.

CONCLUSIONS

Care stigma is present among service-users and may affect outcomes of the intake.

Assessment of physical illness by mental health clinicians during intake visits

OBJECTIVES

This study explored how mental health clinicians assess and respond to physical illness among patients presenting for mental health intake evaluations.

METHODS

A total of 129 adults were seen for a mental health intake visit. The intake visits were videotaped and involved 47 mental health clinicians from eight clinics who provided outpatient mental health and substance abuse treatment. A total of 120 videos of patient-provider interactions were coded using an information checklist containing 21 physical illness items. Twenty-eight intake visits exemplifying in-depth physical illness assessments were selected and transcribed for qualitative analysis.

RESULTS

Physical health was discussed in most intake visits (87%). Clinicians elicited information on physical health in 79 visits (66%), and patients volunteered such information in 80 visits (67%). Frequency of assessment differed by clinician discipline (p<.05) and by patient ethnicity (p=.06). Qualitative analysis revealed characteristics of appropriate assessments, such as formulating the contribution of physical conditions in the psychiatric differential diagnosis, noting physical side effects of medications, adjusting treatment plans, encouraging patient contact with primary care providers, and promoting physical health care.

CONCLUSIONS

Assessment of physical illness is relatively common among mental health clinicians but was lacking in one-third of the cases in this study, until raised by patients. Because frequency of assessment differed by clinician discipline and patient ethnicity, innovations in patient assessment and clinician education are needed to address disparities in management of physical illness among individuals with mental illness.