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Löthberg M, Wirström E, Meyer J, Girdler S, Bölte S, Jonsson U. 'If I Don't Have My Support Worker in the Room…': A Multi-perspective Mixed Methods Study of Remote Daily Living Support for Neurodivergent Young Adults. J Autism Dev Disord 2024:10.1007/s10803-024-06425-z. [PMID: 38837062 DOI: 10.1007/s10803-024-06425-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Information technology is increasingly being employed for providing support and interventions in disability and health service contexts. This study aimed to investigate service users' and support workers' perspectives on remote support in daily living for young adults with neurodevelopmental conditions. METHODS Using a convergent mixed methods approach, we integrated qualitative and quantitative findings from survey responses and focus groups. Young service users (aged 18 to 29) diagnosed with ADHD and/or autism (n = 35) and support workers (n = 64) from four municipalities in Sweden responded to a survey designed to tap into their lived experiences and views. The topic was explored further in focus groups with young service users (n = 7) and support workers (n = 3). Open-ended survey questions were analyzed using qualitative content analyses and complemented with information from the focus groups, while closed survey questions were summarized descriptively. Inferences were merged in a joint display. RESULTS While participants reported having access to digital devices, service routines for remote contact were not in place. Service users were more hesitant than support workers in endorsing remote support, expressing concerns that this approach would be inferior to in-person support (e.g., owing to miscommunications and insufficient social and emotional contact). Still, both groups expressed that remote contact may at times be a beneficial complement to in-person meetings, increasing accessibility and user choice. CONCLUSION Service providers planning to implement remote support elements should explore the demand, acceptability, and organizational readiness for this approach. Moving forward, user engagement will be crucial to meet individual preferences, values, and needs.
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Affiliation(s)
- Maria Löthberg
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
| | - Eda Wirström
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Social Psychiatry and Individual Support, Municipality of Uppsala, Uppsala, Sweden
| | - Jenny Meyer
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Sonya Girdler
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Ulf Jonsson
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Medical Sciences, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
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Cunniff PJ, Ahsan A, McCrary C, Dien T, Kuhn TH, Vazifedan T, Harrington JW. ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting. BMC Psychiatry 2024; 24:188. [PMID: 38454358 PMCID: PMC10921583 DOI: 10.1186/s12888-024-05623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND COVID-19 impacted all students, especially those with attention deficit hyperactivity disorder (ADHD), putting them at risk for disruption to their medication regimen and school performance. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refills and if telehealth management demonstrated a higher rate of adherence. METHODS A total of 396 patients from the General Academic Pediatrics (GAP) clinic at Children's Hospital of The King's Daughters (CHKD) were included in the study. Patients were between the ages of 8-18 with a history of ADHD for three or more years that was medically managed with four or more prescription refills between January 2019 and May 2022. A retrospective chart review collected age, sex, race, refill schedule, appointment schedule, and number of telehealth appointments. Data analysis compared the variables and defined "pre-pandemic months" as January 2019 through March 2020 and "pandemic months" as April 2020 through June 2022. RESULTS The total percentage of patients who had their ADHD medications during pre-pandemic months ranged from 40 to 66% versus 31-44% during pandemic months. Additionally, the total percentage of patients who had quarterly ADHD management appointments during pre-pandemic months ranged between 59 and 70% versus 33-50% during pandemic months. The number of months with ADHD prescription refills over the last three years was significantly higher among those who had both virtual and in-person visits than those who had just in-person visits, p < 0.001. Regarding race, Black patients had a lower number of medication refills compared to White patients when controlled for appointment type. They also had a lower number of total appointments, but there was not a significant difference in the number of virtual appointments. CONCLUSIONS Since the start of the pandemic, ADHD patients have both refilled their prescriptions and returned to clinic less frequently. This data suggests a need to re-evaluate the ADHD symptoms of GAP patients periodically and return them to a more consistent medication regimen. Telehealth appointments are a potential solution to increase adherence. However, racial inequities found in this study need to be addressed.
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Affiliation(s)
| | - Amil Ahsan
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Tracy Dien
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Turaj Vazifedan
- Department of Pediatrics, General Academic Pediatrics, Children's Hospital of The King's Daughters, Norfolk, VA, USA
| | - John W Harrington
- Eastern Virginia Medical School, Norfolk, VA, USA
- Department of Pediatrics, General Academic Pediatrics, Children's Hospital of The King's Daughters, Norfolk, VA, USA
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Bajgain B, Rabi S, Ahmed S, Kiryanova V, Fairie P, Santana MJ. Patient-reported experiences and outcomes of virtual care during COVID-19: a systematic review. J Patient Rep Outcomes 2023; 7:126. [PMID: 38038800 PMCID: PMC10692047 DOI: 10.1186/s41687-023-00659-8] [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] [Received: 12/26/2022] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION The onset of COVID-19 has caused an international upheaval of traditional in-person approaches to care delivery. Rapid system-level transitions to virtual care provision restrict the ability of healthcare professionals to evaluate care quality from the patient's perspective. This poses challenges to ensuring that patient-centered care is upheld within virtual environments. To address this, the study's objective was to review how virtual care has impacted patient experiences and outcomes during COVID-19, through the use of patient-reported experience and outcome measures (PREMs and PROMs), respectively. METHODS A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to evaluate patient responsiveness to virtual care during COVID-19. Using an exhaustive search strategy, relevant peer-reviewed articles published between January 2020 and 2022 were pulled from MEDLINE, CINAHL, EMBASE, and PsychInfo databases. Study quality was independently assessed by two reviewers using the Mixed Methods Appraisal Tool. A patient partner was consulted throughout the study to provide feedback and co-conduct the review. RESULTS After removing duplicates, 6048 articles underwent title and abstract review, from which 644 studies were included in the full-text review stage. Following this, 102 articles were included in the study. Studies were published in 20 different countries, were predominantly cross-sectional, and reported on the delivery of virtual care in specialized adult outpatient settings. This review identified 29 validated PREMs and 43 PROMs. Several advantages to virtual care were identified, with patients citing greater convenience, (such as saving travel time and cost, less waiting experienced to see care providers) and increased protection from viral spread. Some studies also reported challenges patients and caregivers faced with virtual care, including feeling rushed during the virtual care appointment, lack of physical contact or examination presenting barriers, difficulty with communicating symptoms, and technology issues. CONCLUSION This review provides supportive evidence of virtual care experiences during the COVID-19 pandemic from patient and caregiver perspectives. This research provides a comprehensive overview of what patient-reported measures can be used to record virtual care quality amid and following the pandemic. Further research into healthcare professionals' perspectives would offer a supportive lens toward a strong person-centered healthcare system.
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Affiliation(s)
- Bishnu Bajgain
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sarah Rabi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sadia Ahmed
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada.
| | - Veronika Kiryanova
- Patient and Community Engagement Research, University of Calgary, Calgary, AB, Canada
| | - Paul Fairie
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada
| | - Maria J Santana
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Alberta SPOR SUPPORT Unit, Patient Engagement Team, Calgary, AB, Canada
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Praus P, Proctor T, Rohrmann T, Benedyk A, Tost H, Hennig O, Meyer-Lindenberg A, Wahl AS. Female sex and burden of depressive symptoms predict insufficient response to telemedical treatment in adult attention-deficit/hyperactivity disorder: results from a naturalistic patient cohort during the COVID-19 pandemic. Front Psychiatry 2023; 14:1193898. [PMID: 37867771 PMCID: PMC10585110 DOI: 10.3389/fpsyt.2023.1193898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is a chronic neuropsychiatric disorder, that typically manifests itself during childhood and persists in a majority of the affected individuals into adulthood, negatively affecting physical and mental health. Previous studies have shown detrimental effects of the COVID-19 pandemic on mental health in individuals with ADHD. Thus, telemedicine could be a useful tool for optimizing treatment-outcomes in adult ADHD by improving treatment adherence and persistence. However, data on telemedical treatment outcomes in adult patients with ADHD is scarce. Methods We report here the sub-cohort analysis of a naturalistic cohort of adult patients (N = 254) recruited between April 2020-April 2021, comparing the effects of telemedical treatment on participants either clinically diagnosed with depression (N = 54) or ADHD (N = 67). Participants were asked to fill out the WHO-5 repetitively during >12 weeks of telemedical treatment. Furthermore scores of WHO-5, SCL-90R and BDI-II, psychopathology, psychosocial functioning, sociodemographic data, medical records and a feedback survey were analyzed for both groups and compared. Participants with ADHD were further stratified according to the development of well-being during the study period in order to identify factors associated with a satisfactory treatment outcome. Results Participants with depression reported a significant improvement of well-being during the course of the study, while no such effect could be seen in participants with ADHD on a group level. Despite the good outcome, participants with depression were more severely affected at baseline, with significantly worse psychopathology and a more precarious labor and financial situation. A detailed analysis of ADHD participants without clinical improvement revealed significantly higher BDI-II scores than for ADHD participants with a satisfactory outcome (p = 0.03, Mann-Whitney-U-Test), suggesting successful treatment was hampered by the combination of ADHD and depressive symptoms. Furthermore, female sex among ADHD patients was correlated with an unfavorable treatment outcome during the course of the study (p = 0.001, Spearman correlation) as well as living with children (p = 0.02, Spearman correlation). Conclusion Besides screening for depressive symptoms before telemedical treatment, future research should address the specific needs of female ADHD patients as these patients may be at a particularly high risk of being overburdened with family work.
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Affiliation(s)
- Peter Praus
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Tanja Proctor
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Tobias Rohrmann
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Anastasia Benedyk
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Heike Tost
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Oliver Hennig
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | | | - Anna-Sophia Wahl
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
- Brain Research Institute, University of Zurich, Zurich, Switzerland
- Department of Neuroanatomy, Institute of Anatomy, Ludwigs-Maximilians-University, Munich, Germany
- Institute for Stroke and Dementia Research, University Hospital of Ludwigs-Maximilians-University, Munich, Germany
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Agbali RA, Balas EA, Beltrame F, Heboyan V, De Leo G. A review of questionnaires used for the assessment of telemedicine. J Telemed Telecare 2023:1357633X231166161. [PMID: 37032470 DOI: 10.1177/1357633x231166161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
INTRODUCTION Telemedicine is the exchange of medical information from one site to another via electronic communications with the goal of improving a patient's clinical health status. Prior studies have identified the absence of a standardized assessment tool for evaluating telemedicine encounters. This study aims to collect and to analyze questionnaires used for the assessment of audiovisual telemedicine encounters from a patient perspective and aims to identify reasons driving the use of self-developed questionnaires. METHODS We conducted a systematic search in PubMed for studies that used survey questionnaires to assess synchronous audiovisual telemedicine encounters from 2016 to 2021. We categorized questionnaires used into validated and non-validated types, and for each of them, collected questions, response format, author, year, specialty, and country of publication. RESULTS AND DISCUSSION We analyzed a total of 71 articles. We found that only 16 studies used three validated questionnaires. The remaining 55 studies used non-validated questionnaires. Non-validated questionnaires had a high variability in length and used Likert scales, binary responses, multiple choice, and open-ended answers. We found only eight studies in which the authors gave a reason for resorting to designing their own questionnaires. This review reveals insufficient standardized survey questionnaires to be used for the assessment of audiovisual telemedicine encounters. Future research initiatives should focus on developing a standardized and validated instrument well accepted by researchers.
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Affiliation(s)
- Raphael A Agbali
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
| | - E Andrew Balas
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
| | - Francesco Beltrame
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genova, Italy
| | - Vahe Heboyan
- Department of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Gianluca De Leo
- College of Allied Health Sciences, 1421Augusta University, Augusta, GA, USA
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Remote assessment of ADHD in children and adolescents: recommendations from the European ADHD Guidelines Group following the clinical experience during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2023; 32:921-935. [PMID: 36764972 PMCID: PMC9918404 DOI: 10.1007/s00787-023-02148-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023]
Abstract
The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.
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Ali D, O'Brien S, Hull L, Kenny L, Mandy W. 'The key to this is not so much the technology. It's the individual who is using the technology': Perspectives on telehealth delivery for autistic adults during the COVID-19 pandemic. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:552-564. [PMID: 35791666 PMCID: PMC10076158 DOI: 10.1177/13623613221108010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
LAY ABSTRACT The COVID-19 pandemic meant that a lot of healthcare services had to move online, such as to video-calls, or to telephone. However, not many studies have looked at how autistic adults feel about this kind of service delivery. It is important to know this, as autistic people may have poorer health than non-autistic people, and they may also struggle to access services more than non-autistic people. This study asked 11 autistic adults (aged 27-67 years), seven family members/carers (aged 44-75) reporting about autistic adults and six service providers about their experiences of accessing or providing a telehealth service. These experiences were collected through interviews, which were then analysed through thematic analysis. Two main themes were: technology aids communication and access - except when it doesn't, and in/flexibility. The themes pointed out some positive aspects of telehealth delivery, including improved communication and decreased stress. The themes also pointed out negative aspects of telehealth, such as increased rigidity of the healthcare system, amplifying pre-existing barriers. Because autistic people have many barriers to accessing healthcare, this study encourages researchers and healthcare providers to think about how such barriers could be addressed through telehealth, and about the possible limitations of telehealth for some autistic people.
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Affiliation(s)
- Dorota Ali
- Autistica, London, UK.,King's College London, UK
| | | | - Laura Hull
- University of Bristol, UK.,University College London, UK
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Schlief M, Saunders KRK, Appleton R, Barnett P, Vera San Juan N, Foye U, Olive RR, Machin K, Shah P, Chipp B, Lyons N, Tamworth C, Persaud K, Badhan M, Black CA, Sin J, Riches S, Graham T, Greening J, Pirani F, Griffiths R, Jeynes T, McCabe R, Lloyd-Evans B, Simpson A, Needle JJ, Trevillion K, Johnson S. Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review. Interact J Med Res 2022; 11:e38239. [PMID: 35767691 PMCID: PMC9524537 DOI: 10.2196/38239] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/20/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Katherine R K Saunders
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Norha Vera San Juan
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Una Foye
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Rowan Olive
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Karen Machin
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Prisha Shah
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Beverley Chipp
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Natasha Lyons
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Camilla Tamworth
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Monika Badhan
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Carrie-Ann Black
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jacqueline Sin
- Centre for Mental Health Research, City, University of London, London, United Kingdom
| | - Simon Riches
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Tom Graham
- Centre for Anxiety Disorders & Trauma, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jeremy Greening
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Farida Pirani
- Psychological Medicine & Older Adult Directorate, South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Raza Griffiths
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Tamar Jeynes
- NIHR Mental Health Policy Research Unit Lived Experience Working Group, Division of Psychiatry, University College London, London, United Kingdom
| | - Rose McCabe
- Centre for Mental Health Research, City, University of London, London, United Kingdom
| | - Brynmor Lloyd-Evans
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Justin J Needle
- Centre for Health Services Research, City, University of London, London, United Kingdom
| | - Kylee Trevillion
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
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Doyle N, Bradley E. Disability coaching in a pandemic. JOURNAL OF WORK-APPLIED MANAGEMENT 2022. [DOI: 10.1108/jwam-07-2022-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeAn applied study using convenience data was conducted to compare the experiences of neurodivergent adults undergoing workplace coaching before and during the pandemic.Design/methodology/approachThe naturally occurring opportunity permitted a comparison of face-to-face and remote coaching in three cohorts, pre-pandemic (100% face-to-face), forced-remote (100% remote) and choice (remote or face-to-face; 85% selected remote). A total of 409 participants self-reported performance before and 12 weeks after completing an average of 11 h coaching.FindingsSignificant differences between before and after scores for performance, with large effect sizes, were reported for all three cohorts across six dependent variables: memory, time management, organisational skills, stress management, understanding neurodiversity and concentration. There was no significant difference between the cohorts in terms of the magnitude of the effect. There were significant differences between the cohorts in terms of which topics were chosen as foci for the coaching, with executive functions related topics becoming less popular in the choice cohort.Research limitations/implicationsThe authors abductively reasoned the results to suggest a positive relationship between personalised environments and cognitive demands for this client group. They call for further, theoretically grounded research exploring the role of coaching and environment in understanding the work performance of neurodivergent adults at work.Originality/valueThe study contributes to the emerging knowledge on the different experiences of in-person and video-mediated coaching. The focus on neurodivergent employees, which are heretofore less well researched within the workplace, provides essential data to support practitioners in maximising opportunity for a marginalised group.
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Rosen V, Blank E, Lampert E, Dominick K, Will M, Erickson C, Pedapati E, Lamy M, Shaffer R. Brief Report: Telehealth Satisfaction Among Caregivers of Pediatric and Adult Psychology and Psychiatry Patients with Intellectual and Developmental Disability in the Wake of Covid-19. J Autism Dev Disord 2022; 52:5253-5265. [PMID: 35987932 PMCID: PMC9392497 DOI: 10.1007/s10803-022-05712-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 11/01/2022]
Abstract
Telehealth has been shown to be both acceptable and effective in many areas of healthcare, yet it was not widely adopted prior to the SARS-CoV-2 (COVID-19) pandemic. Additionally, previous evaluations of telehealth for autism spectrum condition (ASC) and intellectual and developmental disability (IDD) populations are limited in both number and scope. Here, we investigated satisfaction amongst Psychology and Psychiatry patient caregivers at Cincinnati Children’s Hospital Medical Center (CCHMC) after the onset of the COVID-19 pandemic. Results (640 responses) showed high rates of satisfaction across departments, appointment types, and diagnoses, with 92% indicating overall satisfaction with their appointment. There were, however, notable decreases in satisfaction among Group Therapy respondents, and those whose diagnosis was classified as Other.
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11
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Spain D, Stewart GR, Mason D, Milner V, Fairhurst B, Robinson J, Gillan N, Ensum I, Stark E, Happe F. Telehealth Autism Diagnostic Assessments With Children, Young People, and Adults: Qualitative Interview Study With England-Wide Multidisciplinary Health Professionals. JMIR Ment Health 2022; 9:e37901. [PMID: 35857358 PMCID: PMC9302612 DOI: 10.2196/37901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (hereafter, autism) is a common neurodevelopmental condition. Core traits can range from subtle to severe and fluctuate depending on context. Individuals can present for diagnostic assessments during childhood or adulthood. However, waiting times for assessment are typically lengthy, and many individuals wait months or even years to be seen. Traditionally, there has been a lack of standardization between services regarding how many and which multidisciplinary health professionals are involved in the assessment and the methods (diagnostic tools) that are used. The COVID-19 pandemic has affected routine service provision because of stay-at-home mandates and social distancing guidelines. Autism diagnostic services have had to adapt, such as by switching from conducting assessments in person to doing these fully via telehealth (defined as the use of remote technologies for the provision of health care) or using blended in-person or telehealth methods. OBJECTIVE This study explored health professionals' experiences of and perspectives about conducting telehealth autism diagnostic assessments, including barriers and facilitators to this, during the COVID-19 pandemic; potential telehealth training and supervision needs of health professionals; how the quality and effectiveness of telehealth autism diagnostic services can be enhanced; and experiences of delivering postdiagnostic support remotely. METHODS A total of 45 health professionals, working in varied settings across England, participated in one-off, in-depth semistructured qualitative interviews. These were conducted via videoconferencing or telephone. Altogether, participants represented 7 professional disciplines (psychiatry, medicine, psychology, speech and language therapy, occupational therapy, nursing, and social work). The data were then analyzed thematically. RESULTS Thematic analysis indicated the following 7 themes: practicalities of telehealth, telehealth autism diagnostic assessments, diagnostic conclusions, clinical considerations, postdiagnostic support, future ways of working, and health professionals' experiences and needs. Overall, telehealth autism diagnostic assessments were deemed by many participants to be convenient, flexible, and efficient for some patients, families, and health professionals. However, not all patients could be assessed in this way, for example, because of digital poverty, complex clinical presentation, or concerns about risk and safeguarding. Working remotely encouraged innovation, including the development of novel assessment measures. However, some participants expressed significant concerns about the validity and reliability of remotely assessing social communication conditions. CONCLUSIONS A shift to telehealth meant that autism diagnostic services remained operational during the COVID-19 pandemic. However, this method of working has potentially affected the parity of service, with people presenting with clinical complexity having to potentially wait longer to be seen or given a diagnostic opinion. There is also a lack of standardization in the provision of services. Further research should identify evidence-based ways of enhancing the timeliness, accessibility, and robustness of the autism diagnostic pathway, as well as the validity and reliability of telehealth methods.
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Affiliation(s)
- Debbie Spain
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,The National Psychology Clinic, London, United Kingdom
| | - Gavin R Stewart
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - David Mason
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Victoria Milner
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,The National Psychology Clinic, London, United Kingdom
| | - Bryony Fairhurst
- The National Psychology Clinic, London, United Kingdom.,Berrywood Hospital, Northampton Healthcare National Health Service Foundation Trust, Northampton, United Kingdom
| | - Janine Robinson
- Cambridge Lifespan Autism Spectrum Service, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Nicola Gillan
- Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership National Health Service Trust, Bristol, United Kingdom
| | - Ian Ensum
- Bristol Autism Spectrum Service, Avon and Wiltshire Mental Health Partnership National Health Service Trust, Bristol, United Kingdom
| | | | - Francesca Happe
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
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12
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Kreysa H, Schneider D, Kowallik AE, Dastgheib SS, Doğdu C, Kühn G, Ruttloff JM, Schweinberger SR. Psychosocial and Behavioral Effects of the COVID-19 Pandemic on Children and Adolescents with Autism and Their Families: Overview of the Literature and Initial Data from a Multinational Online Survey. Healthcare (Basel) 2022; 10:healthcare10040714. [PMID: 35455891 PMCID: PMC9028372 DOI: 10.3390/healthcare10040714] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 02/04/2023] Open
Abstract
Since COVID-19 has become a pandemic, everyday life has seen dramatic changes affecting individuals, families, and children with and without autism. Among other things, these changes entail more time at home, digital forms of communication, school closures, and reduced support and intervention. Here, we assess the effects of the pandemic on quality of life for school-age autistic and neurotypical children and adolescents. First, we provide a comprehensive review of the current relevant literature. Next, we report original data from a survey conducted in several countries, assessing activities, well-being, and social life in families with autism, and their changes over time. We focus on differences between children with and without autism from within the same families, and on different outcomes for children with high- or low-functioning autism. While individuals with autism scored lower in emotional and social functioning than their neurotypical siblings, both groups of children showed comparable decreases in well-being and increases in anxiety, compared to before the pandemic. By contrast, decreases in adaptability were significantly more pronounced in autistic children and adolescents compared to neurotypical children and adolescents. Overall, although individual families reported some positive effects of pandemic restrictions, our data provide no evidence that these generalize across children and adolescents with autism, or even just to individuals with high-functioning autism. We discuss the increased challenges that need to be addressed to protect children and adolescents’ well-being under pandemic conditions, but also point out potentials in the present situation that could be used towards social participation and success in older children and young adults with autism.
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Affiliation(s)
- Helene Kreysa
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
- Correspondence: (H.K.); (S.R.S.)
| | - Dana Schneider
- Social Potential in Autism Research Unit & Department of Social Psychology, Friedrich Schiller University Jena, 07743 Jena, Germany; (D.S.); (C.D.)
- DFG Scientific Network “Understanding Others”, SCHN 1481/2-1, 10117 Berlin, Germany
| | - Andrea Erika Kowallik
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
- Early Support and Counseling Center Jena, Herbert Feuchte Stiftungsverbund, 07743 Jena, Germany;
- Department of Psychiatry, Jena University Hospital, 07743 Jena, Germany
| | - Samaneh Sadat Dastgheib
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
| | - Cem Doğdu
- Social Potential in Autism Research Unit & Department of Social Psychology, Friedrich Schiller University Jena, 07743 Jena, Germany; (D.S.); (C.D.)
| | - Gabriele Kühn
- Early Support and Counseling Center Jena, Herbert Feuchte Stiftungsverbund, 07743 Jena, Germany;
| | - Jenny Marianne Ruttloff
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
| | - Stefan R. Schweinberger
- Social Potential in Autism Research Unit & Department of General Psychology and Cognitive Neuroscience, Friedrich Schiller University Jena, 07743 Jena, Germany; (A.E.K.); (S.S.D.); (J.M.R.)
- Correspondence: (H.K.); (S.R.S.)
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13
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Callahan R, Kail B, Lerman DC, Johnson-Patagoc K, Whitcher D. Teaching Adults with Neurodevelopmental Disabilities to Interact Successfully with Others in a Virtual Format. Behav Anal Pract 2022; 15:1279-1295. [PMID: 35281673 PMCID: PMC8896411 DOI: 10.1007/s40617-022-00681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
As a result of the COVID-19 pandemic, individuals with neurodevelopmental disabilities (NDD) are engaging more with others in virtual group formats for social, educational, and professional reasons. This study extends prior research by evaluating the efficacy of common behavioral interventions, including behavioral skills training, provided via group video conferencing to teach skills that are important when interacting with others in a virtual format. Four adults with NDD were taught to use their cameras and microphones appropriately and to make encouraging statements to one another while discussing current events and social skills-based lessons via Zoom™. Two of the three skills increased and maintained for all participants even after the experimenter faded the contingencies for appropriate responding. The third skill maintained after the experimenter arranged for the response to produce natural consequences. Tests for generalization across group leads and activities yielded promising results. Findings suggest that adults with NDD benefit from group-based telehealth services to improve skills needed to interact successfully with others in a virtual format.
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Affiliation(s)
| | | | - Dorothea C. Lerman
- University of Houston, Clear Lake, 2700 Bay Area Blvd, Houston, TX 77058 USA
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Neely L, Tsami L, Graber J, Lerman DC. Towards the development of a curriculum to train behavior analysts to provide services via telehealth. J Appl Behav Anal 2022; 55:395-411. [PMID: 35099076 DOI: 10.1002/jaba.904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 12/19/2022]
Abstract
The COVID-19 pandemic has led to a dramatic increase in behavior analysts' use of telehealth services. Nonetheless, no research has evaluated the skills or training needed for therapists to provide these services effectively. The purpose of this study was to develop and evaluate a curriculum for providing high-quality, parent-training telehealth services. Four in-service Board Certified Behavior Analysts® (BCBAs®) who received brief behavioral skills training on this curriculum reached 100% fidelity within four sessions. The skills generalized to a novel family and maintained nearly 1 year after the training. All participants rated the training as highly acceptable and effective. The independent ratings of 4 in-service BCBAs, blinded to the study conditions, also supported the social validity of the outcomes. This curriculum may be considered an initial step towards development of competency for interventionists providing ABA services via telehealth. Further research is warranted as demand for telehealth services continues to grow.
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Sidiras C, Sanchez-Lopez R, Pedersen ER, Sørensen CB, Nielsen J, Schmidt JH. User-Operated Audiometry Project (UAud) - Introducing an Automated User-Operated System for Audiometric Testing Into Everyday Clinic Practice. Front Digit Health 2021; 3:724748. [PMID: 34713194 PMCID: PMC8529271 DOI: 10.3389/fdgth.2021.724748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/13/2021] [Indexed: 11/16/2022] Open
Abstract
Hearing loss is the third leading cause of years lived with disability. It is estimated that 430 million people worldwide are affected, and the number of cases is expected to increase in the future. There is therefore increased pressure on hearing health systems around the world to improve efficiency and reduce costs to ensure increased access to quality hearing health care. Here, we describe the User-Operated Audiometry project, the goal of which is to introduce an automated system for user-operated audiometric testing into everyday clinic practice as a means to relieve part of this pressure. The alternative to the existing referral route is presented in which examination is executed via the user-operated system. This route is conceptualized as an interaction between the patient, the system, and the hearing care professional (HCP). Technological requirements of the system and challenges that are related to the interaction between patients, the user-operated system, and the HCPs within the specific medical setting are discussed. Lastly, a strategy for the development and implementation of user-operated audiometry is presented, which includes initial investigations, a validation study, and implementation in a real-life clinical situation.
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Affiliation(s)
- Christos Sidiras
- Faculty of Engineering, The Maersk Mc-Kinney Møller Institute, University of Southern Denmark, Odense, Denmark
| | - Raul Sanchez-Lopez
- Interacoustics Research Unit, Kongens Lyngby, Denmark.,Hearing Systems Section, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Ellen Raben Pedersen
- Faculty of Engineering, The Maersk Mc-Kinney Møller Institute, University of Southern Denmark, Odense, Denmark
| | - Chris Bang Sørensen
- Faculty of Engineering, The Maersk Mc-Kinney Møller Institute, University of Southern Denmark, Odense, Denmark
| | - Jacob Nielsen
- Faculty of Engineering, The Maersk Mc-Kinney Møller Institute, University of Southern Denmark, Odense, Denmark
| | - Jesper Hvass Schmidt
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.,OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.,Research Unit for ORL-Head and Neck Surgery and Audiology, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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