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An environmental scan of mental health services for indigenous youth in Canada. 加拿大土著青年心理健康服务环境扫描。
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
Sofia Hempelmann Perez, Isabella Kakish, Gregory Brass, Kathleen MacDonald, Chris Mushquash, Srividya N Iyer

Background: There is an urgent need for culturally and contextually relevant mental health support for First Nations, Inuit and Métis youth.

Objective: Our aim was to identify mental health and wellness services that are currently available to Indigenous youth across Canada.

Methodology: As a first step, we conducted a web-based environmental scan of services tailored to Indigenous youth. Specific factors were examined for each program, including organization type and mission, types of services, and who provides services.

Results: One hundred and seventeen programs were found, with 54% being non-profits and 34% being on-reserve. Four core features were identified. The first was a strengths-based focus, rather than a pathology/deficit-focus, in programs' vision and mission statements, reflected in words like wellness and resilience. The second (87% of included programs) was the integration of mental health services with a range of other services and supports (e.g., health, employment, housing). The third was the provision of land-based programming (in 34% of programs) such as camps or hunting. Such programs were framed as promoting wellness and healing and strengthening identity. The fourth was the role of community members without formal mental health professional training (in 42% of programs), for example, as youth workers or knowledge keepers. This stems not only from the dearth of specialists in many Indigenous settings, but also a valuing of Indigenous knowledge.

Conclusion: These core features in mental health services for Indigenous youth may be promising avenues for communities seeking to strengthen the services they offer to First Nations, Inuit and Métis youth.

背景:第一民族、因纽特人和梅蒂斯人青年迫切需要文化和背景相关的心理健康支持:第一民族、因努伊特人和梅蒂斯人青年迫切需要与文化和背景相关的心理健康支持:我们的目的是确定目前加拿大各地为土著青少年提供的心理健康和保健服务:作为第一步,我们对针对土著青少年的服务进行了网络环境扫描。我们对每个项目的具体因素进行了研究,包括组织类型和使命、服务类型以及服务提供者:结果:我们找到了 177 个项目,其中 54% 为非营利组织,34% 在保留地。确定了四个核心特征。第一,在项目的愿景和使命陈述中,以优势为重点,而不是以病理/缺陷为重点,这体现在健康和复原力等字眼上。其次(87%的项目)是将心理健康服务与一系列其他服务和支持(如健康、就业、住房)相结合。第三种是提供陆上项目(34% 的项目),如营地或狩猎。这些计划的目的是促进健康、治疗和加强身份认同。第四是让没有接受过正规心理健康专业培训的社区成员发挥作用(42%的项目),例如,担任青年工作者或知识守护者。这不仅是因为在许多土著环境中缺乏专家,而且也是对土著知识的重视:为原住民青少年提供心理健康服务的这些核心特点,可能是社区寻求加强为原住民、因努伊特和梅蒂斯青少年提供服务的有前途的途径。
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引用次数: 0
Clinical pathway development to standardize pharmacological medication management of agitation in pediatric inpatient settings. 制定临床路径,规范儿科住院病人躁动症的药物治疗。
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
Michael D Wood, Kavi Gandhi, Dean Elbe, Kelly Saran, Sarah Leung, Joanna McKay, Roxane Carr, Andrea Chapman

Objective: Acute agitation in pediatrics is commonly encountered in hospital settings, can contribute to significant physical and psychological distress, and management is highly varied in practice. As such, the development of a standardized pharmacologic guideline is paramount. We aimed to develop a novel clinical pathway (CP) for management of acute agitation for all hospitalized pediatric patients in Canada.

Methods: Healthcare professionals in Canada with expertise in treating and managing pediatric agitation formed a working group and developed a CP through conducting a literature review, engaging key partners, and obtaining interdisciplinary consensus (iterative real-time discussions with content experts). Once developed, the preliminary CP was presented to additional internal and external partners via multiple grand rounds and a webinar; feedback from participants guided final CP revisions.

Results: The working group created a pediatric inpatient CP to guide pharmacologic management of agitation and serve as an easy-to-use clinical and educational resource with three complementary sections including: 1) a treatment algorithm, 2) a quick reference medication chart, and 3) two supporting documents, which provide a general overview of non-pharmacologic strategies prior to CP implementation and an illustrative scenario to accompany the medication chart to ensure effective utilization.

Conclusions: This is the first CP to standardize pharmacological treatment and management of acute agitation in children in inpatient settings in Canada. Although further research is warranted to assess implementation and support process improvement, the CP can be adapted by individual institutions to assist in prompt pharmacological management of pediatric agitation to potentially improve outcomes for patients, families, and healthcare professionals.

目的:儿科急性躁动症在医院环境中很常见,可导致严重的身心痛苦,而且在实践中处理方法千差万别。因此,制定标准化的药物治疗指南至关重要。我们的目标是为加拿大所有住院儿科患者的急性躁动管理制定一个新的临床路径(CP)。方法:加拿大在治疗和管理儿科躁动方面具有专长的医护人员组成了一个工作组,并通过进行文献综述、吸引主要合作伙伴参与以及获得跨学科共识(与内容专家进行迭代式实时讨论)来制定 CP。初步方案制定后,通过多次大查房和网络研讨会向更多的内部和外部合作伙伴进行了介绍;与会者的反馈意见指导了方案的最终修订:工作组创建了儿科住院病人 CP,用于指导躁动的药物治疗,并作为易于使用的临床和教育资源,包括三个互补部分:1) 治疗算法;2) 快速参考用药表;3) 两份辅助文件,其中包括在实施 CP 之前对非药物治疗策略的概述,以及与用药表配套的示例情景,以确保有效利用:这是加拿大首个对住院环境中儿童急性躁动的药物治疗和管理进行标准化的 CP。虽然还需要进一步的研究来评估实施情况并支持流程改进,但各医疗机构可对该 CP 进行调整,以协助对儿科躁动进行及时的药物治疗,从而改善患者、家属和医护人员的治疗效果。
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引用次数: 0
Integrating school environment strategies into adolescent substance use prevention: insights from Taiwan and implications for global research. 将学校环境策略纳入青少年药物使用预防:台湾的启示和对全球研究的影响。
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
Lien-Chung Wei
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引用次数: 0
The urgency in child welfare services is addressing poor mental health trajectories. 儿童福利服务的当务之急是解决不良的心理健康轨迹。
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
Nico Trocmé, Barbara Fallon
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引用次数: 0
Psychodynamic psychotherapy for gender dysphoria is not conversion therapy. 针对性别焦虑症的心理动力学心理疗法不是转换疗法。
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
Joanne Sinai, Peter Sim

Over the last ten years, there has been a substantial increase in the number of children and adolescents referred to gender clinics for possible gender dysphoria. The gender affirming model of care, a dominant treatment approach in Canada, is based on low quality evidence. Other countries are realizing this and making psychosocial treatments and/or exploratory psychotherapy a first line of treatment for gender related distress in young patients. Psychodynamic (exploratory) psychotherapy has established efficacy for a range of conditions, and has been used in youth and adults with gender dysphoria. In Canada, the adoption of psychodynamic psychotherapy for gender dysphoria is impeded by some academics who argue that it may violate laws against conversion therapy. Psychodynamic psychotherapy is not conversion therapy and should be made available in Canada as a treatment modality for gender dysphoria.

在过去的十年中,因可能出现性别障碍而被转诊到性别诊所的儿童和青少年人数大幅增加。在加拿大,性别平权护理模式是一种主要的治疗方法,但其依据的证据质量却很低。其他国家也意识到了这一点,并将社会心理治疗和/或探索性心理治疗作为治疗年轻患者性别相关困扰的第一线治疗方法。心理动力学(探索性)心理疗法已被证实对多种疾病具有疗效,并已用于患有性别焦虑症的青少年和成年人。在加拿大,一些学者认为心理动力学心理疗法可能会违反禁止转换疗法的法律,这阻碍了采用心理动力学心理疗法治疗性别障碍。心理动力学心理疗法不是转换疗法,加拿大应将其作为治疗性别焦虑症的一种方法。
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引用次数: 0
Recommended Academic Reading. 推荐学术读物。
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
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引用次数: 0
Advocacy and an advocacy column: more questions than answers. 宣传和宣传专栏:问题多于答案。
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
Peter Braunberger
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引用次数: 0
Highlights of the July issue. 七月刊亮点
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
John D McLennan
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引用次数: 0
Mental health service use of young people in child welfare services in Quebec, Canada. 加拿大魁北克省儿童福利服务机构中青少年使用心理健康服务的情况。
IF 2.9 Q2 PSYCHIATRY Pub Date : 2024-07-01
Kathleen MacDonald, Lyne Desrosiers, Lise Laporte, Srividya N Iyer

Background: Youth involved in child welfare have high rates of mental health problems and are known to receive mental health services from multiple settings. Still, gaps remain in our understanding of service use patterns across settings over the course of youth's involvement with child welfare.

Objective: To examine the settings, reasons for contact, persons involved in initiating care, and timing of each mental health service contact for individuals over their involvement with the child welfare system, and to identify factors that predict multi-setting use.

Methods: Data on mental health service contacts were collected retrospectively from charts for youth aged 11-18 (n=226) during their involvement with child welfare services in Montreal, Quebec. Logistic regression analysis was conducted to determine predictors of multi-setting mental health services use (defined as ≥3 settings).

Results: 83% of youth had at least one mental health service contact over the course of their child welfare services follow-up, with 45% having multi-setting use. Emergency Departments were the top setting for mental health services. Youth with a higher number of placements and from neighborhoods with greater social and material deprivation were significantly likelier to use ≥3 mental health service settings over the course of their follow-up.

Conclusion: These findings suggest a need for enhanced collaboration between youth-serving sectors to ensure that continuous and appropriate mental health care is being offered to youth followed by child welfare systems. The relationship between placement instability and multi-setting mental health service use calls for specific policies to ensure that young people do not experience multiple discontinuities of care.

背景:参与儿童福利的青少年有较高的心理健康问题发生率,而且众所周知,他们会在多种环境中接受心理健康服务。然而,我们对青少年在参与儿童福利过程中在不同环境中使用服务的模式的了解仍然存在差距:目的:研究青少年在参与儿童福利系统的过程中,每次接触心理健康服务的环境、接触原因、参与启动护理的人员和时间,并确定预测多环境使用的因素:我们从魁北克省蒙特利尔市 11-18 岁青少年(n=226)参与儿童福利服务期间的病历中回顾性地收集了他们接触心理健康服务的数据。我们进行了逻辑回归分析,以确定使用多机构心理健康服务(定义为≥3 个机构)的预测因素:结果:83%的青少年在接受儿童福利服务跟踪期间至少接触过一次心理健康服务,其中45%的青少年使用过多种心理健康服务。急诊室是接受心理健康服务最多的场所。在随访过程中,安置次数较多且来自社会和物质条件较差社区的青少年更有可能使用≥3个心理健康服务机构:这些研究结果表明,有必要加强青少年服务部门之间的合作,以确保为儿童福利系统跟踪的青少年提供持续、适当的心理健康护理。安置的不稳定性与使用多套心理健康服务之间的关系要求制定具体的政策,以确保青少年不会经历多次护理中断。
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引用次数: 0
A comparison of psychiatric inpatient admissions in youth before and during the COVID-19 pandemic. COVID-19 大流行之前和期间青少年精神病住院情况的比较。
Joanne L Park, Chris A Clark, Mercedes Bagshawe, Jennifer Kuntz, Andrea Perri, Avril Deegan, Brian Marriott, Abdul Rahman, Susan Graham, Carly A McMorris

Background: The current understanding of the effect of COVID-19 on child and youth admissions to psychiatric inpatient units over time is limited, with conflicting findings and many studies focusing on the initial wave of the pandemic.

Objectives: This study identified changes in psychiatric inpatient admissions, and reasons for admission, including suicidality and self-harm, before and during the COVID-19 pandemic.

Method: This time series study analyzed 3,723 admissions of youth (ages 0-18.88 years) admitted to four major psychiatry inpatient units in a large Canadian city between January 1st, 2016 and December 31st, 2021. Pre-pandemic (before March 11, 2020) and during-pandemic (after March 11, 2020) trends of admissions were explored using a Bayesian structural time series model (BSTS).

Results: The model revealed that overall admissions during the pandemic period exceeded what would have been predicted in the absence of a pandemic, a relative increase of 29%. Additionally, a rise in the total number of admissions due to self-harm and suicidality (29% increase), externalizing/behavioral issues (69% increase), and internalizing/emotional issues (28% increase) provided strong evidence of increased admissions compared to what might have been expected from pre-pandemic numbers.

Conclusions: There was strong evidence of increases in psychiatric inpatient admissions during the COVID-19 pandemic compared to expected trends based on pre-pandemic data. To ensure accessible and continuous mental health supports and services for youth and their families during future pandemics, these findings highlight the need for rapid expanse of inpatient mental health services, similar to what occurred in many intensive care units across Canada.

背景:目前,人们对 COVID-19 对儿童和青少年入住精神病院的影响了解有限,研究结果相互矛盾,而且许多研究都集中在大流行的最初阶段:本研究确定了 COVID-19 大流行之前和期间精神科住院病人入院情况的变化以及入院原因,包括自杀和自残:这项时间序列研究分析了 2016 年 1 月 1 日至 2021 年 12 月 31 日期间加拿大某大城市四个主要精神病住院部收治的 3723 名青少年(0-18.88 岁)。使用贝叶斯结构时间序列模型(BSTS)探讨了大流行前(2020 年 3 月 11 日之前)和大流行期间(2020 年 3 月 11 日之后)的入院趋势:结果:模型显示,大流行期间的总体入院人数超出了在没有大流行的情况下的预测,相对增加了 29%。此外,因自残和自杀(增加 29%)、外化/行为问题(增加 69%)和内化/情感问题(增加 28%)而入院的总人数增加,有力地证明了入院人数比大流行前的预期人数有所增加:结论:有确凿证据表明,在 COVID-19 大流行期间,精神科住院病人入院人数与根据大流行前数据预计的趋势相比有所增加。为了确保在未来的大流行期间为青少年及其家庭提供可获得的、持续的心理健康支持和服务,这些研究结果强调了迅速扩大住院心理健康服务的必要性,这与加拿大许多重症监护病房的情况类似。
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Journal of the Canadian Academy of Child and Adolescent Psychiatry
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