Mental health consultation

This paper presents a systematic model describing current consultation. It originates from the needs of consultees to adapt to new roles and to meet grassroots pressure. It builds upon the earlier consultation models of Caplan and Berlin and their intention that consultation have far-reaching consequences. It has strong roots in the public health tradition of primary prevention. Processes consistent with the model focus on relationship, self-disclosure, and role modeling to effect change in other systems. Examples of pay-off for consultees and their systems are presented.     

Anatomy of psychiatric consultation to rural Indians

The development of a community mental health consultation program to an Indian population both geographically isolated and with minimal community resources poses major tasks. The first is the successful negotiation of a consultation contract with several levels of government involved in Indian health affairs. Second is the selection of entry into the community that will afford community visibility and acceptance. Third is the necessity of providing a modicum of direct services to operate concurrently with the indirect services of consultation. Fourth a systematic method of program evaluation must be carried on to prevent premature solidification of consultation work and provide guidelines for necessary program change and development.This project was supported in part by State of Washington Initiative 171 Funds for Research in Biology and Medicine. The paper was read at the 126th Annual Meeting of the American Psychiatric Association San Francisco, May 1970.     

A collaborative-interactive model for mental health consultation: Teacher inservice education by psychiatric clinicians

Primary prevention of emotional disorders is often cited as a goal in community mental health consultation. The daily contact with children and parents by the classroom teacher can yield effective prevention, if the teacher is appropriately prepared to act as a resource, and by clinicians given an awareness of emotional difficulties in children and their parents. Though consultation is often described as facilitative of change, typically discussions of such programs emphasize technique rather than content. Presented here is acollaborative model based upon a didactic input of humanistic psychology, upon which educator and clinician draw as they become allies in pursuit of answers to questions raised in current examples from the teacher's classroom experience. Excerpts and results of the model's effectiveness are given.     

Création d’une consultation psychiatrique ouverte aux préparationnaires du 5e et du 6e arrondissement de Paris : retour d’activité sur l’année 2017–2018

Part of the French post-secondary education system is the Classes Préparatoires aux Grandes Écoles (High School Preparatory Classes) which consists of two intensive years (or three years sometimes) to pass the entrance examination of the Grandes Écoles. Grandes Écoles are highly selective, elite, and prestigious institutions [10]. The difficulties for these students are a higher stress (succeed the entrance examination), lack of time (all their time is dedicated to studies). The access to public psychiatric health system depends on where you live. Due to their schedule, they spend most of their time in the high school and they can’t consult in the psychological centre whom they depend [9]. In these conditions, in December 2017, public psychiatric care of the 5th and 6th districts of Paris created a psychiatric consultation in one high school opened to the students in Classes Preparatoires which signed a convention with the psychiatric ward.ObjectivesThis study aims to debrief the activity and the student profiles in the first year of this consultation.Patients and methodsThe patients are composed of students registered in Classes Préparatoires from the 5th and 6th district of Paris and who came to the psychiatric consultation, aged from 16 to 19 years old and referred by school nurses, school doctors, psychiatric ward or student himself. Retrospective study based on the activity of the consultation and medical files of psychiatrics consultations between December 2017 and July 2018.ResultsFifteen students consulted with a mean of 5.2 ± 2.9 consultations per students, eleven of them were oriented by school nurses. Eleven students benefited from a regular follow-up or an “in case of need” consultation. Five students had already received a psychotropic drug before the consultation; at the end of the year, ten of them received medication. The most prescribed category of medication are antidepressants and anxiolytics with seven patients apiece. The most represented disorders are a major depressive disorder (41%), adaptative disorder (29%), anxiety disorder (12%). Four students stopped their studies in the high school during the academic year. Two students needed to be hospitalized in the psychiatric ward of the district, they continued their education in their high school after hospitalization.ConclusionThe consultation for the Classes Préparatoires aux Grandes Écoles allowed an access to a psychiatric offer next to the place those students spend most of their time, without going to an emergency structure and with a shorter waiting time compared to the psychological centre in public health system. This consultation enables the evaluation, the follow-up and the orientation of the students, including the hospitalization when it is needed but also to sustain some students in their studies. In views of requesting a psychotherapy and the usual waiting time in the psychotherapeutic centre for students which already exist, there is important need to provide increased resources for these students.     

An interaction method of teaching consultation: Role-playing

Role-playing is not a reckless undertaking for instructors or seminar participants if they follow a careful progression. First, instructors show standard techniques and how to handle awkward situations. The students first experience role-playing in the familiar role of therapist to differentiate therapy and consultation responses. Then they practice being consultants, anticipating certain pitfalls in consultation. Later, they role-play consultees and discover which consultation interventions work best. Class members gradually set up their own role-play, challenge the limits of each others' styles, and draw upon their real-life experiences in class as a model.     

Consultation and group process with indigenous neighborhood workers

This paper describes a group experience with neighborhood workers in a black, ghetto community action program, with a white psychiatrist as group leader. It focuses on the definition of the task of consultation, derivation of mutually agreed upon goals, evolution of the group, and issues dealt with during the experience. Excerpts are presented to illustrate what the neighborhood workers themselves found relevant from the sessions. Finally, the meetings are discussed from the point of view of white professional consultation to a black community agency, and aspects of group dynamics are considered.     

The First 10 Thrombolysis for Acute Ischemic Stroke in Lao People's Democratic Republic under Teleconsultation from Thailand

Background: Acute ischemic stroke patients in Lao People's Democratic Republic (Lao PDR) are unable to access the intravenous thrombolytic therapy using recombinant tissue plasminogen activator (rtPA) due to various reasons. Aims: This study aimed to evaluate the feasibility and safety of thrombolytic therapy administration at Mittaphab Hospital, Lao PDR under the international telestroke consultation system from King Chulalongkorn Memorial Hospital, Thailand. Methods: Acute ischemic stroke patients who presented at Mittaphab Hospital within 4.5 hours after the onset and received thrombolytic therapy between December 2016 and June 2017 were studied. An immediate real time teleconsultation with 24 hours availability between neurologists at Mittaphab hospital and the Chulalongkorn stroke team was performed in all cases for patient evaluation and decision for thrombolytic treatment. Results: There were 205 patients with acute stroke, 28 patients (14%) arrived at the hospital within 4.5 hours after the onset. Ten patients (5%) were eligible for intravenous rtPA. The mean duration from onset to hospital arrival was 122.50 minutes and the mean door to needle time was 108 minutes. The mean National Institute of Health stroke scale (NIHSS) before thrombolysis was 10. At 90 days, the mean NIHSS was 3 and the mean mRS was 2. Seventy percent of patients had good outcome (mRS ≤2). Only one patient developed massive cerebral infarction. None of the patient developed symptomatic intracerebral hemorrhage or major bleedings. Conclusions: Telestroke consultation from Thailand can facilitate the thrombolytic therapy for acute ischemic stroke patients in Lao PDR.     

The use of indigenous volunteers in a rehabilitation living unit for disturbed college students

Indigenous volunteers may provide a supplementary source of help to their emotionally disturbed peers. Lowering the threshold of accessibility of professional staff for direct service to students and consultation with dormitory staff are also a part of this program. Initial findings show promise for decreasing the dropout rate of disturbed students. There is a consensus among volunteers and clients concerning the relative value of the therapeutic community as a resource for treatment and maturation.     

An Examination of Behavioral Rehearsal During Consultation as a Predictor of Training Outcomes

The training literature suggests that ongoing support following initial therapist training enhances training outcomes, yet little is known about what occurs during ongoing support and what accounts for its effectiveness. The present study examined consultation sessions provided to 99 clinicians following training in cognitive-behavioral therapy for youth anxiety. Recorded consultation sessions (N = 104) were coded for content and consultative methods. It was hypothesized that behavioral rehearsal (an active learning technique) would predict therapist adherence, skill, self-efficacy, and satisfaction at post-consultation. Regression analyses found no significant relation, however, clinician involvement during consultation sessions positively moderated the relationship between behavioral rehearsals and skill. Implications, limitations, and future directions are discussed.     

Priority setting for mental health research in Chile

Background

Scientific knowledge is a fundamental tool for making informed health policy decisions, but the link between health research and public policy decision-making is often missing. This study aims to identify and prioritize a national set of research gaps in mental health.

Methods

A multi-approach method to identify gaps in knowledge was developed, including (1) document analysis and identification of possible research questions, (2) interviews to Ministry of Health key informants, (3) focus groups with different stakeholders, and (4) a web consultation addressed to academics. The identified gaps were translated to a standardized format of research questions. Criteria for prioritization were extracted from interviews and focus groups. Then, a team of various professionals applied them for scoring each question research.

Findings

Fifty-four people participated in the knowledge gaps identification process through an online consultation (n = 23) and focus groups (n = 18). Prioritization criteria identified were: extent of the knowledge gap, size of the objective population, potential benefit, vulnerability, urgency and applicability. 155 research questions were prioritized, of which 44% were related to evaluation of systems and/or health programs, and 26% to evaluation of interventions, including questions related to cost-effectiveness. 30% of the research questions came from the online consultation, and 36% from key informants. Users groups contributed with 10% of total research questions.

Conclusion

A final priority setting for mental health research was reached, making available for authorities and research agencies a list of 155 research questions ordered by relevance. The experience documented here could serve to other countries interested in developing a similar process.

     

Using Multi-component Consultation to Increase the Integrity with Which Teachers Implement Behavioral Classroom Interventions: A Pilot Study

The goal of this pilot study was to evaluate the effectiveness of a multi-component consultation package in improving teachers’ classroom management skills, particularly among teachers with lower baseline levels of knowledge, skills, and intervention-supportive beliefs. Participants were 58 elementary school teachers (93% female; 50% non-Hispanic White) who received up to eight biweekly consultation sessions focused on general classroom management strategies and implementation of a daily report card intervention with one target student with or at risk of ADHD. Teachers were randomly assigned to either a comparison consultation condition designed to mirror current best practices (Frank & Kratochwill, in: Erchul, Sheridan (eds) Handbook of research in school consultation, Routledge, New York, 2014; Noell & Gansle, in: Erchul, Sheridan (eds) Handbook of research in school consultation, Routledge, New York, 2014) or a multi-component condition designed to simultaneously address teacher knowledge, skills, and beliefs as possible barriers to implementation of classroom interventions. Teachers in both conditions showed significant improvements in labeled praise, appropriate response to student rule violations, and general competence in classroom management. In support of the hypotheses, teachers with lower baseline levels of knowledge, skills, and intervention-supportive beliefs demonstrated more improvement in key outcomes in response to multi-component consultation, as compared to the comparison consultation (Cohen’s d ranged from 0.33 to 1.12). Implications for research and practice in school consultation are discussed.     

A comparison of individual and group mental health consultation with teachers

Mental health consultation with individual teachers (IC) or with groups of teachers (GC) was provided in eight elementary schools. On a follow-up questionnaire, GC teachers rated the consultation program more favorably than did IC teachers with regard to “general usefulness,” amount of communication generated between teachers, and amount of knowledge of child development acquired. Ratings of improvement in child behavior and parent-school relations were not significantly different for GC and IC. Apparent effects on ratings of such variables as amount of contact with consultant, diagnosis of children referred, group composition, and administrative commitment are discussed. Results suggest that GC is not only more economical than IC but also is a more effective means of educating and supporting teachers.     

Results of a four-year multi-channel regional program for monitoring stroke survivors in Franche-Comté, France

IntroductionClinical monitoring of stroke survivors after hospital discharge was initiated in France in 2012 and funding for its model began in 2016. A regional program in Franche-Comté relying on various assessment methods including telehealth was initiated. The objective of this study was to describe the implementation and quality of the program.MethodsA retrospective observational study was conducted from 1^st January 2016 to 31^st December 2019. Patients were included if they were adults, hospitalized for stroke or transient ischemic attack in one of the six public hospitals in the region and discharged alive. There were five types of monitoring methods: physical consultation, day hospital, nurse-led phone consultation, postal mail or medical record analysis. Characteristics, method of monitoring and discharge delay were described.ResultsIn total, 7166 patients were identified; male gender predominated (52.9%); mean age was 72.2 years. Monitoring coverage increased from 89.2% to 92% within the period. Most patients had ischemic stroke (68.5%, n = 4912) and were at home at the time of monitoring (71.6%, n = 5130). The main method was nurse-led phone consultations (40.8%, n = 2921) followed by physical consultation (16%, n = 1143). Day hospital monitoring increased (1.5% to 14.4%) while the postal mail method decreased (18.7% to 8.1%). The average delay decreased from 240.3 to 148.6 days. Monitoring period of less than four months was 46.2% in 2019 and 75.3% for thrombolysis. In 2019, 99.3% of patients were being monitored at one year. Mortality decreased from 10% to 6.3%.DiscussionThe program improved over time with an increase in the number of patients and reduction in delays and mortality rate.     

Neighborhood psychiatry: New community approach

Neighborhood health and multiservice centers are increasingly becoming a means of delivering medical care to communities. This paper describes the function of a “neighborhood psychiatric team,” using a “family life center” as a base of operations for a comprehensive preventive and treatment program in one neighborhood of Boston. This program consists of direct treatment services to neighborhood residents, consultation with health and social service professionals and paraprofessionals in the Family Life Center itself, and consultation with other community agencies. The advantages of working in a neighborhood-early intervention in crisis with individuals and agencies, accessibility to the entire family, integration with general health services, easy follow-up and aftercare of recently discharged psychiatric patients-are described with case examples.     

Practice parameter for psychiatric consultation to schools

This practice parameter reviews the topic of psychiatric consultation to schools. The review covers the history of school consultation and current consultative models; the process of developing a consultative relationship; school administrative procedures, personnel, and milieu; legal protections for students with mental disabilities; and issues typically arising in consultative situations. The objective of the parameter is to provide an introduction to the special vocabulary, knowledge, and skills that are important prerequisites for successful consultation in school settings.     

Effectiveness and Sustainability of School-Based Interventions for Youth with or at Risk for ADHD

In a pre–post design study, we examined the effectiveness and sustainability of a school mental health program for youth with or at-risk for ADHD (n = 41) when implemented over the course of 4 years by district-employed school mental health professionals (SMHPs) in a rural community. In the program, children received a daily report card (DRC) intervention and teachers received behavioral consultation sessions twice a month. Parent and teacher ratings of symptoms and impairment were collected at pre-intervention (typically fall) and post-intervention (spring) of each academic year. According to parent ratings, children experienced significant improvement in academic functioning (effect size (ES) = .65) and overall functioning (ES = .57). Changes in parent-rated symptoms were in the expected direction, but small in magnitude (ranged from .22 to .32) and nonsignificant. Changes in teacher ratings of symptoms and impairment were nonsignificant. The ESs ranged from ?.12 (self-esteem) to .42 (inattention). Results are discussed in the context of current efforts to disseminate treatments for youth with ADHD and disruptive behavior disorders.     

Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality

Objective:

To examine the prevalence of bullying victimization among adolescents referred for urgent psychiatric consultation, to study the association between bullying victimization and suicidality, and to examine the relation between different types of bullying and suicidality.

Method:

A retrospective chart review was conducted for all adolescents referred to a hospital-based urgent consultation clinic. Our study sample consisted of adolescents with a history of bullying victimization. The Research Ethics Board of Queen’s University provided approval. Data analysis was conducted using SPSS (IBM SPSS Inc, Armonk, NY). Chi-square tests were used for sex, suicidal ideation, history of physical and sexual abuse, and time and type of bullying, and an independent sample t test was used for age.

Results:

The prevalence of bullying victimization was 48.5% (182 of 375). There was a significant association between being bullied and suicidal ideation (P = 0.01), and between sex and suicidal ideation (P ≤ 0.001). Victims of cyberbullying reported more suicidal ideation than those who experienced physical or verbal bullying (P = 0.04).

Conclusions:

Bullying victimization, especially cyberbullying, is associated with increased risk of suicidal ideation among adolescents referred for psychiatric risk assessment. The detailed history of the type and duration of bullying experienced by the victims should be considered when conducting a psychiatric risk assessment.     

Not Just a Walk in the Park: Efficacy to Effectiveness for After School Programs in Communities of Concentrated Urban Poverty

This study examined a model for mental health consultation, training and support designed to enhance the benefits of publicly-funded recreational after-school programs in communities of concentrated urban poverty for children’s academic, social, and behavioral functioning. We assessed children’s mental health needs and examined the feasibility and impact of intervention on program quality and children’s psychosocial outcomes in three after-school sites (n = 15 staff, 89 children), compared to three demographically-matched sites that received no intervention (n = 12 staff, 38 children). Findings revealed high staff satisfaction and feasibility of intervention, and modest improvements in observed program quality and staff-reported children’s outcomes. Data are considered with a public health lens of mental health promotion for children in urban poverty.