Literature Collection

BACKGROUND: Many allied health services now provide both telehealth and in-person services following a rapid integration of telehealth as a response to the COVID-19 pandemic. However, little is known about how decisions are made about which clinical appointments to provide via telehealth versus in person. OBJECTIVE: The aim of this study is to explore clinicians' decision-making when contemplating telehealth for their clients, including the factors they consider and how they weigh up these different factors, and the clinicians' perceptions of telehealth utility beyond COVID-19 lockdowns. METHODS: We used reflexive thematic analysis with data collected from focus groups with 16 pediatric community-based allied health clinicians from the disciplines of speech-language pathology, occupational therapy, social work, psychology, and counseling. RESULTS: The findings indicated that decision-making was complex with interactions across 4 broad categories: technology, clients and families, clinical services, and clinicians. Three themes described their perceptions of telehealth use beyond COVID-19 lockdowns: "flexible telehealth use," "telehealth can be superior to in-person therapy," and "fear that in-person services may be replaced." CONCLUSIONS: The findings highlight the complexity of decision-making in a community-allied health setting and the challenges experienced by clinicians when reconciling empirical evidence with their own clinical experience.

OBJECTIVE: The authors aim to measure differences in primary care clinicians' (PCC's) perceptions of managing pediatric mental health before and after launch of a child psychiatry access program (the access program) and identify the impact of engaging trainees from child psychiatry, pediatrics, and family medicine in administration and use of this program. METHODS: Child psychiatry fellows provide coverage of a grant-funded state-wide access program and engage trainee-peers in learning how to use the program. A survey measuring PCC's experience managing children's mental health conditions was administered before and after the child psychiatry access program launched. Rotation evaluations collect trainee's feedback. RESULTS: Statistically significant differences are identified before and after the program's launch in PCC's perception of access to child psychiatry (U = 294.5, p < 0.001) and between PCC's perceptions of the impact of behavioral health problems in their patients in those with less than 4 years post-residency training compared with those with 4 or more years post-residency (U = 524.5, p < .01). Trainee evaluation of the rotation is consistently positive (average 5:6 rating). CONCLUSION: The authors conclude that (1) the presence of a state-wide access program positively impacts PCC's reported access to child psychiatry; (2) child psychiatry fellows rate the clinical rotation experience favorably; and (3) there appears to be an association between less time out of primary care residency training and perception of improved access to child psychiatry and less clinical burden from behavioral health issues. Further research is required to understand the impact of a training in this model.

In years past, an adolescent patient presenting to primary care with symptoms of opioid use disorder (OUD) would have been a highly rare event in most communities. With OUD and fatal overdoses rising among adolescents and young adults (termed youth) over the past 15 years, this scenario has unfortunately become more common. Fatal drug overdoses increased 3.5-fold for youth aged 15 to 24 years from 1999 to 2014.1 Amidst this epidemic, relatively little is known about how primary care clinicians treat youth with OUD. Of particular interest is whether youth receive medication-assisted treatments (MATs), which have been shown to improve quality of life and reduce overdose risk.2

BACKGROUND: Health care disparities in rural and underserved areas necessitate quality primary care, especially in behavioral health management. Family nurse practitioners (FNPs) are critical in these regions, which often lack psychiatric specialists. PROBLEM: Rural communities face unique challenges exacerbated by primary care and mental health provider shortages. The deficit in behavioral health specialists highlights the need to optimize FNP education programs. APPROACH: The Collaborative Academic Practice (CAP) program prepares FNP students for entry-to-practice through hybrid learning, immersive training, and comprehensive behavioral health integration, effectively training them to meet the health care needs of underserved populations. OUTCOMES: The CAP program prepares FNPs, resulting in increased practice in underserved areas and enhanced preceptor satisfaction. Key measures contribute to its effectiveness, including immersive training, telehealth education, and preceptor enhancement. CONCLUSIONS: Despite financial and communication challenges, the CAP program transforms FNP education, addressing mental health needs and bridging critical gaps in health care delivery.