Implementing One-at-a-Time Therapy in community addiction and mental health centres: a retrospective exploration of the implementation process and initial outcomes.

BACKGROUND: The Department of Health of the Government of New Brunswick and Regional Health Authorities elected to implement Stepped Care 2.0 (SC2.0) in 2021, and began with One-at-a-Time (OAAT) therapy in Community Addiction and Mental Health Centres (CAMHCs) to facilitate rapid access to addiction and mental healthcare. This study: 1) explicated the process of implementing OAAT therapy as it aligned to evidence-based implementation frameworks and strategies; 2) assessed readiness for change among providers during the implementation; and 3) evaluated initial client and system outcomes. METHODS: The process of implementing OAAT therapy within CAMHCs was documented and retrospectively aligned with the Active Implementation Frameworks-Stages of Implementation, Consolidated Framework for Implementation Research, and incorporated strategies endorsed by the Expert Recommendations for Implementing Change. Providers working in CAMHCs completed online asynchronous courses in OAAT therapy and SC2.0, and were recruited to participate in research on perceptions of organizational readiness. Initial outcomes of the implementation were evaluated through client satisfaction surveys administered in CAMHCs and system performance indicators. RESULTS: Aligning with implementation stages, key strategies included: 1) continuously monitoring readiness and soliciting stakeholder feedback for iterative improvement; 2) building a representative implementation team with engaged leaders; 3) creating a comprehensive implementation plan on staff training, communication, and system changes; and 4) supporting sustainability. Providers who participated in research (N = 170, ~ 50% response rate) agreed that their organization was ready for implementation, and that OAAT therapy delivered within a SC2.0 framework was acceptable, appropriate, and feasible. More than 3,600 OAAT therapy sessions were delivered during the initial implementation stage, and waitlists were reduced by 64.1%. The majority of clients who completed surveys (N = 1240, ~ 35% response rate) reported that their OAAT therapy session was helpful, with a minority reporting that additional intervention was needed. CONCLUSIONS: Thoughtful planning and execution, aligned with evidence-based implementation frameworks and strategies, played an important role in this provincial change initiative. Implementation steps outlined can help inform others looking to enact large-scale change.

[Mechanical ventilation with explicit recall: a concept analysis.] / Rappel explicite d'une ventilation mécanique : une analyse conceptuelle.

Mechanical ventilation in the intensive care unit requires the use of medication to reduce pain, discomfort, anxiety, and agitation. An explicit recall refers to the phenomenon where the person remembers the perceptions that occurred under sedation during mechanical ventilation. Severe psychological consequences may occur as a result of an explicit recall. This phenomenon is not well-defined and there is no common language in the literature. A conceptual analysis was carried out using Rodgers' evolutionary method in order to clarify the concept of explicit recall. A total of sixty-eight articles were analyzed interdisciplinarily. The results indicate that an explicit recall occurs following treatment, requiring anesthesia or sedation, and the response to medication varies according to individual characteristics. The explicit recall is defined as perceptive, interpretative, subjective, dynamic, and temporal. Following an explicit recall, the psychological trajectory has various psychological consequences that can lead to post-traumatic stress disorder.

Understanding Children's Accuracy in Recognizing Facial Expressions of Pain.

Facial expressions of pain have an adaptive function in informing others of the need of attention and care. The detection of these nonverbal cues is particularly important in children since they are not always capable of expressing their needs verbally. Nevertheless, research recurrently shows that distinguishing between genuine, suppressed, and simulated pain expressions produced by children is a difficult task for adults; even when their professions require such a skill (e.g. doctors or nurses). Only a few studies have explored the development of this specific ability amongst children's peers. The current study aims to fill this literature gap by exploring children's ability to recognize and judge genuine, simulated, and suppressed expressions of pain produced by other children their age. Seventy-nine children from kindergarten to fourth grade viewed videos in which children encoders expressed the three aforementioned types of pain while plunging their hand in cold or warm water. Participants were asked to select the type of pain that was expressed. They were also asked their level of confidence in their answer and the level of pain they thought the children were experiencing. Despite having a high level of confidence in their answers, kindergarteners had a significantly lower proportion of correct answers compared to children in third and fourth grade. Furthermore, regardless of their grade level, children were better at recognizing suppressed pain expressions and had lower performance rates for genuine pain recognition. Our overall findings revealed an improvement in children's performance with aging.

The Role of Vocabulary Skills in a Storybook-Based Intervention to Stimulate Emotion Comprehension in Preschoolers.

Understanding emotions is an important predictor of children's mental health and school adjustment. However, interventions to improve this skill are not always accessible to all children. In 2019, Roy, Dénommée, and Quenneville developed stories with content specifically designed to 'teach' about emotions. Because it is a literacy-oriented intervention, it is possible that vocabulary may play a role in learning. This project explored the role of vocabulary in understanding emotion in preschool children and its learning. Forty-three preschoolers (19 control and 24 experimental) were evaluated on vocabulary skills and emotion comprehension. For multiple components, results showed an effect of time of measure, regardless of group. However, the addition of receptive vocabulary as a covariate made this effect non-significant. Results revealed that the stories were an effective strategy in promoting emotion comprehension for Components Belief and Reminder; two skills that are in the process of development in this age group. Furthermore, vocabulary skills did not impact the interaction for Belief for post-test gains and, for Reminder, while emotional vocabulary skills impacted the interaction at post-test, receptive vocabulary did not.

The Use of Dyadic Reading in Stimulating the Comprehension of Emotions.

According to the model proposed by Pons, Doudin, and Harris , children develop nine components of emotion comprehension between the ages of three to twelve. Studies reveal that children's comprehension of emotions can be stimulated by adults reading books designed for this purpose to preschool-aged children. The aim of this study is to explore whether dyadic reading is an effective strategy for stimulating emotion comprehension in school-aged children. Elementary school children (3rd, 4th and 5th grade) participated in the experimental or the control group. The Test of Emotion Comprehension (TEC) was administered at pretest and post-test. Participants in the experimental group read the books on emotion comprehension for five sessions, while participants in the control group read classroom books. Results revealed that reading the emotion comprehension books increased the TEC post-test scores significantly from pretest for children in the experimental group, compared to the control group. For the Components Reminder, Belief and Morality scores at post-test were significantly increased from pretest for children in the experimental group, compared to the control group. Results suggest that dyadic book readings are successful in helping children with both complex components of their emotion comprehension and simpler ones. This intervention could be of use for teaching school-aged children emotion comprehension easily, effectively, and at low-cost.