"Stop Imposing on Us": A Critical Examination of Ethnocultural Considerations in the Canadian Volunteer Hospice Palliative Care Landscape.

Volunteers are foundational in hospice programs. The purpose of this research was to address social, ethnic and demographic changes in Southwestern Ontario and understand how this may affect volunteer recruitment, and representation. Interviews and focus groups were conducted with hospice volunteers, key informants from leaders in ethnocultural communities, and hospice staff. Qualitative data from the interviews was analyzed using thematic analysis in five phases. Findings suggest ethnocultural interpretations of hospice can be very different than Westernized, Eurocentric ideas around end-of-life care. Systemic and structural barriers, information sharing, volunteer motivation and representation were found to influence and impact ethnocultural volunteer recruitment in hospice palliative care. Using a critical analysis allows us to identify the "imposition" of a Euro-ethnocentric hospice palliative care model that prevents recruitment of and impedes access of ethnocultural groups to hospice palliative care. To build bridges across predominantly White/Western models of care to ethnocultural racialized communities requires constant communication, relationship building, and determination in mutuality of learning on behalf of the dominant model. This research has implications for different regions of Canada providing hospice palliative care and hoping to increase ethnocultural accessibility and volunteer recruitment for hospice palliative care.

Nonphysical Suffering: An Under-Resourced and Key Role for Hospice and Palliative Care Social Workers.

This article highlights recent research findings that have significance for hospice and palliative care social work in Canada, and for the field of hospice and palliative care more broadly. A 2020 discourse analysis study examined the experiences of 24 interdisciplinary palliative care clinicians across Canada in their work with patients' nonphysical suffering. Nonphysical suffering is suffering that may be emotional, psychological, social, spiritual and/or existential in nature. The study found an absence of specialist social workers on hospice and palliative care teams or limited time for specialist social workers to address patients' nonphysical suffering due to high caseloads and complex practical needs. While the study recognizes social workers have expertise in supporting patients' nonphysical suffering, a competency and skill that has not been sufficiently captured in the existing literature, the systemic barriers they face in providing care may leave patients' needs unmet. The study also highlights the unique pressure social workers may feel to relieve patients' nonphysical suffering due to the psychosocial focus of their role. The need for specialist social workers to be included and adequately resourced on hospice and palliative care teams across diverse settings in Canada is evident.

Cost-effectiveness analysis of single-session walk-in counselling.

BACKGROUND: An increasing number of family service agencies and community-based mental health service providers are implementing a single-session walk-in counselling (SSWIC) as an alternative to traditional counselling. However, few economic evaluations have been undertaken. AIMS: To conduct a cost-effectiveness analysis of two models of service delivery, SSWIC compared to being waitlisted for traditional counselling. METHODS: A quasi-experimental design was employed. Data were collected from two community-based Family Service Agencies, one using SSWIC and one using traditional counselling. Participants were assessed at baseline and four weeks after the baseline. Cost-effectiveness was estimated from the societal and payer's perspective. RESULTS: The societal and payer's costs for SSWIC were higher than for those waiting for traditional counselling, and health outcomes were better. SSWIC is not cost-effective compared to being on the waitlist for traditional counselling (or, for a few patients, having received counselling, but after a wait of several weeks). CONCLUSIONS: SSWIC has the potential to reduce the pressure on the mental health care system by reducing emergency visits and wait lists for ongoing mental health services and eliminating costly-no shows at counselling appointments. Long-term studies involving multiple walk-in counselling services and comparison services are needed to support the findings of this study.

A comparison of walk-in counselling and the wait list model for delivering counselling services.

BACKGROUND: Walk-in counselling has been used to reduce wait times but there are few controlled studies to compare outcomes between walk-in and the traditional model of service delivery. AIMS: To compare change in psychological distress by clients receiving services from two models of service delivery, a walk-in counselling model and a traditional counselling model involving a wait list. METHOD: Mixed-methods sequential explanatory design including quantitative comparison of groups with one pre-test and two follow-ups, and qualitative analysis of interviews with a sub-sample. Five-hundred and twenty-four participants ≥16 years were recruited from two Family Counselling Agencies; the General Health Questionnaire-12 assessed change in psychological distress. RESULTS: Hierarchical linear modelling revealed clients of the walk-in model improved faster and were less distressed at the four-week follow-up compared to the traditional service delivery model. Ten weeks later, both groups had improved and were similar. Participants receiving instrumental services prior to baseline improved more slowly. The qualitative data confirmed participants highly valued the accessibility of the walk-in model, and were frustrated by the lengthy waits associated with the traditional model. CONCLUSIONS: This study improves methodologically on previous studies of walk-in counselling, an approach to service delivery not conducive to randomized controlled trials.

The case for single-session therapy: does the empirical evidence support the increased prevalence of this service delivery model?

BACKGROUND: A significant increase in the number of walk-in counselling clinics offering single-session therapy (SST) prompted this review of the empirical support for the effectiveness of SST. AIMS: The article is intended to (1) increase practitioners' knowledge of the empirical support for the effectiveness of single-session counselling with client populations typically served in community-based mental health and counselling agencies and (2) identify priorities for future research on SST. METHOD: A thorough review of relevant databases was undertaken to locate published studies reporting client outcomes following SST. The focus of the review is research involving clients and presenting problems typically seen in community-based mental health and family counselling agencies. RESULTS: The findings suggest that the majority of clients attending either previously scheduled or walk-in SST find it sufficient and helpful. The studies imply that this model of service delivery leads to perceived improvement in presenting problems in general, and on specific measures of variables such as depression, anxiety, distress level and confidence in parenting skills. CONCLUSIONS: Many of the studies have methodological limitations, and future research requires increased use of standardized measures, control groups and larger and more diverse samples.

Sustaining walk-in counselling services: an economic assessment from a pilot study.

Introducing single-session walk-in counselling services in a counselling agency virtually eliminated a lengthy wait list and reduced costly no-shows for scheduled counselling. A pilot study found that client distress decreased significantly following the single session, and a high proportion of clients were "ready for change." The service diverts clients from using hospitals and family doctors/walk-in clinics and toward using community social services. It also enables an earlier return to work and usual activities. The social benefits (reduced hospital use and faster return to work) exceed the cost of the service. This information is helping to make the case for sustaining and expanding these services.