Development and evaluation of a de-escalation training intervention in adult acute and forensic units: the EDITION systematic review and feasibility trial.

Background: Containment (e.g. physical restraint and seclusion) is used frequently in mental health inpatient settings. Containment is associated with serious psychological and physical harms. De-escalation (psychosocial techniques to manage distress without containment) is recommended to manage aggression and other unsafe behaviours, for example self-harm. All National Health Service staff are trained in de-escalation but there is little to no evidence supporting training's effectiveness. Objectives: Objectives were to: (1) qualitatively investigate de-escalation and identify barriers and facilitators to use across the range of adult acute and forensic mental health inpatient settings; (2) co-produce with relevant stakeholders an intervention to enhance de-escalation across these settings; (3) evaluate the intervention's preliminary effect on rates of conflict (e.g. violence, self-harm) and containment (e.g. seclusion and physical restraint) and understand barriers and facilitators to intervention effects. Design: Intervention development informed by Experience-based Co-design and uncontrolled pre and post feasibility evaluation. Systematic reviews and qualitative interviews investigated contextual variation in use and effects of de-escalation. Synthesis of this evidence informed co-design of an intervention to enhance de-escalation. An uncontrolled feasibility trial of the intervention followed. Clinical outcome data were collected over 24 weeks including an 8-week pre-intervention phase, an 8-week embedding and an 8-week post-intervention phase. Setting: Ten inpatient wards (including acute, psychiatric intensive care, low, medium and high secure forensic) in two United Kingdom mental health trusts. Participants: In-patients, clinical staff, managers, carers/relatives and training staff in the target settings. Interventions: Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) interventions included de-escalation training, two novel models of reflective practice, post-incident debriefing and feedback on clinical practice, collaborative prescribing and ward rounds, practice changes around admission, shift handovers and the social and physical environment, and sensory modulation and support planning to reduce patient distress. Main outcome measures: Outcomes measured related to feasibility (recruitment and retention, completion of outcome measures), training outcomes and clinical and safety outcomes. Conflict and containment rates were measured via the Patient-Staff Conflict Checklist. Clinical outcomes were measured using the Attitudes to Containment Measures Questionnaire, Attitudes to Personality Disorder Questionnaire, Violence Prevention Climate Scale, Capabilities, Opportunities, and Motivation Scale, Coercion Experience Scale and Perceived Expressed Emotion in Staff Scale. Results: Completion rates of the proposed primary outcome were very good at 68% overall (excluding remote data collection), which increased to 76% (excluding remote data collection) in the post-intervention period. Secondary outcomes had high completion rates for both staff and patient respondents. Regression analyses indicated that reductions in conflict and containment were both predicted by study phase (pre, embedding, post intervention). There were no adverse events or serious adverse events related to the intervention. Conclusions: Intervention and data-collection procedures were feasible, and there was a signal of an effect on the proposed primary outcome. Limitations: Uncontrolled design and self-selecting sample. Future work: Definitive trial determining intervention effects. Trial registration: This trial is registered as ISRCTN12826685 (closed to recruitment). Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 16/101/02) and is published in full in Health Technology Assessment; Vol. 28, No. 3. See the NIHR Funding and Awards website for further award information. Context: Conflict (a term used to describe a range of potentially unsafe events including violence, self-harm, rule-breaking, medication refusal, illicit drug and alcohol use and absconding) in mental health settings causes serious physical and psychological harm. Containment interventions which are intended to minimise harm from violence (and other conflict behaviours) such as restraint, seclusion and rapid tranquilisation can result in serious injuries to patients and, occasionally, death. Involvement in physical restraint is the most common cause of serious physical injury to National Health Service mental health staff in the United Kingdom. Violence to staff results in substantial costs to the health service in sickness and litigation payments. Containment interventions are also expensive (e.g. physical restraint costs mental health services £6.1 million and enhanced observations £88 million per annum). Despite these harms, recent findings indicate containment interventions such as seclusion and physical restraint continue to be used frequently in mental health settings. Clinical trials have demonstrated that interventions can reduce containment without increasing violence and other conflict behaviours (e.g. verbal aggression, self-harm). Substantial cost-savings result from reducing containment use. De-escalation, as an intervention to manage aggression and potential violence without restrictive practices, is a core intervention. 'De-escalation' is a collective term for a range of psychosocial techniques designed to reduce distress and anger without the need to use 'containment' interventions (measures to prevent harm through restricting a person's ability to act independently, such as physical restraint and seclusion). Evidence indicates that de-escalation involves ensuring conditions for safe intervention and effective communication are established, clarifying and attempting to resolve the patient's concern, conveyance of respect and empathy and regulating unhelpful emotions such as anxiety and anger. Despite featuring prominently in clinical guidelines and training policy domestically and internationally and being a component of mandatory National Health Service training, there is no evidence-based model on which to base training. A systematic review of de-escalation training effectiveness and acceptability conducted in 2015 concluded: (1) no model of training has demonstrated effectiveness in a sufficiently rigorous evaluation, (2) the theoretical underpinning of evaluated models was often unclear and (3) there has been inadequate investigation of the characteristics of training likely to enhance acceptability and uptake. Despite all National Health Service staff being trained in de-escalation there have been no high-quality trials evaluating the effectiveness and cost-effectiveness of training. Feasibility studies are needed to establish whether it is possible to conduct a definitive trial that can determine the clinical, safety and cost-effectiveness of this intervention.

Mental health hospitals are stressful places for patients and staff. Patients are often detained against their will, in places that are noisy, unfamiliar and frightening. Violence and self-injury happen quite frequently. Sometimes staff physically restrain patients or isolate patients in locked rooms (called seclusion). While these measures might sometimes be necessary to maintain safety, they are psychologically and physically harmful. To help reduce the use of these unsafe measures, staff are trained in communication skills designed to reduce anger and distress without using physical force. Professionals call these skills 'de-escalation'. Although training in de-escalation is mandatory, there is no good evidence to say whether it works or not, or what specific techniques staff should be trained in. The Enhancing de-escalation techniques in adult acute and forensic units: Development and evaluation of an evidence-based training intervention (EDITION) project aimed to develop and evaluate a de-escalation training programme informed by research evidence. We interviewed over one hundred people who either worked in or received treatment in a mental health hospital. These people were clear that the training should target key sources of interpersonal and environmental stress that prevent de-escalation from working. We also reviewed all the scientific studies on de-escalation and training, aiming to identify the elements of training that are most likely to increase use of de-escalation. Then, in partnership with current mental health service users and clinical staff, we developed the training programme. Training was delivered to more than 270 staff working in 10 different wards in mental health hospitals. We measured rates of violence, self-injury and use of physical restraint and seclusion 8 weeks before staff received training and 16 weeks after they received training (24 weeks of data collection in total). Analysis of these data showed that these unsafe events were occurring significantly less frequently after training than they were before training, which raised the possibility that the training was helping to reduce harm.

Non-psychologist practitioners' views of cognitive assessment reports: An evaluation of a learning disability child and adolescent mental health service.

This report details a service evaluation for a learning disability child and adolescent mental health service. The project aimed to explore nonpsychologist healthcare professionals' views of the accessibility and utility of cognitive assessment reports produced in the service. Semistructured interviews were conducted with eight healthcare professionals. Thematic analysis identified three themes: value of reports, readability, and acknowledging multiple audiences, each with supplementary subthemes. The following were recommended: shorter reports; simpler language; examples and recommendations pertinent and applicable to individual clients (supported by the case holder if the assessor is unfamiliar with the client); visual information to support written text; assessor to provide verbal feedback in addition to the written report; main report should contain information most pertinent to families and professionals: the clients' level of functioning/abilities and recommended interventions, whilst the appendix should contain supplementary information such as scoring and performance on individual subtests.

Ethical and Forensic Issues in the Medico-Legal and Psychological Assessment of Women Asylum Seekers.

Asylum-seeking migrants represent a vulnerable segment of the population, and among them, women constitute an even more vulnerable group. Most of these women and girls have been exposed to threats, coercion, and violence of many kinds, including rape, forced prostitution, harassment, sexual slavery, forced marriage and pregnancy, female genital mutilation/excision, and/or other violations of their rights (e.g., deprivation of education, prohibition to work, etc.). The perpetrators of the violence from which they flee are often their own families, partners, and even institutional figures who should be in charge of their protection (such as police officers). In the process for the acceptance/rejection of an asylum application, the forensic and psychological certification can make the difference between successful and unsuccessful applications, as it can support the credibility of the asylum seeker through an assessment of the degree of compatibility between the story told and the diagnostic and forensic evidence. This is why constant and renewed reflection on the ethical, forensic, and methodological issues surrounding medico-legal and psychological certification is essential. This article aims to propose some reflections on these issues, starting from the experience of the inward healthcare service dedicated to Migrant Victims of Maltreatment, Torture, and Female Genital Mutilation operating since 2018 at the Institute of Forensic Medicine of the University Hospital of Palermo.

Corrigendum: Assessing the needs and perspectives of patients with obesity and obstructive sleep apnea syndrome following continuous positive airway pressure therapy to inform health care practice: A focus group study.

[This corrects the article DOI: 10.3389/fpsyg.2022.947346.].

Affirmative Stances in Training Programs Toward Sexual and Gender Minority Clients: Views From Clinical and Counseling Psychology Graduate Students.

Despite training recommendations to address mental health disparities among sexual and gender minority (SGM) individuals, the current state of SGM affirmative training in clinical and counseling doctoral psychology programs remains unclear. The present study surveyed 147 clinical and counseling psychology graduate students in the United States. Participants completed surveys on affirmative training stances in their graduate program for sexual minority clients, gender minority clients, and self-reported perceptions of their attitudes, knowledge, and skills related to SGM clients. Results revealed that current graduate students reported more affirmative stances for sexual minority clients compared to gender minority clients. SGM graduate students reported fewer affirmative stances in their programs for both sexual and gender minority clients compared to their heterosexual cisgender peers. Lastly, SGM identity was a significant predictor of perceived SGM clinical competency beyond years of training, program model, or type of graduate program. Implications for training and future research are discussed.

Financial stress and debt in clinical psychology doctoral students.

INTRODUTION: Few studies examine the financial burden of clinical psychology doctoral programs and its impact on achievements, stress, and mental health. OBJECTIVES: The current study sought to better understand students' financial stress and debt, and how financial stress may impact their mental health and the attainment of personal and professional milestones. METHOD: Students (N = 912) completed an online survey assessing demographics, sources of income and expenditures, mental health, and milestones. RESULTS: After accounting for yearly inflation, stipends have not kept pace with the average cost of living in the United States. Over one-third of students indicated that they had no expendable pretax income after paying for their education and typical living expenses. Additionally, over 80% reported acquiring additional debt in graduate school to offset their living expenses. Financial concerns were associated with delays in major life milestones (e.g., buying a car/house, getting married/starting a family, having children), as well as avoiding medical (34.2%) or mental (41.4%) health care, with 17.5% of participants experiencing a health crisis they could not afford while in graduate school. Financial stress was associated with an increase in time spent thinking about finances, higher rates of depression and anxiety symptoms, and decreased sleep. CONCLUSION: Many clinical psychology doctoral students experience financial stress and are often unable to afford basic educational, personal living, and health care expenses, likely worsening mental health. Academic programs and leadership are encouraged to increase student stipends, improve financial transparency, provide access to health care, and alleviate financial stress and debt.

A lida clínica com o suicídio: de binswanger à daseinsanálise hoje / El manejo clínico con el suicidio: de binswanger al análisis existencial hoy / Clinical assessment of suicidal behavior: from binswanger to nowaday's daseinsanalysis

RESUMO. Pretendemos no presente artigo realizar um estudo teórico e um relato de experiência, em que revisitaremos o modo de lida clínica com o suicídio na obra de Ludwig Binswanger, antes mesmo dele estabelecer a sua daseinsanálise, no seu famoso caso Ellen West. Com isso visamos dar relevo ao questionamento do psiquiatra com relação à psiquiatria de ênfase marcadamente biológica, em que o suicídio é compreendido como sintoma associado a quadros psicopatológicos, tendência essa que ainda se faz presente na psiquiatria atual. Por fim, apresentaremos nossa própria experiência clínica com suicídio, em que esse é tomado como possibilidade existencial. Através de um breve relato de experiência iremos mostrar o que consideramos um desdobramento daquilo que tem início com Binswanger, ou seja, a daseinsanálise. Com a denominação daseinsanálise hoje buscamos retornar à obra de Martin Heidegger para então continuar a desenvolver uma lida mais serena frente a situações de risco de suicídio na psicologia clínica daseinsanalítica.

RESUMEN. Pretendemos en el presente artículo realizar un estudio teórico y un relato de experiencia, en que revisitaremos el modo de lectura clínica con el suicidio en la obra de Ludwig Binswanger, antes de que él estableciera su análisis existencial, en su famoso caso Ellen West. Con eso pretendemos dar relieve al cuestionamiento del psiquiatra con relación a la psiquiatría de énfasis biológico, en que el suicidio es comprendido como síntoma asociado a cuadros psicopatológicos, tendencia que aún se hace presente en la psiquiatría. Finalmente, presentaremos nuestra propia experiencia clínica con suicidio, en que éste es tomado como una posibilidad existencial. A través de un breve relato de caso, pretendemos mostrar lo que consideramos un desdoblamiento de lo que comienza con Binswanger, o sea, el análisis existencial. Con la denominación análisis existencial hoy, pretendemos retornar a la obra de Martin Heidegger para entonces continuar desarrollando una actuación más serena frente a situaciones de riesgo de suicidio en la psicología clínica.

ABSTRACT. We intend in this article to carry out a theoretical study and an experience report of the literature in which we will revisit the mode of clinical assessment of suicide in the work of Ludwig Binswanger. To do accomplish this task we'll investigate his famous case Ellen West, carried out even before he established his daseinsanalysis. With this, we intend to highlight the question of the psychiatrist in relation to a biological perspective in psychiatry, in which suicide is understood as a symptom associated with mental diseases, this trend is still present in psychiatry. Finally we will present our own clinical experience with suicidal behavior, in which it is taken as an existential possibility. Through a brief case report, we intend to show what we consider to be an unfolding of what begins with Binswanger: the daseinsanalysis. With the designation of nowadays daseinsanalysis, we intend to return to the work of Martin Heidegger and then continue to develop a serene approach to situations of risk of suicide in clinical psychology.

Saúde mental na universidade: atendimento psicológico online na pandemia da covid-19 / Mental health at the university: online psychological care during the covid-19 pandemic / Salud mental en la universidad: atención psicológica en línea en la pandemia de covid-19

Com a pandemia da covid-19, o contexto universitário, que já vinha sendo palco de discussões em relação à saúde mental, tem vivenciado crises mais severas pelos estudantes. Diante deste cenário, foi desenvolvido o projeto Escuta Solidária, voltado à saúde mental dos discentes de graduação e de pós-graduação. Neste artigo, temos como objetivo discutir o atendimento psicológico online com estudantes do curso de psicologia durante o período de isolamento social rígido (maio a junho de 2020). Fizemos, com os psicólogos voluntários, um grupo focal direcionado para a experiência de atendimento psicológico online de curta duração no contexto pandêmico. Trata-se de um estudo qualitativo, realizado com os 11 psicólogos clínicos participantes do referido projeto. A partir de uma análise fenomenológica crítica, os resultados foram divididos em cinco categorias: a) limitações e contribuições do projeto; b) a importância da capacitação e supervisão clínica para a qualidade do projeto; c) atendimento psicológico online; d) ser psicólogo clínico durante a crise da covid-19; e e) demandas emergentes nos atendimentos psicológicos na quarentena. Por fim, discutimos a importância da desmistificação do atendimento psicológico em situações de crise, especialmente na modalidade online, fomentando questionamentos à formação e atuação dos profissionais, no sentido de estarmos atentos às demandas psicológicas que o contexto de crise acarreta na sociedade.(AU)

With the COVID-19 pandemic, the university context, which had already been the stage for discussions regarding mental health, has experienced more severe crises by students. In view of this scenario, the Solidarity Listening project was developed, aimed at the mental health of undergraduate and graduate students. In this article, we aim to discuss online psychological care with psychology students during the period of strict social isolation (May to June 2020). We carried out, with volunteer psychologists, a focus group aimed at the experience of short-termonline psychological care in the pandemic context. This is a qualitative study, carried out with 11 clinical psychologists participating in the aforementioned project. From a critical phenomenological analysis, the results were divided into five categories: a) limitations and contributions of the project; b) the importance of training and clinical supervision for the quality of the project; c) online psychological care; d) being a clinical psychologist during the COVID-19 crisis; and e) emerging demands in psychological care in quarantine. Finally, we discuss the importance of demystifying psychological care in crisis situations, especially in the online modality, promoting questions regarding the training and performance of professionals, to be aware of the psychological demands that the context of crisis entails in society.(AU)

La pandemia del covid-19 provocó que las universidades, que ya habían sido escenario de discusiones sobre la salud mental, experimentaran crisis más severas entre los estudiantes. Ante este escenario, se desarrolló el proyecto Escucha Solidaria, dirigido a la salud mental de estudiantes de grado y posgrado. Este artículo pretende discutir la atención psicológica en línea con estudiantes de Psicología durante el período de aislamiento social más estricto (mayo/junio de 2020). Se conformó un grupo focal con los psicólogos voluntarios orientado a la práctica de la atención psicológica en línea, a corto plazo, en el contexto de una pandemia. Se trata de un estudio cualitativo, realizado con 11 psicólogos clínicos que participaron en el mencionado proyecto. A partir del análisis fenomenológico crítico, los resultados se dividieron en cinco categorías: a) limitaciones y aportes del proyecto; b) importancia de la capacitación y la supervisión clínica para la calidad del proyecto; c) atención psicológica en línea; d) ser psicólogo clínico durante la crisis del covid-19; y e) demandas emergentes en atención psicológica en la cuarentena. Se concluye que es importante desmitificar la atención psicológica en situaciones de crisis, especialmente en la modalidad en línea, al promover principalmente preguntas sobre la formación y el desempeño de los profesionales con el fin de ser conscientes de las demandas psicológicas que el contexto de crisis conlleva la sociedad.(AU)

Co-designing research with Aboriginal and Torres Strait Islander consumers of mental health services, mental health workers, elders and cultural healers.

INTRODUCTION: The disparity in mental health outcomes compared with non-Indigenous Australians means that there is an urgent need to develop an evidence base around how services can better support Aboriginal and Torres Strait Islander communities. A critical first step is to embed cultural safety into research methodologies. OBJECTIVE: Here, we aim to establish the foundation of a research project through co-designing a qualitative interview with Aboriginal and Torres Strait Islander consumers and community members about experiences of cultural safety with mainstream mental health services. DESIGN: Voices of Aboriginal and Torres Strait Islander peoples must be empowered across all stages of research. An Aboriginal-led research team conducted focus groups to understand clear, sensitive, and culturally appropriate ways of asking about experiences in mental health care, to co-design an interview on this topic. Participants were Aboriginal and Torres Strait Islander consumers of mental health services, carers, mental health workers, Elders and Cultural Healers, living in Metropolitan and Regional Western Australia. FINDINGS: Results suggest that Indigenous governance, together with investing in ongoing, and meaningful cultural awareness and cultural safety training (cultural awareness being a first step towards safety) for non-Indigenous researchers, together with taking the time to build respectful partnerships with communities through ongoing consultation, were appropriate and comprehensive methods of co-designing an interview. DISCUSSION: The process of working with Aboriginal and Torres Strait Islander peoples in research is as important as the outcome. Aboriginal and Torres Strait Islander leadership, self-determination, and relationship building with communities are essential. CONCLUSION: Empowering co-design methodologies are flexible, iterative, and ensure that the experiences and views of participants are valued, leading to more meaningful results.

Assessing the needs and perspectives of patients with obesity and obstructive sleep apnea syndrome following continuous positive airway pressure therapy to inform health care practice: A focus group study.

Objective: This study aims to investigate the lived experience in patients with obstructive sleep apnea syndrome (OSAS) and comorbid obesity following after continuous positive airway pressure (CPAP) therapy made with the disease the device, and to identify barriers and facilitators to the use of CPAP to improve rehabilitation provision and aid in disease self-management. Methods: Qualitative research was conducted using three focus groups with a representative sample of 32 inpatients (37% female) undergoing a 1-month pulmonary rehabilitation program at the IRCSS Istituto Auxologico Italiano San Giuseppe Hospital, Verbania, Italy. The focus groups were recorded on tape, and contemporaneous notes were made. The tapes were transcribed verbatim, and Interpretative Phenomenological Analysis was used to develop themes. Results: Six main themes were extracted: (1) Living the diagnosis as a shock; (2) You should not sleep on it: the importance of prevention; (3) The adjustment to CPAP; (4) Barriers and facilitators to the use of CPAP; (5) Three in a bed; and (6) The relationship with the healthcare system. Conclusion: Results of this study suggest potential avenues for interventions to increase adherence to CPAP, including the provision of information and continued support. Individual counseling providing strategies aimed at helping the person to cope with the emotional problem and relational difficulties associated with the use of CPAP, and at strengthening self-efficacy and self-management skills are also encouraged for optimal care during the rehabilitation program.

Assessment of perceived support in the context of emergency: Development and validation of the psycho-social support scale.

In research and clinical contexts, it is important to briefly evaluate perceived Psychological and Social Support (PSS) to plan psychological interventions and allocate efforts and resources. However, an appropriate brief assessment tool for PSS was lacking. This study aimed at developing a brief and accurate scale to specifically measure PSS in clinical and emergency contexts, with specific, relevant, targeted, and irredundant items. Experienced clinicians developed the perceived Psycho-Social Support Scale (PSSS) and administered it to a clinical sample (N = 112) seeking psychological help during the COVID-19 emergency. A Confirmatory Factor Analysis examined the PSSS internal structure, and a Multiple Indicator and Multiple Causes model investigated its association with the number of sessions and emotional symptoms. The PSSS showed good psychometric properties and the Confirmatory Factor Analysis provided acceptable fit indexes for a unidimensional structure. The Multiple Indicators and Multiple Causes revealed that more sessions and emotional symptoms were associated with lower PSSS scores. The PSSS is a reliable brief tool to measure PS and could be useful to individualize treatments (i.e., number of sessions) to efficiently allocate efforts and resources in clinical contexts and emergencies (e.g., earthquake, COVID-19 pandemic). Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03344-z.

Affect and Cognitive Closure in Students-A Step to Personalised Education of Clinical Assessment in Psychology with the Use of Simulated and Virtual Patients.

INTRODUCTION: Since there was no general model of competencies to determine a successful clinical assessment, we based our study on the many skills that are needed to perform one. We analysed students' learning performance based on inner determinants, such as affect and cognitive closure, with the use of two teaching methods (i.e., simulated patient (SP) or virtual patient (VP)). METHODS: The sample comprised 56 fifth-year clinical psychology students. The need for closure (NFC) and efficacy in fulfilling the need for closure (EFNC) were measured using standardised questionnaires. The authors' VP and SP tools were used to teach and measure the effectiveness of learning psychological interview techniques and clinical reasoning. Clinical interview skills included building contact with the patient, gathering important information and making mistakes. Clinical reasoning skills were divided into eight dimensions for the assessment of mental health. RESULTS: Affect and cognitive closure are important psychological variables in anticipating and developing interview and clinical reasoning skills for psychology students. The simulated patient was more effective for interview skills, while the virtual patient was a beneficial teaching tool for most clinical reasoning skills. Virtual patient training was a useful teaching method for students with a low EFNC, probably because it provided a stable and strong structure. Simulated patient training was effective for people with a high EFNC, presumably because it allowed them to build on their advanced structuring skills. CONCLUSIONS: Affect and cognitive closure can be used to identify students' learning abilities to provide a more personalised education. The results of the present study may be useful for evaluating different teaching methods, monitoring their effectiveness and enhancing students' performance.

Characterizing changes in mental health-related outcomes for health service psychology graduate students during the first year of the COVID-19 pandemic.

OBJECTIVES: Health service psychology (HSP) graduate students experienced adverse mental health outcomes during COVID-19. However, little is known about how mental health outcomes changed in this population after the onset of COVID-19. METHODS: N = 496 HSP graduate students reported onset or worsening of mental health outcomes, inability to access mental health care, worry about COVID-19, and stress at two different timepoints during the first year of the COVID-19 outbreak (timepoint 1: May 1 to June 25, 2020; timepoint 2: September 2 to October 17, 2020). This study tested whether mental health outcomes improved, worsened, or stayed stable during this timeframe. The study also examined whether rising COVID-19 case rates in the state where a participant lived moderated changes in mental health outcomes. RESULTS: Overall, HSP graduate students endorsed adverse mental health outcomes at a higher rate during the first survey relative to the second survey. Even still, 62.68% of students reported worsened mental health symptoms, 49.84% reported worsened sleep, and 23.92% reported increased alcohol and substance use in the 2 months leading up to the second survey. CONCLUSION: HSP programs should monitor graduate students' evolving mental health, provide wellness resources, and adopt flexible approaches to support graduate students navigating training during periods of immense disruption.

Excellence, access, and the public good: Building socially responsive admissions practices for health science programs.

The health sciences have a public calling to provide socially responsive health care for all of society, particularly those most in need. This call is reverberating in universities and has particular relevance for health science professions. Despite universities' public mission, admissions practices in the health sciences exhibit a fundamental tension between excellence and access, with excellence defined by rankings and research productivity, and access defined by broader public access both to universities themselves and to the knowledge created there. Health science programs' popularity among students intensifies the exclusivity of admissions processes, at the expense of access. This paper presents both a psychometric and social justice critique of existing admissions criteria and processes. A psychometric perspective demonstrates that admissions processes have inherent bias and fairness issues not limited to reliance on standardized test scores, but extending to measures such as interviews, grade point averages, personal statements, recommendation letters, and CVs. Evaluating admissions criteria using a social justice lens focuses attention on procedural, background, and stake fairness, as well as practices that tend to exclude underrepresented groups. Potential improvements to admissions include applying promising practices from holistic approaches, reducing applicants' financial burden, instituting admissions criteria that more broadly represent all groups, involving underrepresented groups in adjudicating candidate applications, implementing equitable educational strategies, and evaluating the degree to which programs' climate and theoretical underpinnings are conducive to recruiting from underrepresented groups. Finally, to fulfill our public call for social responsiveness, it is essential to frame admissions to health science programs in terms of serving the public good by training candidates from underrepresented groups and by positioning excellence as access.

UK clinical and community psychology: Exploring personal and professional connections.

This paper explores the personal and professional connections between clinical psychologists in the United Kingdom (UK) and critical/community psychology (CCP). Specifically, it asks how clinical psychologists define the area, how they relate to it and how they apply it in their work. Twenty clinical psychologists responded to an online survey, 12 of whom went on to take part in a follow-up telephone interview. Data were analysed using inductive thematic analysis. The results are divided into three sections: i. "describing CCP": social justice and a questioning stance are considered, ii. "relating to CCP": an interplay between lifespan events and personal responses are described and iii. "applying CCP": a dynamic between role-specific applications and reality checks that either enable or constrain is illustrated. Although the continued need for a CCP is described, the results highlight both challenges and tensions of practising CCP within clinical psychology.

Characterization of the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) in Lung Transplant Candidates.

The SIPAT is a standardized measure for pre-transplant psychosocial evaluation. Previous SIPAT studies utilized a relatively small lung transplant sample and only included listed patients. This study characterized the SIPAT in 147 lung transplant candidates to better elucidate its utility. The average score corresponded to a minimally acceptable rating and nearly half of the patients had relative or absolute contraindications. Interstitial Lung Disease (ILD) patients scored more favorably than non-ILD patients (U = 7.69, p < .05). The Total (ß = - .05, SE = .018, p < .01), Social Support Subscale (ß = - .133, SE = .058, p < .05), and Psychosocial Stability and Psychopathology Subscale (ß = - .103, SE = .040, p < .05) significantly predicted listing status. The SIPAT has a unique profile in lung transplant candidates and demonstrated utility for guiding transplant decisions. Future research should examine which lung transplant outcomes are significantly associated with SIPAT scores.

An Immersive and Interactive Platform for Cognitive Assessment and Rehabilitation (bWell): Design and Iterative Development Process.

BACKGROUND: Immersive technologies like virtual reality can enable clinical care that meaningfully aligns with real-world deficits in cognitive functioning. However, options in immersive 3D environments are limited, partly because of the unique challenges presented by the development of a clinical care platform. These challenges include selecting clinically relevant features, enabling tasks that capture the full breadth of deficits, ensuring longevity in a rapidly changing technology landscape, and performing the extensive technical and clinical validation required for digital interventions. Complicating development, is the need to integrate recommendations from domain experts at all stages. OBJECTIVE: The Cognitive Health Technologies team at the National Research Council Canada aims to overcome these challenges with an iterative process for the development of bWell, a cognitive care platform providing multisensory cognitive tasks for adoption by treatment providers. METHODS: The team harnessed the affordances of immersive technologies while taking an interdisciplinary research and developmental approach, obtaining active input from domain experts with iterative deliveries of the platform. The process made use of technology readiness levels, agile software development, and human-centered design to advance four main activities: identification of basic requirements and key differentiators, prototype design and foundational research to implement components, testing and validation in lab settings, and recruitment of external clinical partners. RESULTS: bWell was implemented according to the findings from the design process. The main features of bWell include multimodal (fully, semi, or nonimmersive) and multiplatform (extended reality, mobile, and PC) implementation, configurable exercises that pair standardized assessment with adaptive and gamified variants for therapy, a therapist-facing user interface for task administration and dosing, and automated activity data logging. bWell has been designed to serve as a broadly applicable toolkit, targeting general aspects of cognition that are commonly impacted across many disorders, rather than focusing on 1 disorder or a specific cognitive domain. It comprises 8 exercises targeting different domains: states of attention (Egg), visual working memory (Theater), relaxation (Tent), inhibition and cognitive control (Mole), multitasking (Lab), self-regulation (Butterfly), sustained attention (Stroll), and visual search (Cloud). The prototype was tested and validated with healthy adults in a laboratory environment. In addition, a cognitive care network (5 sites across Canada and 1 in Japan) was established, enabling access to domain expertise and providing iterative input throughout the development process. CONCLUSIONS: Implementing an interdisciplinary and iterative approach considering technology maturity brought important considerations for the development of bWell. Altogether, this harnesses the affordances of immersive technology and design for a broad range of applications, and for use in both cognitive assessment and rehabilitation. The technology has attained a maturity level of prototype implementation with preliminary validation carried out in laboratory settings, with next steps to perform the validation required for its eventual adoption as a clinical tool.

Mental health concerns and barriers to care among future clinical psychologists.

Few studies have examined the mental health of clinical psychology doctoral students, a unique group given their education and training in psychopathology, assessment, and intervention. Students (N = 912) completed an online survey assessing demographics, mental health, mental healthcare utilization, and barriers to care during graduate school. Nearly 25% of participants reported moderate to severe symptoms of anxiety, 20% reported moderate to severe symptoms of depression or suicidal intent (SI), and more than 10% reported a high risk of alcohol abuse or moderate to severe drug use during graduate school. In comparison to peers, ethnic minority and lesbian, gay, bisexual, transgender, and queer (LGBTQ+) participants reported more symptoms of depression and SI. LGBTQ+ participants reported more nonsuicidal self-injury and drug use. Participants also experienced significant barriers to receiving mental healthcare (e.g., financial difficulties, limited availability, insufficient time). Leadership is encouraged to prioritize the mental health of clinical psychology doctoral students, which may have implications on their service provision.