The effects of self-management interventions on depressive symptoms in adults with chronic physical disease(s) experiencing depressive symptomatology: a systematic review and meta-analysis.

BACKGROUND: Chronic diseases are the leading cause of death worldwide. It is estimated that 20% of adults with chronic physical diseases experience concomitant depression, increasing their risk of morbidity and mortality. Low intensity psychosocial interventions, such as self-management, are part of recommended treatment; however, no systematic review has evaluated the effects of depression self-management interventions for this population. The primary objective was to examine the effect of self-management interventions on reducing depressive symptomatology in adults with chronic disease(s) and co-occurring depressive symptoms. Secondary objectives were to evaluate the effect of these interventions on improving other psychosocial and physiological outcomes (e.g., anxiety, glycemic control) and to assess potential differential effect based on key participant and intervention characteristics (e.g., chronic disease, provider). METHODS: Studies comparing depression self-management interventions to a control group were identified through a) systematic searches of databases to June 2018 [MEDLINE (1946 -), EMBASE (1996 -), PsycINFO (1967 -), CINAHL (1984 -)] and b) secondary 'snowball' search strategies. The methodological quality of included studies was critically reviewed. Screening of all titles, abstracts, and full texts for eligibility was assessed independently by two authors. Data were extracted by one author and verified by a second. RESULTS: Fifteen studies were retained: 12 for meta-analysis and three for descriptive review. In total, these trials included 2064 participants and most commonly evaluated interventions for people with cancer (n = 7) or diabetes (n = 4). From baseline to < 6-months (T1), the pooled mean effect size was - 0.47 [95% CI -0.73, - 0.21] as compared to control groups for the primary outcome of depression and - 0.53 [95% CI -0.91, - 0.15] at ≥ 6-months (T2). Results were also significant for anxiety (T1) and glycemic control (T2). Self-management skills of decision-making and taking action were significant moderators of depression at T1. CONCLUSION: Self-management interventions show promise in improving depression and anxiety in those with concomitant chronic physical disease. The findings may contribute to the development of future Self-management interventions and delivering evidence-based care to this population. Further high-quality RCTs are needed to identify sources of heterogeneity and investigate key intervention components.

The training needs for gender-sensitive care in a pediatric rehabilitation hospital: a qualitative study.

BACKGROUND: Gender is an important social determinant of health; however, clinicians often lack training in how to provide gender-sensitive care. Offering appropriate and relevant training could help to address some gender-based health inequalities. Our objective was to identify and describe the training needs for gender-sensitive care among pediatric rehabilitation healthcare providers. METHODS: This study used an interpretive descriptive qualitative design to conduct interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man), from a pediatric rehabilitation hospital in a large urban center, in Ontario, Canada from a range of disciplines. Interviews were transcribed verbatim and analyzed using an open-coding inductive thematic analysis. RESULTS: Our analysis revealed the following themes: [1] lack of knowledge about gender-sensitive care and the need for more training; [2] content of the desired training (i.e., gender differences, effective communication and how to practice gender-sensitive care) and [3] delivery method of the training. CONCLUSIONS: Enhanced gender-sensitive training for healthcare providers is required for optimizing patient outcomes and addressing gender-based health inequalities. Educators in pediatric rehabilitation should consider developing gender-sensitive care training that is embedded within post-graduate education and also continuing education within hospitals and community care centers.

Measures of Workplace Inclusion: A Systematic Review Using the COSMIN Methodology.

Purpose To systematically assess the measurement properties and the quality of the evidence for measures of inclusion or exclusion at work. Methods Comprehensive searches of five electronic databases were conducted up to February 2019. Eligible studies aimed to develop a measure of workplace inclusion or exclusion or assessed at least one measurement property. Pairs of reviewers independently screened articles and assessed risk of bias. Methodological quality was appraised with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best-evidence synthesis approach guided the analysis. For each measurement property, evidence quality was rated as high, moderate, low, or very low and results were classified as sufficient, insufficient, or inconsistent. Results The titles and abstracts of 14,380 articles were screened, with 151 full-text articles reviewed for eligibility. Of these, 27 studies were identified, 10 of which were measure development studies. Included measures were the Workplace Ostracism Scale, Ostracism Interventionary Behaviour Scale, Workplace Culture Survey, Workplace Exclusion Scale, Perceived Group Inclusion Scale, Organizational Cultural Intelligence Scale, Inclusion-Exclusion Scale, Climate for Inclusion Scale, Workplace Social Inclusion Scale and the Inclusion-Diversity Scale. Most workplace inclusion instruments were not examined for some form of validity or reliability and evidence for responsiveness was absent. The quality of the evidence for content validity was low for 30% of studies and very low for 70% of studies. Conclusion Future research should focus on comprehensive evaluations of the psychometric properties of existing measures, with an emphasis on content validity, measurement error, reliability and responsiveness.

A scoping review of the role of gender within speech-language pathology practice.

PURPOSE: The purpose of this scoping review was to explore the role of gender within speech-language pathology practice. METHOD: A scoping review was conducted using the Arksey and O'Malley's framework. Comprehensive and systematic searches of four international databases were conducted. Eligible studies included empirical findings that focussed on gender related to the practice of speech-language pathology, or gender issues amongst clinicians, published in a peer-reviewed journal, in English or French between 1994 and 2020. RESULT: Twenty articles met our inclusion criteria, involving 4035 participants across seven countries over a 25-year period. Our conceptual mapping highlighted the following key trends: (1) speech-language pathology is a gendered profession; (2) gender-related factors affecting career choice and job satisfaction; and (3) gender differences among speech-language pathologist practice. CONCLUSION: This review highlights the need for further research to understand the role of gender within speech-language pathology practice.

Understanding clinicians' strategies for providing gender-sensitive care: an exploration among pediatric rehabilitation health care providers.

PURPOSE: Although there is an increasing awareness of the critical role of gender within pediatric rehabilitation, little is known about the strategies that clinicians use to provide such care. The purpose of this study was to explore clinicians' strategies for providing gender-sensitive care within a pediatric rehabilitation hospital. METHODS: We used a qualitative needs assessment design and a convenience sampling strategy to recruit clinicians from a pediatric rehabilitation hospital. We conducted interviews with 23 pediatric rehabilitation health care providers from various disciplines. We applied a thematic analysis to the interview transcripts. RESULTS: Our analysis revealed the following themes regarding clinicians' strategies in providing gender-sensitive care: (1) awareness of gender biases and not making assumptions; (2) recognizing gender-based vulnerabilities; (3) respecting patient values, preferences and needs; and (4) advocacy. CONCLUSION: Health care providers working within pediatric rehabilitation have several strategies for providing a gender-sensitive care approach to clients.IMPLICATIONS FOR REHABILITATIONClinicians should seek training (i.e., appropriate terminology, creating inclusive spaces) in how to recognize gender-based health vulnerabilities, especially among patients who identify as non-binary or transgender.Clinicians should make an effort to try to be aware of their own biases and not make gender-based assumptions.Advocacy, respecting patient values, preferences and needs are important aspects of providing gender-sensitive care.

Challenges with providing gender-sensitive care: exploring experiences within pediatric rehabilitation hospital.

PURPOSE: The purpose of this study was to explore the perceived challenges with providing a gender-sensitive care approach among pediatric rehabilitation care providers. METHODS: Using a qualitative needs assessment design and a purposive sampling strategy, we recruited clinicians from a Canadian pediatric rehabilitation hospital. We conducted interviews with 23 pediatric rehabilitation healthcare providers (19 women, 3 men, 1 transgender man) from a range of disciplines. Three coders performed a thematic analysis of the transcripts. RESULTS: Our analysis revealed the following themes regarding the perceived challenges in providing a gender-sensitive care approach: (1) a lack of training and experience; (2) gender differences and stereotypes; (3) binary documentation and potential for misgendering; (4) the complexity of gender identity; and (5) the gender of the clinician. CONCLUSIONS: Pediatric rehabilitation care providers face many challenges in offering a gender-sensitive care approach and need further training and systemic support.Implications for rehabilitationAwareness of the challenges in providing gender-sensitive care could be an important first step in helping to address inequities.Systemic and interpersonal barriers may impede the provision of gender-sensitive care among rehabilitation providers.Clinicians need more training and support in how to provide gender-sensitive care.

Assessing the environmental quality of an adapted, play-based LEGO® robotics program to achieve optimal outcomes for children with disabilities.

PURPOSE: This study assessed the environmental quality of an adapted, play-based LEGO® robotics program for children and youth with disabilities to determine the degree to which the activity setting supports the therapeutic goals of the program. MATERIALS AND METHODS: We measured the environmental qualities of a robotics program held at a paediatric rehabilitation hospital. We observed and coded video-recordings of the robotics program, specifically one session from each of five different rooms where the program took place. Using the 32-item Measure of Environmental Qualities of Activity Settings (MEQAS), we described the place- and opportunity-related qualities of these settings. RESULTS: Our observations revealed that, across all five settings, the environments support the therapeutic goals of the program, including providing opportunities for social interaction with peers and adults to a great extent. We also identified several environmental features of the robotics program that support optimal outcomes for children and youth with disabilities. CONCLUSIONS: Our findings lend support for the value of examining environmental opportunities and affordances of play-based therapy within rehabilitation.IMPLICATIONS FOR REHABILITATIONAssessing the environmental opportunities and affordances of play-based activities using the Measure of Environmental Qualities of Activity Settings (MEQAS) is valuable for supporting positive outcomes in rehabilitation.The settings of an adapted LEGO® robotics program offer children with disabilities opportunities to engage in social interactions with peers and adults, to learn a new skill, and to develop a sense of self-identity.Optimal therapeutic outcomes of an adapted LEGO® robotics program can be supported by environmental features, including: large tables with sufficient space for two youth and one or two adult volunteers to interact at eye-level, arranged separately with enough space to invite movement between tables, in such a way that children may also interact across tables.

Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation.

BACKGROUND: Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. OBJECTIVE: This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. METHODS: We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. RESULTS: Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). CONCLUSIONS: Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities.

Electronic Mentoring Programs and Interventions for Children and Youth With Disabilities: Systematic Review.

BACKGROUND: Children and youth with disabilities experience many challenges in their development, including higher risk of poor self-esteem, fewer friendships, and social isolation. Electronic mentoring is a potentially viable approach for youth with disabilities to access social and peer support within a format that reduces physical barriers to accessing mentors. OBJECTIVE: Our objective was to synthesize and review the literature on the impact of electronic mentoring for children and youth with disabilities. METHODS: We conducted a systematic review, completing comprehensive searches of 7 databases from 1993 to May 2018. We selected articles for inclusion that were peer-reviewed publications, had a sample of children or youth with disabilities (≤25 years of age), and had empirical findings with at least one outcome focusing on the impact of electronic mentoring. Two reviewers independently applied the inclusion criteria, extracted the data, and rated the study quality before discussing the findings. RESULTS: In the 25 studies meeting our inclusion criteria, 897 participants (aged 12-26, mean 17.4 years) were represented across 6 countries. Although the outcomes varied across the studies, of 11 studies testing significance, 9 (81%) reported a significant improvement in at least one of the following: career decision making, self-determination, self-advocacy, self-confidence, self-management, social skills, attitude toward disability, and coping with daily life. The electronic mentoring interventions varied in their delivery format and involved 1 or more of the following: interactive websites, virtual environment, email, mobile apps, Skype video calls, and phone calls. A total of 13 studies involved one-to-one mentoring, 6 had group-based mentoring, and 6 had a combination of both. CONCLUSIONS: The evidence in this review suggests it is possible that electronic mentoring is effective for children and youth with disabilities. More rigorously designed studies are needed to understand the impact and effective components of electronic mentoring interventions.

New ways to get policy into practice.

PURPOSE: Health service effectiveness continues to be limited by misaligned objectives between policy makers and frontline clinicians. While capturing the discretion workers inevitably exercise, the concept of "street-level bureaucracy" has tended to artificially separate policy makers and workers. The purpose of this paper is to understand the role of social-organizational context in aligning policy with practice. DESIGN/METHODOLOGY/APPROACH: This mixed-method participatory study focuses on a locally developed tool to implement an Australia-wide strategy to engage and respond to mental health services for parents with mental illness. Researchers: completed 69 client file audits; administered 64 staff surveys; conducted 24 interviews and focus groups (64 participants) with staff and a consumer representative; and observed eight staff meetings, in an acute and sub-acute mental health unit. Data were analyzed using content analysis, thematic analysis and descriptive statistics. FINDINGS: Based on successes and shortcomings of the implementation (assessment completed for only 30 percent of clients), a model of integration is presented, distinguishing "assimilist" from "externalist" positions. These depend on the degree to which, and how, the work environment affords clinicians the setting to coordinate efforts to take account of clients' personal and social needs. This was particularly so for allied health clinicians and nurses undertaking sub-acute rehabilitative-transitional work. ORIGINALITY/VALUE: A new conceptualization of street-level bureaucracy is offered. Rather than as disconnected, it is a process of mutual influence among interdependent actors. This positioning can serve as a framework to evaluate how and under what circumstances discretion is appropriate, and to be supported by managers and policy makers to optimize client-defined needs.