behavioral health

行为健康
  • 文章类型: Journal Article
    目的:青少年和年轻成人(AYA)肿瘤患者的预后改善落后于其他特定年龄的癌症人群。研究表明,临床试验的可用性低,这个年龄组的生物学差异,和一些心理社会因素,包括较高的情绪困扰影响结果。为了提高这些患者的护理和生存率,医院已经实施了AYA肿瘤学计划。目前的研究评估了在一个学术医学中心的AYA计划中的护理文件,该计划基于国家综合癌症网络的AYA肿瘤学临床实践指南中强调的三个领域:临床试验注册,生育力,和心理社会护理。方法:对AYA肿瘤学项目开始前治疗的45例患者和项目开始后治疗的45例患者进行回顾性图表回顾。包括诊断为恶性肿瘤的15-39岁患者。评估的变量包括临床试验登记的文件,生育能力保护和性健康考虑,和行为健康推荐。结果:大多数临床试验和生育变量的文档从计划前到计划后都没有显着改善,尽管更多的患者在项目后记录了这些变量.行为健康推荐从计划前的52.8%显着增加到计划后的95.4%。结论:获得行为保健改善了我们AYA计划的最以下实施,这可能是因为该计划开始时,AYAs的专门心理学家的整合。通过指定的行为健康提供者和更系统的文档流程,可以更好地评估和改进针对该人群的基于指南的护理实践。
    Purpose: Improvements in outcomes for adolescent and young adult (AYA) oncology patients have lagged behind those of other age-specific cancer populations. Research has indicated that low availability of clinical trials, biological differences of this age-group, and several psychosocial factors including higher emotional distress impact outcomes. To improve care and survival rates for these patients, hospitals have implemented AYA oncology programs. The current study evaluated documentation of care in an AYA program housed in an academic medical center based on three areas emphasized in the National Comprehensive Cancer Network\'s Clinical Practice Guidelines in Oncology for AYAs: clinical trial enrollment, fertility, and psychosocial care. Methods: Retrospective chart reviews were conducted for 45 patients treated before the start of the AYA oncology program and 45 patients treated after program initiation. Patients aged 15-39 years with a diagnosis of a malignant tumor were included. Variables evaluated included documentation of clinical trial enrollment, fertility preservation and sexual health considerations, and behavioral health referrals. Results: Documentation of most clinical trial and fertility variables did not significantly improve from pre- to post-program, although a higher number of patients had these variables documented post-program. Behavioral health referrals increased significantly from 52.8% pre-program to 95.4% post-program. Conclusion: Access to behavioral health care improved the most following implementation of our AYA program, which is likely because of the integration of a dedicated psychologist for AYAs when the program began. The practice of guideline-based care for this population can be better assessed and improved with designated behavioral health providers and more systematic documentation processes.
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  • 文章类型: Journal Article
    COVID-19大流行对青年福祉造成了重大负面影响,尤其是在黑人中,西班牙裔,美洲印第安人,阿拉斯加原住民,和LGBTQ+(女同性恋,同性恋,双性恋,变性人,酷儿或质疑)青年。大流行破坏了与家庭的联系,学校,和社区,这是青年心理健康的重要支持。从大流行中吸取的经验教训表明,压力和建立弹性的机会之窗的作用。从4个美国护理学会专家小组就青年心理健康危机进行的政策对话中得出,我们提出了当前青年心理健康问题增加的方法。包括关于建立青年韧性的新兴文献,特别是通过重新建立学校和社区联系。家庭的作用,学校,强调社区支持,特别是通过创造一个愈合的学校环境和学校护士的关键作用。建议包括增加对家庭的支持,扮演学校护士的角色,并制定以学校为基础的创新计划,以建立联系和青少年健康。
    The COVID-19 pandemic wrought significant negative impacts on youth well-being, particularly among Black, Hispanic, American Indian, Alaska Native, and LGBTQ+ (Lesbian, gay, bisexual, transgender, queer or questioning) youth. The pandemic disrupted connections to family, school, and community, which are essential supports for youth mental health. Lessons learned from the pandemic suggest the role of stress and windows of opportunity to build resiliency. Drawing from a policy dialog on the youth mental health crisis conducted by 4 American Academy of Nursing Expert Panels, we present approaches to the current increase in youth mental health problems. Included is emerging literature on building youth resilience, particularly via re-establishing school and community connections. The role of families, schools, and community support is emphasized, particularly by creating a healing school environment and the pivotal role of school nurses. Recommendations include increased support for families, engaging the school nurse role, and developing school-based innovative programs to build connections and youth wellness.
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  • 文章类型: Journal Article
    识别干预的核心组件对于衡量干预是否以保真度实施和/或修改是必不可少的;它通常是一个多阶段过程,从第一阶段开始,确定一组逐渐完善的核心组件。识别初始核心组件的第一阶段尚未得到彻底检查。如果没有一套明确的步骤,干预措施可能在确定其初始核心组成部分的严密性和思路上有所不同。我们设计了CORE(相关要素共识)方法来综合干预开发者/实施者的意见,以确定干预的初始核心组件,特别适用于创新干预措施。我们将CORE应用于基于同行的干预措施,以帮助退伍军人在监禁后重返社区。我们的CORE应用程序涉及四个干预开发人员/实施者和两个主持人,以促进七个CORE步骤。我们的CORE应用程序有两次迭代,从步骤1(个人核心组成部分建议)到步骤7(小组讨论达成共识),然后重复步骤4(组件定义的合并)到步骤7。这导致了18个共识达成的基于同行的干预的初始核心组成部分,低于开发人员/实施者在步骤1中单独建议的60。即使不存在,移除的组件也被认为不会威胁干预的有效性。CORE有助于填补关于识别干预措施的初始核心组件的关键空白(以便随后可以改进识别的组件),通过提供具体步骤来综合干预的开发人员/实施者的知识。未来的研究应该检查CORE在各种干预措施和实施设置中的效用。
    Identifying an intervention\'s core components is indispensable to gauging whether an intervention is implemented with fidelity and/or is modified; it is often a multi-stage process, starting with the first stage of identifying an initial set of core components that are gradually refined. This first stage of identifying initial core components has not been thoroughly examined. Without a clear set of steps to follow, interventions may vary in the rigor and thought applied to identifying their initial core components. We devised the CORE (Consensus on Relevant Elements) approach to synthesize opinions of intervention developers/implementers to identify an intervention\'s initial core components, particularly applicable to innovative interventions. We applied CORE to a peer-based intervention that aids military veterans with post-incarceration community reintegration. Our CORE application involved four intervention developers/implementers and two moderators to facilitate the seven CORE steps. Our CORE application had two iterations, moving through Steps 1 (individual core component suggestions) through 7 (group discussion for consensus), then repeating Steps 4 (consolidation of component definitions) through 7. This resulted in 18 consensus-reached initial core components of the peer-based intervention, down from the 60 that the developers/implementers individually suggested at Step 1. Removed components were deemed to not threaten the intervention\'s effectiveness even if absent. CORE contributes to filling a critical gap regarding identifying an intervention\'s initial core components (so that the identified components can be subsequently refined), by providing concrete steps for synthesizing the knowledge of an intervention\'s developers/implementers. Future research should examine CORE\'s utility across various interventions and implementation settings.
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  • 文章类型: Journal Article
    为了解决对在长期护理(LTC)设施工作的心理学家培训有限的担忧,长期护理心理学家(PLTC)组织发布了长期护理设施中的心理服务标准(Lichtenberg等人。,1998).知识和技能的证据基础不断扩大,LTC居民的日益多样化,提出问题的复杂性使心理学家在这种情况下提供服务时需要的指导更加复杂。在这篇文章中,PLTC指南修订工作组根据原始的规定性PLTC标准提出了PLTC指南。PLTC标准的内容已更新,格式从规定标准更改为理想指南。我们从关于LTC(教育和培训)知识和技能的一般准则开始。了解LTC系统。临终关怀),其次是涵盖LTC基本心理服务活动的具体指南(转诊,评估,治疗,伦理问题,和倡导)。PLTC指南旨在为工作的心理学家提供指导,或者计划工作,在LTC和指导继续教育的追求。
    To address concerns about limited training of psychologists working in long-term care (LTC) facilities, the Psychologists in Long-Term Care (PLTC) organization published Standards for Psychological Services in Long-Term Care Facilities (Lichtenberg et al., 1998). The expanding evidence base for knowledge and skills, the increasing diversity of LTC residents, and the complexity of presenting problems have compounded the guidance psychologists need when providing services in this setting. In this article, the PLTC Guidelines Revision Task Force presents PLTC guidelines based on the original prescriptive PLTC Standards. The content of the PLTC Standards was updated and the format changed from prescriptive standards to aspirational guidelines. We begin with general guidelines regarding knowledge and skills in LTC (education and training. understanding of LTC systems. end-of-life care), followed by specific guidelines covering the basic psychological service activities in LTC (referral, assessment, treatment, ethical issues, and advocacy). The PLTC Guidelines are designed to provide direction for psychologists who work, or plan to work, in LTC and to guide continuing education pursuits.
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  • 文章类型: Journal Article
    使用药物的人通常不信任初级保健系统,阻碍进入。
    在阐明如何改善患者安全感的研究基础上,通过与医生和患者代表共同创建最佳实践指南。
    获得研究伦理委员会批准后,这项定性研究涉及22名参与者,包括患者,医师,和卫生系统合作伙伴。我们举办了一系列研讨会,由患者和研究人员共同推动,与研究的三个阶段相对应:(1)在研讨会期间为参与者建立文化安全流程;(2)促进,协作世界咖啡馆制定指南内容;(3)验证最佳实践指南。制定并实施了一项实施计划。最后,麦吉尔大学进行了外部同行评审。
    制定了最佳实践指南,为患者提供了如何加强初级保健的观点。如下:(1)了解创伤信息;(2)考虑您的临床环境;(3)建立网络;(4)提供一系列资源;(5)共同制定长期治疗计划;(6)帮助我保持健康;(7)确保及时获得专门的医疗和外科护理;(8)成为倡导者;(9)寻求反馈;(10)跟进。开发和分发了资源。
    最佳实践指南反映了患者对患者遇到的常见挑战的看法,这阻碍了他们获得初级保健。他们支持初级保健医生为这个具有挑战性的患者群体提供更有效的服务。
    People who use substances often mistrust the primary care system, impeding access.
    To build on research clarifying how to improve patients\' feelings of safety, through co-creating best practice guidelines with physicians and patient representatives.
    After obtaining Research Ethics Board approval, this qualitative study engaged 22 participants including patients, physicians, and health system partners. We held a series of workshops, co-facilitated by patients and researchers, corresponding to 3 phases of the research: (1) establishment of cultural safety processes for participants during the workshops; (2) a facilitated, collaborative world café to develop guideline content; (3) validation of best practice guidelines. An implementation plan was developed and implemented. Finally, an external peer review was conducted by McGill University.
    Best practices guidelines were developed giving the patient perspective on how to enhance primary care, as follows: (1) become trauma informed; (2) consider your clinical environment; (3) build a network; (4) supply an array of resources; (5) co-create a long-term treatment plan; (6) help me to stay healthy; (7) ensure timely access to specialized medical and surgical care; (8) be an advocate; (9) ask for feedback; (10) follow up. Resources were developed and disseminated.
    The best practice guidelines reflect the patients\' perspectives on common challenges patients have encountered, which impede their access to primary care. They support primary care physicians in providing more effective services to this challenging population of patients.
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