The feasibility of providing remote functional family therapy with adolescents during the COVID-19 pandemic

Background: Due to the recent COVID-19 pandemic, mental health care has largely transferred its services to online platforms, using videoconferencing (VC) or teletherapy. Within the field of family therapy, however, there is little evidence on the feasibility of using VC, especially when working with whole families at the edge of care. Objective: This study investigated the feasibility of remote Functional Family Therapy (FFT), using a mixed-method approach. Methods: Study 1 consisted of semi- structured interviews with 23 FFT professionals (18 female) about their experience of providing remote FFT during the COVID-19 pandemic. Study 2 included monitoring data of 209 FFT clients (46% female, M age = 14.00) who participated in FFT during the pandemic. We compared families who received mainly in-person, mainly remote or a mix of remote and in-person on client-reported alliance, drop-out, therapist-rated outcomes, and treatment intensity using MANCOVA’s and chi-square tests. Results: In Study 1 two themes emerged around experienced challenges, namely ‘Feeling in control’ and ‘Engagement and alliance’. Two other themes emerged around adaptations, namely ‘Being more on top’ and ‘Connecting in different ways’. In Study 2, we found that the therapeutic alliance was not related to using VC. Also, families had less between-session contact during the Engagement and Motivation Phase when receiving mainly VC, but had more sessions and longer therapy when receiving a mix of in-person and remote therapy. Conclusions. The current study suggests that providing systemic family teletherapy to families on the edge of care is feasible. Further development of systemic family teletherapy is warranted

Measuring recall of medical information in non-English-speaking people with cancer: A methodology

Background Many patients who require an interpreter have difficulty remembering information from their medical consultations. Memory aids such as consultation audio-recordings may be of benefit to these patients. However, there is no established means of measuring patients’ memory of medical information. Objectives This study aimed to develop a method for eliciting and coding recall of medical information in non-English-speaking patients. Design This method, called Patient-Interpreter-Clinician coding (PICcode), was developed in the context of a phase II trial conducted in two outpatient oncology clinics in Melbourne, Australia, and was refined iteratively through consultation with an expert panel and piloting. Between-coder differences in early versions of the coding system were resolved through discussion and consensus resulting in refinements to PICcode. Results The final version of PICcode involved transcribing, translating and coding of audio-recorded consultations and semi-structured interviews (SSI). The SSIs were designed to elicit patients’ free-recall of medical information. Every unit of medical information in the consultation was identified and categorized in a coding tree. SSIs were coded to identify the extent to which information was recalled from the consultation. Discussion The iterative changes involved in developing PICcode assisted in clarifying precise details of the process and produced a widely applicable coding system. PICcode is the most comprehensively described method of determining the amount of information that patients who use an interpreter recall from their medical consultations. PICcode can be adapted for English-speaking patients and other healthcare populations

The role of leadership and environmental context in the implementation of an evidence based programme: a qualitative analysis of three local government services which implemented multi systemic therapy in 2008

This is a qualitative study examining three of the ten English Local Authorities who implemented the intervention Multi Systemic Therapy (MST) in their Children’s Services Department in 2008. The research considers the implementation of MST and the consequent organisational impact as the services mobilised and then matured. One service closed at two years, another at five years and a third service was sustained and expanded. The research explores the concept of ‘evidence based practice’ in contemporary social work before considering and applying implementation science theory to understand the implementation process in the three sites. A grounded theory methodological approach (Charmaz, 2006, 2014) was taken to analyse twelve participant interviews across the three Authorities, including one with the national programme lead for MST. The findings propose new theoretical categories which extend understanding of implementation: The high collaborative environment and The hostile environment. These two environmental categories are especially relevant when linked to leadership. Both categories demonstrate the importance of the contextual setting within which implementation takes place. The high collaborative environment enabled the facilitation of the strategic and operational space for the intervention to successfully embed and sustain itself in the Authority continuing to provide MST. Taking a values based approach connecting to both operational practice and desired strategic outcomes significantly assisted in the implementation. A hostile environment is conceptualised as a context of threat, strategic change and uncertainty where the intervention is poorly placed. In the first setting this led to early closure as the service could not find a fit within the Authority. In the second setting, a successful mobilisation followed by a period of positive performance, could not sustain MST in the long term as the strategic and operational context changed negatively. The findings support and contribute to the understanding of the category of Leadership for implementation (Aarons 2016). Leadership which is attentive, relational, collaborative and perseverant appears most conducive to the successful implementation outcomes. Consistent leadership at the MST steering group is identified as vital as it is in this forum where the high collaborative environment and leadership for implementation were evident. In conclusion the research considers the implications of the findings and what these mean for practice and for the implementation of evidence based interventions in new settings as well as for the sustainability of interventions post mobilisation

The ‘land in-between’: A comparative European study of the victimisation of young people travelling to and from school

This article draws upon the initial results of a survey of school students from eight European countries regarding their experiences of victimisation and offending while travelling to and from school. This is the first such comparative survey to be undertaken. This article provides evidence from the research that travel between the perceived safety of home and school is a risky activity for a significant proportion of young people across Europe. Utilising the notion of anti-social behaviour as the most useful measure for comparative research of victimisation of young people, this article suggests that almost one-fifth of the young people are regularly subjected to behaviour they consider anti-social. However, the majority of young people show surprisingly high levels of self-confidence and security. The key is the existence of friendship groups, which provide security from victimisation, and if something negative does occur, the friendship group also provides a place to share concerns. Teachers, police officers, youth workers and even parents are far less important in dealing with incidents of anti-social behaviour. This article concludes by arguing that this points to a move away from increasing 'formal' interventions, such as CCTV, adults travelling on buses with young people, or police officers outside schools, towards supporting the, already existing, informal methods used by young people to limit the possibility of victimisation