Practice-based Qualitative Research: Participant Experiences of Walk-in Counselling and Traditional Counselling

Walk-in single session counselling is becoming a more widely used model for delivering mental health services across Ontario. This paper reports findings from the qualitative phase of a mixed method study, exploring the experiences of those attending walk-in counselling (WIC) model compared to the traditional service delivery model employing a wait list. We used a comparative case study design for the qualitative phase. Findings reveal that participant outcomes of the walk-in counselling model is influenced by accessibility, how a participant makes sense of the service, and the degree to which a participant is motivated and able to engage in counselling. WIC supports the mental health system by reducing wait lists associated with traditional service delivery models, and meeting the needs many people identify for immediate consultation. Other participants still perceive themselves as requiring ongoing counselling over time and involving in-depth exploration. This research supports health systems providing access to both models

The Walk-in Counselling Model of Service Delivery: Who Benefits Most?

The walk-in counselling (WIC) model of service delivery has been found to reduce psychological distress more quickly than a traditional model of service delivery involving a wait list. A question remains, however, as to the relative benefit of the WIC model for different client groups. The present study uses graphical inspection and multilevel modeling to conduct moderator analyses comparing two agencies, one with a WIC clinic and the other with a traditional wait list approach, and their relative impact on psychological distress. Key findings regarding the differential benefits for different types of presenting problems as well as clients at different stages of change are discussed. La recherche montre qu\u27un service de consultation sans rendez-vous réduit la détresse psychologique plus rapidement qu\u27un modèle traditionnel fonctionnant avec liste d\u27attente. Les bénéfices relatifs du modèle de consultation sans rendez-vous pour différentes clientèles demeurent cependant méconnus. Cette étude utilise l\u27inspection de graphiques et la modélisation multiniveau afin de mener une analyse de modération qui compare deux cliniques: sans rendez-vous ou suivant le modèle traditionnel avec liste d\u27attente. L\u27étude examine les impacts relatifs de ces modèles sur la détresse psychologique. Les principaux résultats portent sur les bénéfices différentiels selon les problématiques de santé mentale présentées et selon les stades de changement des usagers

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 subsample. 524 participants 16 years and older were recruited from two Family Counselling Agencies; the General Health Questionnaire assessed change in psychological distress; prior use of other mental health and instrumental services was also reported. Results: Hierarchical linear modelling revealed clients of the walk-in model improved faster and were less distressed at the 4-week follow-up compared to the traditional service delivery model. At the 10-week follow-up, both groups had improved and were similar. Participants receiving instrumental services prior to baseline improved more slowly. Qualitative interviews confirmed participants valued the accessibility of the walk-in model. Conclusions: This study improves methodologically on previous studies of walk-in counselling, an approach to service delivery that is not conducive to randomized controlled trials

Inequities in the delivery of mental health care: a grounded theory study of the policy context of primary care

Background Strengthening capacity for mental health in primary care improves health outcomes by providing timely access to coordinated and integrated mental health care. The successful integration of mental health in primary care is highly dependent on the foundation of the surrounding policy context. In Ontario, Canada, policy reforms in the early 2000’s led to the implementation of a new interprofessional team-model of primary care called Family Health Teams. It is unclear the extent to which the policy context in Ontario influenced the integration of mental health care in Family Health Teams emerging from this period of policy reform. The research question guiding this study was: what were key features of Ontario’s policy context that influenced FHTs capacity to provide mental health services for mood and anxiety disorders? Methods A qualitative study informed by constructivist grounded theory. Individual interviews were conducted with executive directors, family physicians, nurse practitioners, nurses, and the range of professionals who provide mental health services in interprofessional primary care teams; community mental health providers; and provincial policy and decision makers. We used an inductive approach to data analysis. The electronic data management programme NVivo11 helped organise the data analysis process. Results We conducted 96 interviews with 82 participants. With respect to the contextual factors considered to be important features of Ontario’s policy context that influenced primary care teams’ capacity to provide mental health services, we identified four key themes: i) lack of strategic direction for mental health, ii) inadequate resourcing for mental health care, iii) rivalry and envy, and, iv) variations across primary care models. Conclusions As the first point of contact for individuals experiencing mental health difficulties, primary care plays an important role in addressing population mental health care needs. In Ontario, the successful integration of mental health in primary care has been hindered by the lack of strategic direction, and inconsistent resourcing for mental health care. Achieving health equity may be stunted by the structural variations for mental health care across Family Health Teams and across primary care models in Ontario.Medicine, Faculty ofNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult

Patient perspectives on quality of care for depression and anxiety in primary health care teams: A qualitative study

Background: Widespread policy reforms in Canada, the United States and elsewhere over the last two decades strengthened team models of primary care by bringing together family physicians and nurse practitioners with a range of mental health and other interdisciplinary providers. Understanding how patients with depression and anxiety experience newer team-based models of care delivery is essential to explore whether the intended impact of these reforms is achieved, identify gaps that remain and provide direction on strengthening the quality of mental health care. Objective: The main study objective was to understand patients’ perspectives on the quality of care that they received for anxiety and depression in primary care teams. Methods: This was a qualitative study, informed by constructivist grounded theory. We conducted focus groups and individual interviews with primary care patients about their experiences with mental health care. Focus groups and individual interviews were recorded and transcribed verbatim. Grounded theory guided an inductive analysis of the data. Results: Forty patients participated in the study: 31 participated in one of four focus groups, and nine completed an individual interview. Participants in our study described their experiences with mental health care across four themes: accessibility, technical care, trusting relationships and meeting diverse needs. Conclusion: Greater attention by policymakers is needed to strengthen integrated collaborative practices in primary care so that patients have similar access to mental health services across different primary care practices, and smoother continuity of care across sectors. The research team is comprised of individuals with lived experience of mental health who have participated in all aspects of the research process.This research was funded by the Connaught New Researcher Award, University of Toronto