Sophie Soklaridis

Buddies in Bad Times? The Role of Co-workers After a Work-Related Injury

Introduction Co-workers can play an important role after a work-related injury. They can provide details about the circumstances of an accident, offer emotional support to the injured worker and help with job tasks upon a co-worker’s return to work (RTW). Working with an injured co-worker, however, can also strain work relationships and increase workload. The purpose of this study was to determine the role that co-workers play after a work-related injury and during the RTW process in the unionized, electrical construction sector. Methods We conducted two focus groups with injured electricians and union representatives. We also interviewed co-workers who had worked with someone who had been injured in the course of employment. We examined the role that co-workers can play after a work-related injury and some of the factors facilitating and hindering co-worker support. Results The structure of work in the electrical sector—a focus on cost-cutting and competition, job insecurity, perceptions of “different camps” among co-workers, little modified work and poor formal communication—can impede co-worker support and contribute to making injured workers’ experiences difficult. Management can play an important role in setting an example for how injured workers are regarded and treated. Conclusions Future research should explore how workers can better be supported after a work-related injury and during the RTW process.

Does early management of whiplash-associated disorders assist or impede recovery?

Study Design. Narrative review of the literature and commentary. Objective. To discuss from an epidemiological and sociological perspective whether the early clinical management of whiplash-associated disorders can lead to iatrogenic disability. Summary of Background Data. There is a lack of evidence supporting the effectiveness of early rehabilitation care for whiplash-associated disorders. Methods. We describe the epidemiological evidence on the effectiveness of early rehabilitation on health outcomes for patients with whiplash-associated disorders and analyze from a sociological perspective how the medicalization of this condition may have contributed to increasing its burden on disability. Results. The evidence from randomized clinical trials suggests that education, exercise, and mobilization are effective modalities to treat whiplash-associated disorders. However, the evidence from large population-based cohort studies and a pragmatic randomized trial suggests that too much health care and rehabilitation too early after the injury can be associated with delayed recovery and the development of chronic pain and disability. These findings suggest that clinicians may be inadvertently contributing to the development of iatrogenic disability. The epidemiological evidence is supported by the sociological concepts of medicalization, iatrogenesis, and moral hazard. Conclusion. The current evidence suggests that too much health care too early after the injury is associated with delayed recovery. Clinicians need to be educated about the risk of iatrogenic disability.

Defining competencies for the practice of telepsychiatry through an assessment of resident learning needs

BackgroundA foundational assessment of learning needs is missing from previous reports of telepsychiatry curricula. We used an in-depth needs assessment to identify specific skills required for the practice of effective telepsychiatry, and provide an evidence base to guide the development of telepsychiatry curricula in postgraduate psychiatry training. Many of these skills set telepsychiatry apart from practice in traditional face-to-face clinical settings, or result from adaptations to clinical practice to meet the needs of a telepsychiatry interface in patient care.MethodsWe used a qualitative, modified grounded theory approach to gain insight into areas of importance for telepsychiatry training in postgraduate psychiatry residency. 16 interviews of faculty and residents (9 and 7 interviews, respectively), allowed participants to reflect on their experiences in telepsychiatry. Data were then thematically analyzed.ResultsInterview respondents identified important aspects of the context for telepsychiatry training; the skills required to competently practice telepsychiatry; and the desired teaching and learning methods for acquiring these skills. Specific domains of competency were identified: technical skills; assessment skills; relational skills and communication; collaborative and interprofessional skills; administrative skills; medico-legal skills; community psychiatry and community-specific knowledge; cultural psychiatry skills, including knowledge of Indigenous cultures; and, knowledge of health systems. The skills identified in this study map well to competency- based medical education frameworks.ConclusionsTelepsychiatry is increasingly being adopted as a solution to health systems problems such as regional disparities in access to care, and it requires explicit competency development. Ensuring adequate and quality exposure to telepsychiatry during residency training could positively impact our health systems and health equity.

Lost information during the handover of critically injured trauma patients: a mixed-methods study

Background Clinical information may be lost during the transfer of critically injured trauma patients from the emergency department (ED) to the intensive care unit (ICU). The aim of this study was to investigate the causes and frequency of information discrepancies with handover and to explore solutions to improving information transfer. Methods A mixed-methods research approach was used at our level I trauma centre. Information discrepancies between the ED and the ICU were measured using chart audits. Descriptive, parametric and non-parametric statistics were applied, as appropriate. Six focus groups of 46 ED and ICU nurses and nine individual interviews of trauma team leaders were conducted to explore solutions to improve information transfer using thematic analysis. Results Chart audits demonstrated that injuries were missed in 24% of patients. Clinical information discrepancies occurred in 48% of patients. Patients with these discrepancies were more likely to have unknown medical histories (p<0.001) requiring information rescue (p<0.005). Close to one in three patients with information rescue had a change in clinical management (p<0.01). Participants identified challenges according to their disciplines, with some overlap. Physicians, in contrast to nurses, were perceived as less aware of interdisciplinary stress and their role regarding variability in handover. Standardising handover, increasing non-technical physician training and understanding unit cultures were proposed as solutions, with nurses as drivers of a culture of safety. Conclusion Trauma patient information was lost during handover from the ED to the ICU for multiple reasons. An interprofessional approach was proposed to improve handover through cross-unit familiarisation and use of communication tools is proposed. Going beyond traditional geographical and temporal boundaries was deemed important for improving patient safety during the ED to ICU handover.

Healthy and productive workers: using intervention mapping to design a workplace health promotion and wellness program to improve presenteeism

BackgroundPresenteeism is a growing problem in developed countries mostly due to an aging workforce. The economic costs related to presenteeism exceed those of absenteeism and employer health costs. Employers are implementing workplace health promotion and wellness programs to improve health among workers and reduce presenteeism. How best to design, integrate and deliver these programs are unknown. The main purpose of this study was to use an intervention mapping approach to develop a workplace health promotion and wellness program aimed at reducing presenteeism.MethodsWe partnered with a large international financial services company and used a qualitative synthesis based on an intervention mapping methodology. Evidence from systematic reviews and key articles on reducing presenteeism and implementing health promotion programs was combined with theoretical models for changing behavior and stakeholder experience. This was then systematically operationalized into a program using discussion groups and consensus among experts and stakeholders.ResultsThe top health problem impacting our workplace partner was mental health. Depression and stress were the first and second highest cause of productivity loss respectively. A multi-pronged program with detailed action steps was developed and directed at key stakeholders and health conditions. For mental health, regular sharing focus groups, social networking, monthly personal stories from leadership using webinars and multi-media communications, expert-led workshops, lunch and learn sessions and manager and employee training were part of a comprehensive program. Comprehensive, specific and multi-pronged strategies were developed and aimed at encouraging healthy behaviours that impact presenteeism such as regular exercise, proper nutrition, adequate sleep, smoking cessation, socialization and work-life balance. Limitations of the intervention mapping process included high resource and time requirements, the lack of external input and viewpoints skewed towards middle and upper management, and using secondary workplace data of unknown validity and reliability.ConclusionsIn general, intervention mapping was a useful method to develop a workplace health promotion and wellness program aimed at reducing presenteeism. The methodology provided a step-by-step process to unravel a complex problem. The process compelled participants to think critically, collaboratively and in nontraditional ways.

Developing a Mentorship Program for Psychiatry Residents

ObjectiveThe authors sought to evaluate a formal mentorship program for second-year psychiatry residents at the University of Toronto after the program’s first year of implementation.MethodsTen mentees and ten faculty mentors were interviewed by fellow second-year residents and an independent researcher, respectively, about their experiences in the program. Interview data were thematically coded and analyzed using a grounded theory approach.ResultsThree major themes were identified. First, participants emphasized the importance of a natural, flexible, and engaging matching process for mentors and mentees. Many experienced the random assignment approach to matching and the mandatory nature of the program as barriers to developing a meaningful relationship with their mentors. Second, participants expressed a preference for geographic proximity between mentor and mentee workplaces and for meetings to take place in informal settings in order to improve the quality and quantity of their interactions. Lastly, participants felt that clear directions and expectations about the program’s goals should be communicated, and that a forum for information sharing among mentors was needed.ConclusionsOverall, the majority of participants believed that the program facilitated growth and development and provided positive opportunities for both mentors and mentees. While challenges were present in the program, participants provided tangible recommendations to improve the process.

Integrating Quality Improvement and Continuing Professional Development: A Model From the Mental Health Care System.

Purpose To explore the perspectives of leaders in psychiatry and continuing professional development (CPD) regarding the relationship, opportunities, and challenges in integrating quality improvement (QI) and CPD. Method In 2013–2014, the authors interviewed 18 participants in Canada: 10 psychiatrists-in-chief, 6 CPD leaders in psychiatry, and 2 individuals with experience integrating these domains in psychiatry who were identified through snowball sampling. Questions were designed to identify participants’ perspectives about the definition, relationship, and integration of QI and CPD in psychiatry. Interviews were recorded and transcribed. An iterative, inductive method was used to thematically analyze the transcripts. To ensure the rigor of the analysis, the authors performed member checking and sampling until theoretical saturation was achieved. Results Participants defined QI as a concept measured at the individual, hospital, and health care system levels and CPD as a concept measured predominantly at the individual and hospital levels. Four themes related to the relationship between QI and CPD were identified: challenges with QI training, adoption of QI into the mental health care system, implementation of QI in CPD, and practice improvement outcomes. Despite participants describing QI and CPD as mutually beneficial, they expressed uncertainty about the appropriateness of aligning these domains within a mental health care context because of the identified challenges. Conclusions This study identified challenges with aligning QI and CPD in psychiatry and yielded a framework to inform future integration efforts. Further research is needed to determine the generalizability of this framework to other specialties and health care professions.

Screening and Treatment for Alcohol, Tobacco and Opioid Use Disorders: A Survey of Family Physicians across Ontario.

Introduction As a primary point of contact within the health care system, family physicians are able to play a vital role in identifying individuals with substance use disorders and connecting them to the appropriate treatment. However, there is very little data available on whether family physicians are actively screening for and treating substance use disorders. The objective of the current survey was to assess whether family physicians in Ontario are screening for alcohol, opioid and tobacco use disorders, using validated tools and providing treatment. Methods An online survey consisting of a series of 38 primarily close-ended questions was circulated to family physicians in Ontario. Rates of screening for alcohol, opioid and tobacco dependence, use of validated tools for screening, providing treatment for dependent individuals and the current barriers to the prescription of pharmacotherapies for these drug dependences were assessed. Results The use of validated screening tools was limited for all three substances. Screening by family physicians for the substance use disorders among adolescents was much lower than screening among adults. Pharmacotherapy was more commonly used as an intervention for tobacco dependence than for alcohol and opioid dependence. This was explained by the lack of knowledge among family physicians on the pharmacotherapies for alcohol and opioid dependence. Conclusions Findings from the current study suggest there is a need for family physicians to integrate screening for substance use disorders using validated tools into their standard medical practice. Furthermore, there is a need for increased knowledge on pharmacotherapies for alcohol and opioid use disorders. It is important to note that the low response rate is a major limitation to this study. One possible reason for this low response rate may be a lack of interest and awareness among family physicians on the importance of screening and treatment of substance use disorders in Ontario.

Supervisors’ perceptions of organizational policies are associated with their likelihood to accommodate back-injured workers

Abstract Background Low back pain (LBP) is a major concern among North American workplaces and little is known regarding a supervisor’s decision to support job accommodation for workers with LBP. The extent to which supervisors are included in a company’s effort to institute disability management policies and practices and workplace safety climate are two factors that may influence a supervisor’s decision to accommodate workers with LBP. Objective Determine the association between supervisors’ perceptions of disability management policies, corporate safety culture and their likelihood of supporting job accommodations for workers with LBP. Methods We conducted a cross-sectional study of supervisors (N=796) recruited from a non-random, convenience sample of 19 Canadian and US employers. The outcome was supervisors’ likeliness to support job accommodation and the exposure was global work safety culture and disability management policies and practices. A multivariable generalized linear modelling strategy was used and final models for each exposure were obtained after assessing potential effect modifiers and confounders. Results In the study, 796 eligible supervisors from 19 employers participated. Disability management policies and practices were positively associated with supervisors’ likeliness to accommodate (β=0.19; 95% CI: 0.13; 0.24) while no significant association was found between corporate safety culture (β= −0.084; 95% CI: −0.19; 0.027) and supervisors’ likeliness to accommodate. Conclusions Employers should ensure that proactive disability management policies and practices are clearly communicated to supervisors in order to improve job modification and return to work efforts. Implications for Rehabilitation Low back pain (LBP) is a major workplace concern and little is known regarding what factors are associated with a supervisor’s likelihood to support job accommodation for workers with LBP. The objective of this article was to determine the association between supervisors’ perceptions of disability management policies and practices, corporate safety culture and their likelihood of support job accommodations for workers with LBP. Results suggest that disability management policies and practices are positively associated with supervisors’ likelihood to accommodate while corporate safety culture is not. These results are important for employers as it suggests that employers should ensure that their disability management policies and practices are clearly communicated to supervisors in order to improve job accommodation and return to work efforts.

Teaching Not-Knowing: Strategies for Cultural Competence in Psychotherapy Supervision

Effective psychotherapy requires a culturally competent clinician. Cultural competence is broadly understood as the ability to work skillfully across cultures, engaging the perspectives and identities of both clinician and patient [1]. The concept has been moving from the margins to mainstream of psychiatric pedagogy [2, 3]. While cultural competence is increasingly seen as a core component of training, it remains challenging to operationalize. Arguably, all psychotherapy is cross-cultural, as even a clinician and a patient from similar sociodemographic backgrounds may have widely differing constructs of mental health, relationships, and indeed of the psychotherapeutic process itself. Clinicians must skillfully navigate these complex cultural issues to achieve the alliance, attunement and collaboration necessary for a positive treatment response [4]. The complexity deepens as trainees, patients, and supervisors bring many different cultural systems into play when engaged with one another in therapeutic and educational experiences. A culturally competent supervisor must provide teaching strategies to help the trainee navigate these intersecting cultural forces. Two approaches to cultural competence dominate the literature, each of which fall short in helping supervisors develop these teaching strategies. In the first approach, rigorous and structured instruments, such as the DSM-VCultural Formulation Interview or the previous Outline for Cultural Formulation, offer concrete tools but have incurred critiques for being rigid or formulaic when culture is inherently fluid and evolving [5]. In the second approach, theoretical writings on cultural competence present thoughtful critiques of mainstream paradigms and assumptions but offer few strategies for embodying these insights in specific educational techniques. Supervisors are thus left with the predicament of needing to teach their trainees to navigate issues of culture without a clear sense of just how to do so [6, 7]. The great challenge of teaching cultural competence is to reconcile the gap between pre-written algorithmic approaches and the clinical positions of openness, curiosity and uncertainty that are the hallmarks of a culturally competent practice. This paper offers a set of supervision strategies that bridge the gap between prescriptive clinical instruments and more theoretical discourses on culture. We have distilled these strategies from a focused review of the education, culture, and psychotherapy literatures to devise a theoretical approach and skill set that educators can implement into practice. We have named our model for teaching cultural competence the “not-knowing stance”. Readers familiar with MentalizationBased Therapy will recognize Bateman’s description of “notknowing” as one part of a therapist’s position [8, 9]. This paper draws from this and other literatures to expand the term “not-knowing,” defining and operationalizing a core stance required in cross-cultural clinical and teaching spaces. We delineate three primary teaching components of the notknowing stance: reflection, humility, and working with otherness. In the not-knowing stance, each of these strategies is engaged simultaneously and each strategy promotes the other. Although these techniques have broad application across psychiatric education, here we embed the not-knowing stance within the process of psychotherapy supervision. This addresses the complex supervision and clinical challenges that arise over time, whereas most of the cultural competence literature focuses primarily on assessment. At the end of the paper, a case example illustrates the not-knowing stance and * Priya Watson priya.watson@camh.ca