Evidence for creating distance delivery systems
We are now featuring the article titled “Barriers to Mental Health Care: Perceived Delivery System Differences” by Patricia Lingley-Pottie, PhD, BNRN, CCRC; Patrick J. McGrath, PhD, OC, FRSC; and Pantelis Andreou, PhD. This article reports the results of a study designed to explore differences between distance and face-to-face delivery of care for families with children who have mental health problems. They used tools to measure perceived treatment barriers, therapeutic processes, and outcomes. Their results provide evidence that distance delivery is a viable mode of health care delivery and has potential to bridge gaps in delivery that exist for marginalized populations. In Dr. Lingley-Pottie’s description of her work, she explains how her program of research has evolved; we include here links to the two articles that precede this one so that you can explore more background leading to this article.
It is an honor to have our manuscript published in Advances in Nursing Science (ANS). This is the final paper of my PhD dissertation and the last in a series of three that have been published in ANS. My research focuses on exploring the distance treatment experience from the participants’ perspective. The participants received Strongest Families intervention, evidence-based, psychologically informed mental health services that are delivered from a distance using highly-trained, non-professional coaches. Strongest Families was designed to ensure that neither time nor distance are barriers to care; coaching calls are scheduled at times convenient to families.
With the emergence of new distance service delivery systems and a scarcity of research in the field of pediatric mental health via telehealth using non-professionals, we decided to plan a series of research studies involving Strongest Families intervention programs.
Our initial research showed that therapeutic alliance existed in the absence of face-to-face contact between a coach and adult or child participant. The qualitative data collected to examine the participants’ opinions about advantages and disadvantages of distance treatment versus a face-to-face treatment experience (Lingley-Pottie & McGrath, 2007) suggested enhanced therapeutic alliance, uninhibited self-disclosure and the virtual elimination of stigma, which were attributed to visual anonymity and privacy offered by the distance setting. Results suggested that the barriers that exist with traditional mental health services were absent with Strongest Families. Moreover, results indicated possible differences in therapeutic processes between systems, informing the next projects.
An extensive literature search revealed that existing theoretical frameworks are based on face to face intervention and may not sufficiently apply to distance treatment, especially if a new phenomenon such as visual anonymity has an impact on therapeutic processes. Moreover, existing scales were primarily derived from professional opinion and may not adequately capture important participant or end service user information. To further examine differences between delivery systems (Distance versus face-to-face), we developed and validated a scale (Treatment Barrier Index-TBI) that was grounded in the participants’ distance experience to ensure inclusion of concepts relevant to the distance treatment and the end users’ perspective (Lingley-Pottie & McGrath, 2011).
The TBI was then used in this current study, the featured publication, to explore differences in perceived barriers to care and therapeutic process between two delivery systems (distance versus face-to-face). The results showed significantly fewer barriers associated with distance treatment and suggests significant differences in therapeutic processes between systems. Therapeutic alliance and self-disclosure significantly influenced the TBI score, favoring distance treatment and supporting the assumption that distance systems offering visual anonymity may eliminate the negative effects of stigma that some individuals experience with face-to-face treatment.
Innovative, cost-effective delivery systems are an important key to health care reform. These interesting findings will hopefully inform and generate more research in distance system design as well as stimulate the rethinking of existing theories and their relevance or applicability to distance treatment. Continued research will be important to ensure that programs are designed to meet the users’ needs and yield strong health outcomes. Nurses are often at the forefront of innovation in service delivery. We have the potential to make a significant contribution in this exciting, developing field of research.
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