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The COVID-19 pandemic increased population levels of depression and anxiety, and infection control measures obliged services to provide psychological therapies remotely. Evidence for the routine provision of psychological therapy via telephone and video-conferencing is limited. This study compared therapy outcomes for 5360 clients in two London Improving Access to Psychological Therapy (IAPT) services before and after homeworking produced a compete shift to remotely delivered therapy. Despite the psychological impacts of pandemic restrictions, and the use of a novel therapy modality in video-conferencing, recovery rates and net score change improved in both services, significantly in one. There was no significant worsening of outcomes for any demographic group or presenting disorder. The findings suggest that for those able to access it, therapy provided by telephone and video is a clinically effective option for IAPT services.
Key learning aims
(1) To assess the clinical effectiveness of delivering IAPT therapies remotely.
(2) To gain insight into the impacts of remote therapy on different client groups, including ethnicity, gender, age and presenting problem.
(3) To assess the impact of remote therapy on access to IAPT services.
Videoconferencing therapy (VT) has been an emerging medium of psychological therapy, and during the COVID-19 pandemic there has been substantial growth in its usage as a result of home working. However, there is a paucity of research into client and clinician perceptions of VT. This study sought to assess client and staff experiences of VT. This mixed methods study produced both quantitative and qualitative data. Seven clients who had previously received VT and 11 psychotherapists who had previously delivered VT were recruited from two NHS sites. Clients and psychotherapists took part in qualitative interviews which were analysed using thematic analysis. Quantitative surveys were developed based on themes generated from the interviews and were completed by 172 clients and 117 psychotherapists. These were analysed using simple percentages. VT often exceeded client and psychotherapist expectations and overall experiences of VT were generally positive, although there were mixed findings regarding the therapeutic alliance. Several barriers to VT were cited, such as IT issues, and challenges identified in conducting behavioural experiments, and potential exclusion of certain populations were also cited. The medium of VT was received well by both clients and clinicians, with advantages around convenience seemingly outweighing losses in quality of therapeutic relationship. Future research should focus on overcoming barriers to accessing VT in populations prone to digital exclusion. NHS services not currently employing VT may wish to reconsider their stance, expanding choice of therapy delivery and improving accessibility.
Key learning aims
(1) To gain insight into client and clinician experiences of VT during the COVID-19 pandemic.
(2) To assess the acceptability and feasibility of VT within two NHS short-term psychological support services.
(3) To identify barriers and facilitators to the implementation of VT within two NHS short-term psychological support services.
Consumer satisfaction is considered one of the most important measures of service quality in child mental health; however, there is limited understanding of factors that influence satisfaction. The objective of this study was to investigate key factors influencing satisfaction with care (SWC) in ADMiRE, a specialist service for young people (YP) with attention deficit hyperactivity disorder (ADHD).
Methods:
Parents/carers (n = 67) and YP > 9 years (n = 44) attending ADMiRE completed an anonymous Experience of Service Questionnaire (ESQ), a quantitative/qualitative measure of service user satisfaction. Parents/carers also completed symptom severity rating scales. Data were analysed to determine (i) overall SWC, (ii) the relationship between parent- and youth-reported SWC and (iii) the impact of symptom severity on SWC. Thematic analysis of qualitative ESQ data was completed.
Results:
Parents/carers were significantly more satisfied than YP (p = 0.028). Symptom severity did not impact significantly on parent/carer satisfaction. YP with severe hyperactive/impulsive and inattentive ADHD symptoms were significantly less satisfied with care than those with less severe ADHD symptoms (p = 0.022 and p = 0.017 respectively). Factors related to the therapeutic alliance were identified as being particularly important to both parents/carers and YP.
Conclusions:
This is the first Irish study that has investigated the impact of symptom severity on service user satisfaction in a child mental health service. The results highlight the different perspectives of YP and parents and provide novel insights into the impact of symptom severity on service user satisfaction. The importance of the therapeutic alliance should not be underestimated in future development of services.
The Standards Committee of the Experimental Research Section of the American Political Science Association has produced reporting guidelines that aim to increase the clarity of experimental research reports. This paper describes the Committee's rationale for the guidelines it developed and includes our Recommended Reporting Standards for Experiments (Laboratory, Field, Survey). It begins with a content analysis of current reporting practices in published experimental research. Although researchers report most important aspects of their experimental designs and data, we find substantial omissions that could undermine the clarity of research practices and the ability of researchers to assess the validity of study conclusions. With the need for reporting guidelines established, the report describes the process the Committee used to develop the guidelines, the feedback received during the comment period, and the rationale for the final version of the guidelines.
The extant genetic variation of a population is the legacy of both long-term and recent population dynamics. Most practical methods for estimating effective population size are only able to detect recent effects on genetic variation and do not account for long-term fluctuations in species abundance. The utility of a maximum likelihood estimator of long-term effective population size based upon the coalescent theory of gene genealogies is examined for three endangered Colorado River fishes: humpback chub (Gila cypha), bonytail chub (Gila elegans) and razorback sucker (Xyrauchen texanus). Extant mitochondrial DNA (mtDNA) variation in humpback chub suggests this species has retained its historical equilibrium genetic variation despite recent declines in abundance. The mtDNA variation in razorback suckers indicates the population was quite large and expanding prior to recent declines and that rare alleles still survive in the remnant populations. The remaining mtDNA variation in bonytail chub indicates that dramatic, recent declines may have already obliterated a substantial portion of any historical variation. The results from long-term effective population size analyses are consistent with known natural history and illustrate the utility of the analysis for endangered species management.
A major attraction of the application of genetic engineering to microbial inoculant strains is the ability to create new strains with capabilities that may not be easily obtained by a process of natural selection. Such additional features may enhance the performance of an inoculant strain.
The fluorescent Pseudomonas species are an important group of bacteria that can play a beneficial role in the protection of crop plants against deleterious pathogenic micro-organisms. These bacteria produce a wide range of factors antagonistic to pathogens (particularly fungi) they include the yellow-green, fluorescent siderophores that characterize this group.
Our work has concentrated on the role of siderophores and antibiotics of fluorescent Pseudomonas in the biocontrol of ‘damping-off’ disease of sugar-beet seedlings (see Table 14.1). The biosynthesis and excretion of iron-binding siderophores are thought to decrease the pool of iron available to pathogenic fungi and other harmful micro-organisms and so contribute to the plant growth promotion effect observed when plants are inoculated with the appropriate Pseudomonas strain (Kloepper et al 1980). The producing micro-organism can use the resulting Fe3+ (ferric) siderophore complex via specific receptors located in its outer membrane (Magazin et at., 1986).
Outer membrane receptor proteins can be highly specific and only transport the appropriate ferric siderophore into the producing cell. The structures of these fluorescent (yellow-green) siderophores was reviewed by Leong (1986). Fluorescent siderophores are only produced under iron-limiting conditions, as are receptor proteins.
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