Publications by authors named "Nick Kates"

Objective: To investigate changes in FPs' self-reported clinical practices after participation in a comprehensive 1-year cognitive behavioural therapy (CBT) training course.

Design: Cross-sectional study.

Setting: Norway.

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Objectives: To evaluate the impact of an Integrated Care Pathway (ICP) within a collaborative care framework for anxiety, depression and mild cognitive impairment (MCI) on clinical outcomes, quality of life, and time to treatment initiation.

Design: Prospective Cohort study.

Setting: Primary care practices in Toronto and Hamilton, Ontario, Canada.

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Background: Young people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention may change this course. Shared care with mental health professionals in general practitioner (GP) offices has demonstrated its potential for improvement in these conditions.

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Background: Longitudinal studies examining the impact of changes in COVID-19 pandemic-related stressors and experiences, and coping styles on the mental health trajectory of employed individuals during the lockdown are limited. The study examined the mental health trajectories of a sample of employed adults in Hamilton, Ontario during the initial lockdown and after the re-opening following the first wave in Canada. Further, this study also identified the pandemic-related stressors and coping strategies associated with changes in depressive symptoms in employed adults during the COVID-19 pandemic.

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Objective: Parental psychopathology is a significant risk factor for mental health challenges in offspring, but the nature and magnitude of this link in Indigenous Peoples is not well understood. This systematic review examined the emotional and behavioral functioning of the offspring of Indigenous parents with mental health challenges.

Method: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science from their inceptions until April 2020.

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Background: Patients and families are often referred to as important partners in collaborative mental health care (CMHC). However, how to meaningfully engage them as partners remains unclear. We aimed to identify strategies for engaging patients and families in CMHC programs for depression and anxiety disorders.

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Objective: Although Indigenous women are exposed to high rates of risk factors for perinatal mental health problems, the magnitude of their risk is not known. This lack of data impedes the development of appropriate screening and treatment protocols, as well as the proper allocation of resources for Indigenous women. The objective of this systematic review and meta-analysis was to compare rates of perinatal mental health problems among Indigenous and non-Indigenous women.

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Mental health peer support is an evidence-based approach called for by Canada's mental health strategy that presents health leaders with an opportunity to transform mental health service experiences, improve health outcomes, and lower overall system costs. Originally offered in community settings, peer support has been expanding to clinical settings, but challenges to integration exist. This qualitative case study of peer support in clinical settings in Canada and Norway examines the perceived value of peer support and change management strategies that health leaders, managers, staff, and peer support providers can use to support integration of peer support in existing healthcare teams in clinical settings.

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Previous guidelines and planning documents have identified the key role primary care providers play in delivering mental health care, including the recommendation from the WHO that meeting the mental health needs of the population in many low and middle income countries will only be achieved through greater integration of mental health services within general medical settings. This position paper aims to build upon this work and present a global framework for enhancing mental health care delivered within primary care. This paper synthesizes previous guidelines, empirical data from the literature and experiences of the authors in varied clinical settings to identify core principles and the key elements of successful collaboration, and organizes these into practical guidelines that can be adapted to any setting.

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Objective: To evaluate the mode of implementation, clinical outcomes, cost-effectiveness, and the factors influencing uptake and sustainability of collaborative care for psychiatric disorders in older adults.

Design: Systematic review.

Setting: Primary care, home health care, seniors' residence, medical inpatient and outpatient.

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Purpose: Both providers and patients may have important insights to inform the development of obesity prevention and management services in Canadian primary care settings. In this formative study, insights for new obesity management services were sought from both providers and patients in 1 progressive citywide organization (150 physicians, team services, separate offices).

Methods: Seven focus groups with interprofessional health providers (n = 56) and 4 focus groups with patients (n = 34) were conducted.

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Unlabelled: Aim We report on a formative project to develop an organization-level planning framework for obesity prevention and management services.

Background: It is common when developing new services to first develop a logic model outlining expected outcomes and key processes. This can be onerous for single primary care organizations, especially for complex conditions like obesity.

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Introduction: Collaborative mental healthcare (CMHC) has garnered worldwide interest as an effective, team-based approach to managing common mental disorders in primary care. However, questions remain about how CMHC works and why it works in some circumstances but not others. In this study, we will review the evidence on one understudied but potentially critical component of CMHC, namely the engagement of patients and families in care.

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Context: Early clinical encounters help medical and nursing students build professional competencies. However, there is a necessary emphasis on patient autonomy and appropriate consent. Although most individuals do not object to student involvement in clinical encounters, there are occasions when personal preference and health care education conflict.

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Objective: To develop a framework for research and evaluation of collaborative mental health care for depression, which includes attributes or domains of care that are important to consumers.

Methods: A literature review on collaborative mental health care for depression was completed and used to guide discussion at an interactive workshop with pan-Canadian participants comprising people treated for depression with collaborative mental health care, as well as their family members; primary care and mental health practitioners; decision makers; and researchers. Thematic analysis of qualitative data from the workshop identified key attributes of collaborative care that are important to consumers and family members, as well as factors that may contribute to improved consumer experiences.

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A consistent feature of effective healthcare delivery systems is a strong and well-integrated primary care sector. This paper presents a framework that describes the key elements of high-performing primary care and the supports required to attain it. The framework was developed by the Quality Improvement and Innovation Partnership in Ontario (now part of Health Quality Ontario) to guide the process of primary care transformation.

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For 16 years, the Hamilton Family Health Team Mental Health Program has successfully integrated mental health counselors, addiction specialists, child mental health professionals, and psychiatrists into 81 offices of 150 family physicians in Hamilton, Ontario. Maximising the potential of a "shared care" model requires changes within the primary care setting, to support the addition of mental health and addiction professionals, active involvement of primary care staff in managing mental health problems of patients, and collaborative practice. This coordinated effort allow mental health treatment through onsite support from a mental health team and supplants the need to refer most patients to the mental health setting.

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Objective: To examine the determinants that lead Canadian adults to consult family physicians, psychiatrists, psychologists, psychotherapists, and other health professionals for mental health reasons and to compare the determinants of service use across provider types.

Method: Data from the Canadian Community Health Survey: Mental Health and Well-Being were used for people aged 18 years and older (n = 35,236). A multivariate logistic regression was used to model outpatient consultations with different providers as a function of predictive determinants.

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Over the last five years, increasing attention has been paid to ways of improving collaboration between mental health and primary care services (shared mental health care). This reflects a growing recognition of the significant role that family physicians already play in handling mental health problems of Canadians in almost every community across the country and the need to improve the working relationships between mental health and primary care services. This paper reviews the impact of these factors and looks at how the concept of shared care has evolved in Canada.

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There is growing energy behind primary mental health care reform - from political activity, research, funding and clinical practice. The evidence that early adopters have been busy reforming mental health services in primary health care is apparent in the rise of references to primary mental health care and collaborative care in national and provincial planning documents, clinical trials examining the efficacy of collaborative mental health care, funded clinical programs across the country, and the establishment of a nationally funded initiative - the Canadian Collaborative Mental Health Initiative - to research and develop tools to implement collaborative mental health care. In conclusion, there is real momentum in primary mental health care reform.

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