Exploring the Impact of Open Dialogue Delivered on Digital Platforms: A Special Studies Project Público

Abstract

The world entered into a novel era of healthcare delivery on March 11, 2020 when the World Health Organization announced the Coronavirus Disease 2019 (COVID-19) as a pandemic. In response to the global emergency, social-distancing guidelines and travel restrictions were put in place around the world, greatly limiting people’s access to essential health services as well as many other necessities in day-to-day life (Whaibeh, Mahmoud & Naal, 2020). Hospitals and other healthcare facilities found themselves in an urgent position of needing to rapidly transition the way they delivered their services to patients while adhering to social-distancing guidelines and travel restrictions to prevent risk of transition of the deadly virus. Telehealth has emerged as a primary solution to the limitations that the response to the global pandemic has placed on healthcare delivery and has allowed for the continuity of essential healthcare services. Grady Adult Outpatient Clinic (Grady AOP) located in Atlanta, GA is one example of many community health clinics in the United States and around the world that have transitioned services to digital platforms since March of 2020. The delivery of Open Dialogue, a treatment intervention for individuals experiencing psychosis, was moved from in-person clinic settings to digital platforms during this time. This Special Studies Project aims to better understand how Open Dialogue delivered on digital platforms impacted patient barriers and engagement with the program by developing data collection tools that can be used to explore this experience for clients, clinicians, and staff.

Table of Contents

Chapter One: Introduction…………………………………………………….…………………1

Background………………………………………………………………………………………….………...1

Concept of Project………………………………………………………………………………………….…3

Problem Statement…………………………………………………………………………..………3

Purpose Statement………………………………………………………………………..……….…4

Research Question……………………………………………………………………..………….…4

Significance Statement………………………………………………………………………..……..4

 

Chapter Two: Literature Review………………………………………………………...……... 5

Overview……………………………………………………………………………………………...………5

Psychosis………………………………..……………………………….........……...………………...……..5

           Symptoms, Signs, Diagnoses……………………………………………..………………….…..….5

           Etiology…………………………..……………………………….........……............................……8

           Factors that Increase Risk of Developing Psychosis………………………………………….……..9

           Course of Illness……………………………………………………………………………………10

Treatment for Psychosis……………………………………………………………………………..……….11

           Psychotherapy for Psychosis………………………………………………………………………..12          

           Open Dialogue….…………………………………………………………………………………..13

Barriers to Effective Treatment for Psychosis……...…………………………………………..……………18

           Stigma and Discrimination…………………………………………………………………………19

           Unemployment and Homelessness…………………………………………………………………21

           Substance Abuse……………………………………………………………………………………21

           Family Support……………………………………………………………………………………..22

Telehealth Interventions for Individuals with Psychosis…………………………..………………….……..22

Open Dialogue at Grady Adult Outpatient Clinic...………………………………….………………………24

Conclusion………………………………………………………………………….………………………..25

 

Chapter Three: Methods…………………………………………………………………...……27

Introduction………………………………………………………………………………………….……….27

Population and Sample…………………………………………………………………………….…………27

           Clinicians and Staff of Open Dialogue at Grady AOP……………………………..………………28

           Clients of Open Dialogue at Grady AOP…………………………………………….…………….28

Procedure…………………………………………………………………………………………...………..29

Instruments………………………………………………………………………………………..…….……30

           Key Informant Interview with Open Dialogue Team at Grady AOP………………...……….……30

           Patient Survey with Open Dialogue Clients at Grady AOP………………………………….…….31

 

Chapter Four: Results……………………………………………………………………...…….33

Key Informant Interview Guide……………………………………..…………………………………..……33

Patient Survey……………………………………………...……………...…………...………………...……34

 

Chapter Five: Discussion……………………………………...…………………………………36

Summary. ………………………………………………………………………………………….36

Limitations…………………………………………………………………………………………37

Future Directions and Recommendations………………………………………………………… 37

           Grady AOP……………………………………………………………………………….. 37

           Community Clinics in the United States…………………………………………………. 38

Public Health Implications……………………………………………………...………………… 38

Conclusions………………………………………………………………………………………...41

 

Chapter Six: References…………………………………...……………………………………..43

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Mental Health
Palavra-chave	Psychosis Open Dialogue
Committee Chair / Thesis Advisor	Rachel Waford, Emory University

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