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      Where is the family voice? Examining the relational dimensions of the family- healthcare professional and its perceived impact on patient care outcomes in mental health and addictions

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          Abstract

          Background

          We explored the relationship between family members and healthcare professionals (HCPs), specifically how family members can influence the course and outcome of patient care for youth. Exploring this under-researched area provided an opportunity to understand the tripartite relationship between the family, the youth experiencing mental health problems or substance use concerns and their HCP.

          Methods

          A qualitative research design was used to gain a full understanding of how family members experience relationships with HCPs. We interviewed 21 family members using semi-structure questions to explore the type of relationships formed between HCPs and family members throughout a patient’s course of care, the family member’s perceived role in the care of their youth accessing mental health or addiction services and the family member’s awareness of formalized structures (i.e., hospital rules, policies) and resources that support family involvement.

          Results

          Within a relationship-centred framework, four themes, with various sub-themes emerged from the interviews: 1) The family member–HCP relationship regarding creating a positive impression, being an extension of the patient and the discovery of “pink flags”; 2) The family member–youth–HCP relationship regarding the receptivity of youth to family involvement and a youth’s individual right to privacy; 3)The family member’s relationship to self with regard to the situation being a family illness; and 4) The family member’s relationship with friends, family and peers regarding the feelings of loneliness, stigma and shame and the lack of understanding about mental health problems and substance use.

          Conclusions

          Our study provided in-depth information about the importance of family involvement in the care and health outcomes of youth who are accessing mental health and addiction services. Family members experienced and conceptualized their relationships with HCPs, their youth, themselves and their friends and peers as active interactions that influenced the course and outcomes of care. Future studies are needed to collect the multiple perspectives of youth and HCPs alongside with the family perspectives.

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          Most cited references24

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          Stigma: Advances in Theory and Research

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            The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions, with a focus on young people.

            The family plays a key part in both preventing and intervening with substance use and misuse, both through inducing risk, and/or encouraging and promoting protection and resilience. This review examines a number of family processes and structures that have been associated with young people commencing substance use and later misuse, and concludes that there is significant evidence for family involvement in young people's taking up, and later misusing, substances. Given this family involvement, the review explores and appraises interventions aimed at using the family to prevent substance use and misuse amongst young people. The review concludes that there is a dearth of methodologically highly sound research in this area, but the research that has been conducted does suggest strongly that the family can have a central role in preventing substance use and later misuse amongst young people.
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              Intuition and evidence--uneasy bedfellows?

              Intuition is a decision-making method that is used unconsciously by experienced practitioners but is inaccessible to the novice. It is rapid, subtle, contextual, and does not follow simple, cause-and-effect logic. Evidence-based medicine offers exciting opportunities_for improving patient outcomes, but the 'evidence-burdened' approach of the inexperienced, protocol-driven clinician is well documented Intuition is not unscientific. It is a highly creative process, fundamental to hypothesis generation in science. The experienced practitioner should generate and follow clinical hunches as well as (not instead of applying the deductive principles of evidence-based medicine. The educational research literature suggests that we can improve our intuitive powers through systematic critical reflection about intuitive judgements--for example, through creative writing and dialogue with professional colleagues. It is time to revive and celebrate clinical storytelling as a method for professional education and development. The stage is surely set for a new, improved--and, indeed, evidence-based--'Balint'group.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                12 April 2019
                2019
                : 14
                : 4
                : e0215071
                Affiliations
                [1 ] Centre for Addiction and Mental Health, Toronto, Ontario, Canada
                [2 ] Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
                [3 ] Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
                [4 ] The Wilson Centre for Research in Education, University Health Network and University of Toronto, Toronto, Ontario, Canada
                [5 ] University Health Network, Toronto, Ontario, Canada
                [6 ] Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
                Institute of Mental Health, SINGAPORE
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-5119-8473
                Article
                PONE-D-18-32229
                10.1371/journal.pone.0215071
                6461270
                30978230
                5f2bfb7f-15fd-4cb5-ae47-f7eef7eb71f7
                © 2019 Soklaridis et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 9 November 2018
                : 26 March 2019
                Page count
                Figures: 0, Tables: 1, Pages: 17
                Funding
                This research project was made possible with a Mapping the Landscape, Journeying Together Grant from The Arnold P. Gold Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Social Sciences
                Sociology
                Human Families
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Biology and Life Sciences
                Psychology
                Addiction
                Social Sciences
                Psychology
                Addiction
                Medicine and Health Sciences
                Health Care
                Patients
                Biology and Life Sciences
                Psychology
                Emotions
                Social Sciences
                Psychology
                Emotions
                Research and Analysis Methods
                Research Design
                Qualitative Studies
                Medicine and Health Sciences
                Health Care
                Health Education and Awareness
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognitive Psychology
                Learning
                Human Learning
                Biology and Life Sciences
                Psychology
                Cognitive Psychology
                Learning
                Human Learning
                Social Sciences
                Psychology
                Cognitive Psychology
                Learning
                Human Learning
                Biology and Life Sciences
                Neuroscience
                Learning and Memory
                Learning
                Human Learning
                Custom metadata
                Our Research Ethics Board has imposed restrictions on sharing a de-identified data set due to a lack of patient consent. For researchers who meet the criteria for access to confidential data, the de-identified data are available from the Chair of our Research Ethics Board Dr. Robert Levitan, 416 535-8501 ext. 34020, robert.levitan@ 123456camh.ca ; or from the lead author, Sophie Soklaridis, sophie.soklaridis@ 123456camh.ca .

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