THEME 1, Psychiatrist Access:
Associated Meaning Units: Long waiting lists; Long waiting lists or waiting times for child/adolescent services; No direct access to child and adolescent (c/a) psychiatrist; No/few available c/a psychiatrists; Uses telemedicine or video/online for consults; Referrals refused by c/a psychiatrist: Physician’s referrals are refused or canceled by c/a psychiatrists. -
Examples of Comments with the most frequency count for theme, “Psychiatrist Access”
“Would not refer to for child/adolescent psychiatrists because wait times are too long; unavailable in our region; must travel >1hr and then they are not available anyway”; “Too few psychiatrists in our area who are 1) open to accept new patients of any age and 2) even fewer willing to accept children/adolescents.”; “There is a visiting child psychiatrist but he does not come often and referral process is onerous so I gave up using his services.”.
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THEME 2, Process Issues:
Associated Meaningful Units: Lack of government funding; Undervaluing of mental health shown through funding; Poor communication, continuity and collaboration: No communication, continuity of care, and/or collaboration of care in this field; More systemized and transparent referral processes such as: Lack of clarity regarding referral processes; Need to rely on adult mental health professionals such as having to refer to professionals who work with adults (i.e., such as adult psychiatrists, inappropriate reliance on adult medications). -
Examples of Comments with the most frequency count for theme, “Process Issues”
“Sense that mental health is devalued; segregated; and soiled in terms of funding.”; “No meaningful follow-ups with cases.”; “Need more consultation (initial) from psychiatrist and less of their time given to follow-up…we can do that if given a proper initial/yearly consult.”; “Even with a referral no continuity of care is available since we are remote.”; “Child/adolescent psychiatrist should give us advice on what to do while waiting.”; “Need to improve access for patients in smaller communities to the services available in larger centres for child/adolescent psychiatric care!”; “Need to know when/how/who to refer to psychiatrist.”; “Helping us access advice in crisis situations i.e., - making on call Child/adolescent psychiatrists aware of the sketchy resources in rural areas and need for reassuring advice in these crisis situations.”.
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THEME 3, Resource Needs:
Associated Meaningful Units: Need Mental Health Resources such as more resources (e.g., psychologists, therapists, tele-health, etc.); No access to psychiatry or other mental health services; Need more knowledge/Information on mental health issues/topics; Have limited information/knowledge and/or want more information/knowledge regarding the field (e.g., school issues; specific diagnoses; non-pharmacological treatment; handouts, websites; prevention strategies; treatment); Need inpatient beds: Need for inpatient beds for this population. -
Examples of Comments with the most frequency count for theme, “Resource Needs”
“More counselling services in community that can be accessed by low income families.”; “Need for psychologists and other mental health workers skilled at working with kids.”; “No services for counselling; behaviours therapy etc. - management of patients difficult.”; “Handouts, websites of patient teaching would be helpful….”; “Make checklists and standard questionnaire available and perhaps part of standard practice just like e.g. MMSE in assessment of elderly with dementia, etc.”.
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THEME 4, Professional Development:
Associated Meaningful Units: Desire for professional development; Interested in continuing medical education and will participate in continuing medical education; No desire for professional development: No not interested in continuing medical education or no time to participate in continuing medical education; Mental health is a specialized population requiring more skill; Stating that mental health should be and is specialized. -
Examples of Comments with the most frequency count for theme, “Professional Development”
“CME would have to be timely; very efficient; packed with knowledge.”; “I believe in our community will benefit from having regular CME sessions for child/adolescent psychiatry.”; “I do not currently have opportunities to increase my confidence/competence because personal and family responsibilities hard to do CME.”; “There is only so much time to learn new skills. Need to prioritize for the type of practice I have.”
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THEME 5, Refer to Other Professionals:
Associated Meaningful Units: Refer to paediatricians; Referrals made only or sometimes to paediatricians; Refer to mental health professionals other than child/adolescent psychiatrists; Refer to psychologists, social workers, other specialists, etc. -
Examples of Comments with the most frequency count for theme, “Refer to Other Professionals”
“We have a shortage of child psychiatrists and easier access to paediatricians.”; “Paediatrician quite stable coming regularly, knowing patients, easily available by phone between visits.”; “Child psychologists and school psychologists take the slack and I refer to them and rely on them.”; “I often refer to psychologists who are much easier to access for adolescents (not children) and family can afford.”; “Attention problems; behavioural; eating; developmental seen in multidisciplinary clinic.”; “I refer to psychologists frequently.”.
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THEME 6, Workload:
Associated Meaningful Units: Services are too overloaded in physician practice; Child/adolescent mental health field is exhausting and draining of physician’s practice. -
Examples of Comments with the most frequency count for theme, “Workload”
“I am in under doctored area. Time to do anything is an enormous factor.”; “Yes I need more continuing professional development; however, there are many complex areas in rural medicine that require CME; Rural doctor cannot be expected to be the new/fill-in specialist in every area.”; “Emotional draining/drainage are the fundamental reasons for not further engaging in child (and adult) mental health issues.”; “This field drains time/resources.”
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