The involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support.... Show moreThe involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support. Nevertheless, the collaboration between YPSWs and non-peer colleagues remains challenging, as it requires services to embed a new type of expert into practice. To stimulate the involvement of YPSWs in practice, this study reports on 27 semi-structured interviews with YPSWs and non-peer colleagues to provide insight into the barriers and facilitators in the collaboration process. The study took place in the Netherlands. A total of 10 interviews with YPSWs, and 17 interviews with non-peer colleagues in different healthcare occupations in CAMHS were conducted. Overall, the participants perceived relatively more barriers compared to facilitators in the collaboration process. Barriers to operate efficiently with YPSWs in multidisciplinary teams included: condescending attitudes and professional stigma towards YPSWs; concerns for YPSW boundaries; bureaucratic and clinical language usage by non-peer colleagues; conflicts due to different sets of expertise; and, lack of role clarity and guidelines for YPSWs. To improve the partnership between YPSWs and non-peer colleagues, participants described the importance of supervision and monitoring of YPSW activities. Moreover, participants also stressed the need for clear guidelines, and introduction and evaluation sessions to facilitate the collaboration process. While YPSWs seem to be an asset to CAMHS, there are a number of barriers to overcome. To overcome these barriers, organizational commitment, supervision (especially from peer colleagues), flexibility by non-peer colleagues, training non-peer staff to support YPSWs, and consistent evaluation of the implementation of YPSWs in services is recommended. Show less
The suffering of depressed patients is enormous. It also poses an important burden on their significant others and on society as a whole. Clinicians are therefore being urged to relieve these... Show moreThe suffering of depressed patients is enormous. It also poses an important burden on their significant others and on society as a whole. Clinicians are therefore being urged to relieve these conditions as soon as possible. To that purpose, effective psychotherapeutic, psychopharmacologic and other biological interventions, such as electroconvulsive therapy (ECT), are available. Observing a quick response to a course of ECT in a psychotic depressed patient is astonishing. ECT may restore the patient__s normal mood, but at the same time may provoke anxiety and a sense of shame or stigmatization. Frequently, ECT is accompanied by more or less impairing cognitive side effects. For clinicians and scientists, ECT is fascinating and raises many research questions concerning the effects of this treatment on the functioning of the brain. This thesis reports on our daily practice in which we treat severely ill depressed patients, while simultaneously doing clinical research. To further improve the understanding and the effectiveness of ECT, the electrical dose, which elicits the seizure activity (defined as seizure threshold [ST]), is the subject of this thesis Show less
