Design, Implementation, and Evaluation of a Sport-Focused Mental Health Service Delivery Model Within a Canadian Centre for Mental Health and Sport
Creators: name: Van Slingerland, Krista
Publisher: name: Université d'Ottawa / University of Ottawa
Year: 2021
Subjects: Participatory Action Research
Mental Health
Mental Illness
Athletes
Competitive and High-Performance Sport
Collaborative Care Model

description: The overall aim of this Participatory Action Research (PAR; Chevalier &amp; Buckles, 2013; Lewin, 1946) project was to design, implement, and evaluate a specialized sport-focused mental health service delivery model for competitive and high-performance athletes, integrated within a broader Canadian Centre for Mental Health and Sport (CCMHS). A transformative mixed methods research design (Cresswell, 2014) guided by the PAR approach was employed across three phases during which (a) a sport-specific mental health service delivery model for competitive and high-performance athletes was collaboratively designed by stakeholders (Design Phase [Study 1]), (b) the model was pilot-tested within the CCMHS (Implementation Phase [Study 2]), and (c) the model was evaluated to understand whether practitioners and service-users perceived the care delivered / received within the model to be acceptable and appropriate (Evaluation Phase [Study 3]). Design Phase (Study 1). The purpose of study 1 was to (a) perform an environmental scan of the Canadian mental health care and sport contexts, and (b) design a sport-focused mental health service delivery model for competitive and high-performance athletes within a broader CCMHS. To meet these objectives, 20 stakeholders from the sport and mental health sectors explored (a) the availability and effectiveness of mental health care for competitive and high-performance Canadian athletes, and (b) the strengths, weaknesses, opportunities and threats associated with creating a CCMHS, via two iterations of stakeholder-led focus groups (Rio-Roberts, 2011). The resulting data informed a subsequent Group Concept Mapping (GCM; Burke et al., 2005; Kane &amp; Trochim, 2007; Rosas &amp; Kane, 2012) activity undertaken by stakeholders, which produced an actionable framework (i.e., concept map) organized into six clusters that visually represented the elements (e.g., services, personnel, organizational structures) that stakeholders deemed important to include in the sport-focused mental health care model (e.g., bilingual services, a triage system, sport-specialized practitioners). In addition, the results revealed that misconceptions about the competitive and high-performance population’s mental health and experience of mental illness were widespread and required clarification before significant advances could be made. This led the group to develop six principles designed to establish a common language and understanding upon which to build effective models of mental health care, improved programming, and strategic education for Canada’s competitive and high-performance athletes, coaches, and organizations (Article 1). The framework that emerged from the GCM activity served to guide the remainder of the project, and supported actions (e.g., develop eligibility criteria to access services, hire a team of mental health practitioners with sport competencies [i.e., CCMHS Care Team]) to build the CCMHS and test the model during the Implementation Phase (Article 2). Implementation Phase (Study 2). The purpose of study 2 was to pilot test the mental health service delivery model designed during the first phase of the research project. To do so, an illustrative case study (Keegan et al., 2017; Stake, 1995, 2005) was carried out to demonstrate how (i.e., intake, referral, and service delivery processes) the CCMHS Care Team provided mental health care to a high-performance athlete, and what outcomes resulted from this process. Data to inform the case study was gathered through a review of the service-user’s clinical documents (e.g., intake summary, session notes), and qualitative interviews (n = 2) with the athlete’s Collaborative Care Team lead and the CCMHS Care Coordinator. Document analysis (Bowen, 2009) was used to organize the details of the case found within clinical documents under the categories of the case study framework (i.e., intake and referral process, service-user description, integrated care plan, and outcomes), while a conventional descriptive content analysis (Hsieh &amp; Shannon, 2005) served to extract salient data from the interviews to further build out the case study. Results revealed that sport significantly influenced the onset and experience of mental illness for the athlete service-user. The lead practitioner’s sport-specific knowledge played a significant role in the diagnosis, treatment and recovery of this athlete given the nature of the athlete’s concerns and high athletic identity. Findings support the notion that specialized mental health care models and teams are necessary to address sport-related factors that can pose unique threats to the diagnosis and treatment of mental illness in athletes (Article 3). Implementation Phase (Study 3). The purpose of study 3 was to evaluate the acceptability and appropriateness of the mental health service delivery model designed during Phase 1 and implemented during Phase 2. Qualitative data from three sources (CCMHS practitioners, CCMHS service-users, and CCMHS stakeholders) were collected and analyzed using a multi-step, multi-method process, including16 one-on-one semi-structured interviews with CCMHS practitioners (n = 10) and service-users (n = 6), and a meeting with CCMHS stakeholders (captured via meeting minutes). In addition, 47 documents (e.g., clinical, procedural) created during the implementation phase of the project by CCMHS team members (i.e., practitioners, stakeholders, members of the board of directors) were used to triangulate the other data (Carter, Bryant-Lukosius, DiCenso, Blythe, and Neville, 2014). The Framework Method (Gale et al., 2013; Ritchie and Spencer, 1994) was used to analyze, synthesize, integrate, and interpret the dataset. The deductive data analysis approach taken was guided by the seven components of acceptability developed by Sekhon and colleagues (2017), and the Canadian Medical Association’s definition of appropriate care. Findings showed that the care provided and received within the CCMHS service delivery model was perceived to be acceptable and appropriate, and each component of the model uniquely contributed to practitioner and service-user experiences. For example, the collaborative interdisciplinary approach contributed to the ethicality of the model, promoted the professional development of team members, and enabled Pan-Canadian service provision. The sport-centered nature of care was perceived to enhance the ethicality of services delivered, effectiveness of care, and affective experience of service-users. Implications for further research and practice were discussed in light of areas of the model that emerged as needing improvement (e.g., prohibitive cost of care, practitioner burden from collaborative processes and procedures). Overall, the findings of the research project demonstrate that collaborative approaches to inquiry and practice can be successfully applied in sport to guide stakeholders in developing and testing novel models to improve the health outcomes of sport participants. The research also shows that an interdisciplinary team of practitioners can successfully deliver sport-focused mental health care that is acceptable and appropriate to service-users. Lastly, the project provides data on the first known empirical project to design, implement and evaluate a specialized mental health service delivery model applied nationwide in person and virtually with competitive and high-performance athletes experiencing mental health challenges and symptoms of mental illness.