Table 2 Participating Providers’ Themes and Sub-Themes

Providers’ challenges in assessing mental health

Complexity and severity of cases

One of the challenges, not only for mental health issues, but other chronic illnesses is that a large majority of my patients will only come to their appointments when they need something from me in particular. Not necessarily a medical issue. A lot of times it’s other issues related to filling out forms or seeking disability or stuff like that. So that can be a challenge…and a lot of times there is a lot to address in an appointment. (FP#1)

Time

I would say the biggest reason is time. If a person doesn’t come with a complaint that might warrant that discussion, it tends not to be talked about. And for someone who is coming in with various episodic things, that could potentially not be addressed for a long time or ever. (NP#1)

Language barriers

The biggest challenge would be in language. Because the way people present how they feel to the practitioner doesn’t necessarily reflect how they are feeling inside themselves. So, even if you have an interpreter, you’re not getting that nuance. (NP#3)

Interpreters

When I’m having numerous patients back-to-back that require interpreters… it is not uncommon that they are scheduled like that instead of being interspersed with English-speaking clients where you can often make up some time. (FP#1)

Mental health stigma

There’s definitely a stigma … Especially across cultures. It’s hard to really know from person to person and culture to culture because everyone [is] experiencing things differently. (NP#1)

Vulnerable population

I think we have a big sort of burden of disease with mental health issues in the community health centre sector and ours as well. A lot of the clients that we see have more resistant or pervasive mental health issues, whether it’s post-traumatic stress disorder …we do have a lot of people who spend a lot of time waiting to come and be processed, to come to Canada as refugees (NP#5)

Perceived benefits of using iCCAS

Clients: self-awareness

I think [clients] appreciated it. I think for them, it was helping to unload a very big burden on them. So, I think it’s one more thing that took a little bit of the burden away. (NP#1)

I think that the value of it in this setting is tuning people into their own mental health, showing people what resources are available, and, “Oh, why don’t you talk to this person?” and it also gets people to start thinking about their mental health. FP#4)

Clients: disclosure

They felt more comfortable [talking about mental health] because they had already written it. They’ve already expressed it. Now they can build on what they had expressed. It wasn’t a new thought for them. It was very helpful. (NP#3)

Clients: normalize

I also find that the last part that says recommendations has been really helpful too. Pretty much all of them say referral to social work, so I thought that that was really good because it [is] something that, normalizes it and it says that anyone can really benefit from this service so feel free to take advantage [of] …we’ve it available to you for free because it’s part of our organization and what we value. (NP#1)

Clients: non-invasive

[The clients] entered all these symptoms and they think I have a problem rather than like a doctor telling you that you have a problem. (FP#2)

For the provider point of view, there might be some things that come up because the iCCAS asked the question in a different way, or they are sitting there alone and their impulse is to answer in one way, while when they are in front of me their impulse is to answer another way. (FP#4)

Clients: point-of-care feedback

It has the resources in it as well, so I think—it’s been a while since I saw one smokers’ helpline, there’s an alcohol one, there’s abuse, abuse, like, contact numbers for more information. (NP#5)

Clinician: effective/efficient screening tool

I think it has a benefit, there are times when I’m dealing with the physical needs of the patient, but if I get the report it sort of alerts me to look into that part too… I don’t forget the mental part. (NP#2)

Clinician: useful report

No, I think it’s quite clear. I usually only look at the left-hand side. That’s the main thing I look at. (NP#2)

Clinician: identify new cases

The couple of times I had actually seen it was on a couple of people I was already managing their mental health issues. I think here mental health is very much front and centre. Both in the provider’s mind and also with the patients. It tends to come up more. So what the iCCAS report did for me was simply to solidify what was going on. Although there was one where it said that the person was feeling suicidal and I didn’t realize they were having those thoughts. So that would have been important. (FP#4)

Perceived challenges in using iCCAS

Time & many issues

Sometimes, not always, but often we will know about the mental health issues, or there’s other things that are pertinent to deal with at the time. (FP#3)

Receiving iCCAS report

[The report] was sort of handed to me sometimes even in the middle of a visit, or when I had already started dealing with whatever issues. (FP#3)

False alarm/ misinterpretation

There was an incident from iCCAS; it [the report] says “patient suffers severe depression and intention of hurting herself,” (…) but when I looked at the iCCAS report and I asked the patient … the patient goes “No, I’m fine, I don’t want to hurt myself or others.” I charted it too and I tried to follow up, the patient does have depression, but no intention of hurting themselves, so that was a little bit,… I don’t know what happened there. (NP#2)

Interest in integrating iCCAS into everyday practices.

Integration into regular practices

The more you can get yourself out there to discuss mental health, the better. So if there would be a way of being involved in the community’s services sector of Access Alliance for some of their programs or maybe not necessarily getting the entire group but getting a few people in the group that might be helpful, as well. (NP#1)

iCCAS’s ability to promote better service

It would be a great way to advertise our community programs. That’s another thing, I sometimes find that the primary health care team and the community health program team are disconnected in a way… I find that I identify a lot of patients that could benefit from these programs and what I will do is, I’ll either write it on a piece of paper to say, “Hey, we have a community users desk at the front,” … but it just gets lost sometimes, sometimes that lady is just not there, a lot of that happens, maybe this is a good way. (FP#2)

Promoting an effective integration of iCCAS into primary care practices

Different languages

I think definitely to have it in other languages, and especially because our population…Yeah, like Farsi and Dari, like we have a lot of Afghan patients who again conceptually they don’t necessarily have the vocabulary around it. Korean… (FP#3)

Integration with EMR

It’s good to incorporate with the computer system, the EMR system, also, it can be accessed though, by other clinicians, like a social worker can look at it. (NP#2)

Time of the screening

I think it would be great for initial visits. If it can be timed with the initial visits, or pre-screening before people are seen at the clinic. … So if we knew that information before even seeing the patient, I think that would be very helpful as opposed to just dropping it in the middle of—of managing patients. (FP#3)

Other primary care settings

The clinicians who work here, we all try very hard to stay on time. But, for example, the previous clinician he would see people and fit-ins and all of that. So that might of worked better for him. For us the—yeah the clinicians that were working during the iCCAS study are quite on time. … whereas at another practice maybe that wouldn’t be the case. And I think most doctors’ offices people don’t run on time until it might be easier to catch people when they’re in wait—in the waiting room. (FP#3)