Objetivo: Este estudo apresenta um curso de psicodinâmica para residentes de psiquiatria, direcionado ao atendimento psiquiátrico ambulatorial, com o propósito de favorecer a integração entre as abordagens biológica e psicodinâmica. O objetivo foi investigar o aprendizado dos residentes após o curso, em relação à aquisição de conhecimentos, habilidades e atitudes específicas. Método: Dezoito residentes de primeiro ano do IPq-HC-FMUSP freqüentaram o curso em 2005. Os residentes foram avaliados no primeiro e no último dia do curso através de uma prova escrita que foi corrigida por dois juízes independentes. A análise de variância (ANOVA) e testes não paramétricos, quando necessário, foram utlizados para a análise estatística. A concordância entre os juízes foi testada através do coeficiente de correlação intraclasse. Os residentes também foram entrevistados, após o curso, com a intenção de verificar se os conceitos psicodinâmicos haviam sido integrados em sua prática clínica (avaliação qualitativa). As respostas foram submetidas à metodologia do Discurso do Sujeito Coletivo. Resultados: Houve um alto grau de concordância entre os juízes (r =0,90). Demonstrou-se uma diferença (p= 0,000) entre as notas do período final e do período inicial, com um acréscimo das notas totais no período final, em média, de 2,5 pontos (o valor total da prova era 10,0 pontos). Adicionalmente, verificou-se que os residentes passaram a fazer mais psicoterapia pessoal após o curso (p= 0,031). Nas entrevistas, eles enfatizaram o aprendizado adquirido e uma melhora do relacionamento com os pacientes. Conclusões: Este estudo constatou que, através do método de ensino proposto, os residentes adquiriram conhecimentos, habilidades e atitudes especificamente relacionados aos princípios psicodinâmicos abordados durante o curso. / Objective: The author designed and taught a course for first-year psychiatry residents that specifically addressed psychodynamic principles that can be applied to outpatient psychiatric treatment, in order to integrate biological and psychodynamic approaches. The goal was to evaluate whether this course fostered residents? progress in knowledge, skills and attitudes regarding these psychodynamic concepts. Method: This course was given in the 2005 academic year to all residents (n=18) in their first psychiatric postgraduate year at the Institute of Psychiatry, Hospital das Clínicas of the University of São Paulo Medical School. The residents were assessed in the first and the last sessions of the course through a written test that was blindly rated by two independent judges. They were also interviewed afterwards to observe whether the psychodynamic concepts had been integrated into actual practice (qualitative assessment). Their responses were subjected to content analysis. Significance was tested using analysis of variance (ANOVA) or nonparametric tests when necessary. The agreement between the judges was tested using intraclass correlation coefficients. Results: The judges demonstrated a high level of agreement (minimum r=0.90). There was a difference in mean scores before and after the course (p=0.000), such that the total score increased by a mean of 2.5 points (total score for tests was 10.0 points). Additionally, it was seen that the residents started to undergo more personal psychotherapy after the course (p=0.031). In the interviews, they reported that this course had markedly improved their relationship with patients. They emphasized the opportunities for self-reflection and gaining insights into themselves and patient treatment issues. Conclusions: This initial study indicates that this educational method can effectively promote psychodynamic knowledge, skills and appropriate attitudes among our residents for managing psychiatric outpatients.

Objetivo: Este estudo apresenta um curso de psicodinâmica para residentes de psiquiatria, direcionado ao atendimento psiquiátrico ambulatorial, com o propósito de favorecer a integração entre as abordagens biológica e psicodinâmica. O objetivo foi investigar o aprendizado dos residentes após o curso, em relação à aquisição de conhecimentos, habilidades e atitudes específicas. Método: Dezoito residentes de primeiro ano do IPq-HC-FMUSP freqüentaram o curso em 2005. Os residentes foram avaliados no primeiro e no último dia do curso através de uma prova escrita que foi corrigida por dois juízes independentes. A análise de variância (ANOVA) e testes não paramétricos, quando necessário, foram utlizados para a análise estatística. A concordância entre os juízes foi testada através do coeficiente de correlação intraclasse. Os residentes também foram entrevistados, após o curso, com a intenção de verificar se os conceitos psicodinâmicos haviam sido integrados em sua prática clínica (avaliação qualitativa). As respostas foram submetidas à metodologia do Discurso do Sujeito Coletivo. Resultados: Houve um alto grau de concordância entre os juízes (r =0,90). Demonstrou-se uma diferença (p= 0,000) entre as notas do período final e do período inicial, com um acréscimo das notas totais no período final, em média, de 2,5 pontos (o valor total da prova era 10,0 pontos). Adicionalmente, verificou-se que os residentes passaram a fazer mais psicoterapia pessoal após o curso (p= 0,031). Nas entrevistas, eles enfatizaram o aprendizado adquirido e uma melhora do relacionamento com os pacientes. Conclusões: Este estudo constatou que, através do método de ensino proposto, os residentes adquiriram conhecimentos, habilidades e atitudes especificamente relacionados aos princípios psicodinâmicos abordados durante o curso. / Objective: The author designed and taught a course for first-year psychiatry residents that specifically addressed psychodynamic principles that can be applied to outpatient psychiatric treatment, in order to integrate biological and psychodynamic approaches. The goal was to evaluate whether this course fostered residents? progress in knowledge, skills and attitudes regarding these psychodynamic concepts. Method: This course was given in the 2005 academic year to all residents (n=18) in their first psychiatric postgraduate year at the Institute of Psychiatry, Hospital das Clínicas of the University of São Paulo Medical School. The residents were assessed in the first and the last sessions of the course through a written test that was blindly rated by two independent judges. They were also interviewed afterwards to observe whether the psychodynamic concepts had been integrated into actual practice (qualitative assessment). Their responses were subjected to content analysis. Significance was tested using analysis of variance (ANOVA) or nonparametric tests when necessary. The agreement between the judges was tested using intraclass correlation coefficients. Results: The judges demonstrated a high level of agreement (minimum r=0.90). There was a difference in mean scores before and after the course (p=0.000), such that the total score increased by a mean of 2.5 points (total score for tests was 10.0 points). Additionally, it was seen that the residents started to undergo more personal psychotherapy after the course (p=0.031). In the interviews, they reported that this course had markedly improved their relationship with patients. They emphasized the opportunities for self-reflection and gaining insights into themselves and patient treatment issues. Conclusions: This initial study indicates that this educational method can effectively promote psychodynamic knowledge, skills and appropriate attitudes among our residents for managing psychiatric outpatients.

No description available.

The Patient-Centred Assessment of Symptoms and Activities (P-CASA) is a new idiographic, open-ended assessment that examines each individual patient’s symptoms within the context of his or her daily life. P-CASA asks patients for their most important activities, what interferes with these activities, and any coping strategies. This thesis presents the rationale and design of P-CASA and its first validation study. Sixty patients at the Pain and Symptom Management/Palliative Care Clinic of the BC Cancer Agency (Vancouver Island Centre) completed P-CASA and the Edmonton Symptom Assessment System (ESAS), which is the current nomothetic assessment at the Clinic. The results demonstrated that P-CASA was not redundant with ESAS because it assessed (a) information about patients’ activities and coping strategies, which the ESAS does not; (b) all relevant cancer-related symptoms (not just pain or a fixed list); (c) co-occurring symptoms; (d) more specific details and different priorities about symptoms than in their ESAS. / Graduate

O absenteísmo, ou seja, a falha no atendimento (FA) ou não atendimento (NA) dos usuários nos serviços de saúde do Sistema Único de Saúde (SUS) é um assunto de crescente interesse devido ao grande número de pessoas aguardando atendimento e ao contexto econômico atual. A problemática acarreta prejuízos a todos envolvidos, pois prolonga a conclusão diagnóstica, prejudica o tratamento, diminui a produtividade do prestador, causa aumento de tempo na espera por atendimento dos demais usuários e desperdício de recursos públicos. Portanto, o objetivo deste estudo foi compreender os motivos do absenteísmo nos serviços de saúde e as estratégias praticadas para a redução de falhas no atendimento. Trata-se de pesquisa qualitativa, com desenho de estudo de caso descritivo-exploratório, baseado em entrevistas semi-estruturadas e grupo focal. A coleta de dados visou a identificar diferentes opiniões e explicações para o absenteísmo, as estratégias e perspectivas utilizadas pelas equipes de saúde da AME e das secretarias de saúde de quatro municípios. Foram selecionados quatro casos traçadores para evidenciar experiências típicas, ou seja, dois municípios que pudessem demonstrar uma dinâmica mais exitosa no controle do absenteísmo e outros dois representantes de experiências menos exitosas. A análise permitiu representar o perfil dos serviços locais \"em situação\", discutindo estratégias, processos de trabalho, facilidades e dificuldades. Foi possível evidenciar as diferentes características e fluxos nos quatro municípios estudados, bem como a pequena ou inexistente discussão sobre o absenteísmo. Durante as entrevistas, nenhum dos entrevistados sabia ao certo a taxa de falha de atendimento e demonstraram-se surpresos quando informados de que são em média 560 consultas especializadas perdidas por mês. Todos concordaram que devem ser adotadas estratégias de prevenção ao absenteísmo, e, principalmente, esses dados devem ser divulgados à população. Concordaram ainda que outros setores podem e devem ser copartícipes na efetivação de uma rede local de atenção à saúde, no registro do fluxo dos usuários, utilizando diferentes espaços para a promoção da frequência ao atendimento e educação em saúde. Foram compartilhadas várias estratégias e propostas de mudança para reorganização municipal e alteração nos fluxos de trabalho, bem como comunicação entre os serviços e os usuários. Este estudo proporcionou a oportunidade de discussão entre os envolvidos no processo de acesso aos serviços de saúde do AME Araçatuba. Permitiu a reflexão sobre responsabilidades e papéis dos atores no processo. O folder produzido a partir desta pesquisa e apoiado pela revisão bibliográfica será utilizado na capacitação de profissionais, com a finalidade de subsidiar o planejamento em saúde e melhorar a assistência proposta ao usuário do SUS. / Absenteeism, that is, the non-attendance of users in health services of Unified Health System is a subject of growing interest due to large number of people waiting for care and current economic context. The problem entails damages to all involved, since it prolongs the diagnostic conclusion, impairs the treatment, decreases the provider\'s productivity, causes an increase in waiting time for other users\' attention, and wastage of public resources. Therefore, the aim in this study was to understand the reasons for absenteeism in health services and the strategies used to reduce service failures. It is qualitative research, in the design of the case study, descriptive-exploratory based on interstructure interviews and focal group. The interview is a technique of collecting data through group interactions, mediated by a facilitator, to encourage the formation of opinions on the absenteeism, strategies and perspectives of the health teams. Four tracer cases were selected to show typical experiences, that is, two municipalities that could demonstrate the most successful dynamics in control of absenteeism and two other less successful representatives of the same. The analysis allowed to represent the profile of local services \"in situation\", discussing strategies, work processes, facilities, and difficulties. It was possible to show the different characteristics and flows between the four municipalities studied and how little or no discussion about absenteeism is available. During the interview, none of municipalities interviewed knew for certain that the rate of service failure was surprising when informed that they are on average 560 specialized consultations lost per month. All agreed that strategies should be taken, and especially, these data should be made public. They also agree that other sectors can and should be partners in the implementation of the local health care network, in execution of flow users, use of other spaces for awareness, and education in health. Several strategies and proposals for change have been shared for municipal reorganization and changes in workflows and communication between services and users. This study provided the opportunity for discussion among those involved in the process of access to the health services of Ambulatory Care of Araçatuba. It allowed for reflection on the responsibilities and roles of actors in the process. The folder produced from this research and supported by bibliographic review will be used to train professionals, with the purpose of subsidizing health planning and improving the proposed assistance to Unified Health System users.

No presente trabalho, é apresentado um olhar sobre a atenção na área de Neurologia Infantil na Rede Regional de Atenção da RRAS 13 - Araraquara - Barretos - Franca e Ribeirão Preto. O objetivo é apresentar a RRAS 13 quanto a sua localização, abrangência territorial e populacional; Verificar dados relacionados a atendimentos e encaminhamentos ao ambulatório de Neurologia Infantil do HCFMRP-USP (ANIN) em agosto de 2015 e o alcance diagnóstico neurológico nas DRS correspondentes à RRAS 13. O método utilizado foi o de busca no site do DATASUS e do IBGE. Como resultados, observou-se que o Estado de São Paulo é organizado em 17 RRAS, compostas, administrativamente, por 4 DRS. Estas 4 DRS estão organizadas em 12 Regiões de Saúde. Segundo o IBGE a RRAS 13 possui uma população estimada para 2014 de 3.525.999 habitantes. Em relação ao número total de encaminhamentos aguardando atendimento no ANIN (ambulatório de Neurologia Infantil), encontrou-se em levantamento realizado no mês de agosto de 2015, 1362 encaminhamentos das 4 DRS. A DRS XIII (Ribeirão Preto) é a que mais encaminha com 60,50% acima da média para toda a região e é a que possui o maior percentual de médicos neurologistas, neurocirurgiões e neurofisiologistas por 100.000 habitantes, atingindo 151,43% das diretrizes do SUS. Quanto à distribuição dos equipamentos de uso rotineiro em Neurologia Infantil, eletroencefalógrafo, Tomografia computadorizada e Ressonância Nuclear Magnética, a DRS de Ribeirão Preto (XIII) possui maior concentração de recursos; porém todas as DRSs possuem tais equipamentos e realizam rotineiramente esses exames. Conclui-se que irregularidades na distribuição da atenção no nível secundário contribui para a sobrecarga do número de encaminhamentos ao Ambulatório de Neurologia Infantil do HCFMRP-USP. / In the present work, there is presented a glance on the attention in the area of Child Neurology in the Regional Net of Attention of the RRAS 13 - Araraquara - Barretos - Franca and Ribeirão Preto. The aim of this work is to present the RRAS 13 as its location, territorial and population coverage; Check data relating to care and referrals to Child Neurology Clinic of the ORDERS-USP in august 2015 and the neurological diagnosis in range DRS corresponding to RRAS13. Method - through surveysof DATASUS site and from the IBGE (Brazilian Institute of geography and statistics). As a result, it was observed that the State of Sao Paulo is organized administratively into 17 RRAS, composed, administratively, for 4 DRS (III-Araraquara, V-Barretos, VIIIFranca and XIII-Ribeirão Preto). These 4 DRS are organized into 12 Health Regions. According to the IBGE to RRAS 13 has an estimated population of 3,525,999 inhabitants for 2014. In relation to the total number of children waiting for care in the ANIN (Child Neurology outpatient clinic), found in a study conducted in August 2015, 1362 referrals of 4 DRS; the DRS XIII (Ribeirão Preto) is the most of them with 60.50% above the average for the entire region; as for the number of set of neurologists, neurosurgeons and neurophysiologists, the DRS XIII has the highest percentage of doctors per 100,000 inhabitants and reaches 151.43% the guidelines of SUS. About the distribution of equipment for routine use in Child Neurology, Electroencephalograph (EEG), computed tomography (CT) and magnetic resonance imaging (MRI), for Diagnostics, the DRS of Ribeirão Preto (XIII) has the highest concentration of resources. and all DRSs have such equipment and routinely carry out these examinations. It is concluded that irregularities in the distribution of attention in secondary level contributes to the overload of the number of referrals to Child Neurology Clinic of the ORDERS.

The purpose of the study was to investigate and describe the experiences of a mobile injection team for multi drug resistant-tuberculosis outpatients, and to design and recommend a mobile injection team guideline based on the experiences of the team members in Ugu District, KwaZulu-Natal and to indicate the support that the MIT require. Phenomenological research was conducted. Convenient census sampling was used as all the seven members of the Ugu District mobile injection team were included. The inclusion criteria was at least six months’ working experience with MDR-TB patients in a mobile injection team at Ugu District, be an enrolled nurse registered with the South African Nursing Council as an enrolled nurse and must have an annual practicing certificate, or be a TB assistant, be willing to participate in the study and be located at the decentralised and satellite site. Data were collected through individual in-depth interviews with the participants. Data were analysed using Giorgi’s method of data analysis. The research findings revealed four broad themes (the perceptions held by the team, challenges, available support and needs to promote the service) and 73 sub-themes. The findings of the study indicate that the MDR-TB outreach injection teams experience many challenges in the community and need to be supported by their management in order to provide quality care to the patients. This study contributes to the development of guidelines to assist the mobile injection teams to provide quality patient care and effective service delivery. Based on the findings, the recommendation is that an intervention study be performed to compare the utilisation of the mobile MDR-TB injection team after implementing the recommendations made and the guidelines developed in this study / Health Studies / D. Litt. et Phil. (Health Studies)

Made available in DSpace on 2014-07-29T15:04:30Z (GMT). No. of bitstreams: 1 dissertacao marleneandrade.pdf: 776220 bytes, checksum: 89f7e969fbef687591092b3ded9dd40a (MD5) Previous issue date: 2008-04-30 / Assessing patients with chronic wounds poses a challenge to professionals and doubts still persist concerning characterization of the wound infection status. We believe that the Basic Health Units are in places of reference for the public to submit chronic wounds and should have full attendance and resolution were objectives of this study: characterizing patients with chronic wounds attended as spontaneous demand in the bandage room; characterizing patients chronic wounds regarding the presence of classical signs and additional infection criteria; isolating and identifying aerobic bacteria and fungi in the samples of chronic wounds clinically signaling to infection; verifying strains susceptibility when isolated before antimicrobial agents often used in praxis as well as new antibiotics and analyzing the relationship of local factors with infection status. This is a cross-sectional study, carried out in ambulatory bandage rooms in basic health units with emergency service in the municipality of Goiânia. Data was collected from June to July, in 2007. Data was obtained through the use of structured interviews containing questions about characterization of patients and a check list for the assessment of chronic wounds through the signs and clinical symptoms indicating infection and analysis of wound samples by using swabs in accordance with Levine s technique. After consent and approval of the ethics committee, 46 patients were evaluated and 60 wound samples were assessed. Data bank was organized in Excel table and statistics analysis in SPSS- 15.0. The average age was 55 years, 37 (80.4%) male, 20 (43.5%) belonging to E social class, 23 (50%) retired people having basic sanitation items. 28 (61%) presented venous ulcerated lower limbs, 31 (67.4%) performed the bandage both in the BHU and at home. 45 (75%) out of 60 wounds were infected and 15 (25%) noninfected. Through bivariate analysis we verified an association of the infection status with the following characteristics: width depth of tissular damage, necrotic tissue and exudate amount. Among signs and symptoms, classical ones occurred in a frequency higher than 65% both in the infected and noninfected group. Regarding the additional ones, we verified variance in occurrence in both wound groups. Staphylococcus aureus was predominat in 65% of cases and was sensitive to most antibiotics tested. Among Gram-negative bacteria the most frequent were: Pseudomonas aeruginosa (23%), resistant to amoxylin +clavulanic acid, cefalexin and cefotaxim; Proteus mirabilis (16.6%) and Proteus vulgaris (15.0%), all sensitive to gentamicin, aztreonam, ciprofloxacin, and amicacin. These results indicate the need to structure an integrated net to treat patients with chronic wounds and evidence additional criteria to be employed in the elaboration of service protocols pursuing improvement of quality of assistance given in basic health units. / A avaliação de pacientes com feridas crônicas representa um desafio para os profissionais, e dúvidas, ainda persistem em torno da caracterização do status de infecção, nessas lesões. As Unidades Básicas de Saúde constituem-se locais de referência para a população portadora de feridas crônicas, onde deveriam ter atendimento integral e resolutividade. Objetivos deste estudo: caracterizar os pacientes com feridas crônicas, atendidos como demanda espontânea, na sala de curativos; caracterizar as feridas crônicas dos pacientes atendidos em relação à presença de sinais clássicos e critérios adicionais de infecção; isolar e identificar bactérias aeróbias e fungos das amostras de feridas crônicas, com indícios clínicos de infecção; verificar a susceptibilidade das cepas isoladas, frente aos antimicrobianos freqüentemente utilizados na prática e novos antibióticos, e analisar a relação de fatores locais, com o status de infecção. Trata-se de estudo transversal, realizado em Salas de Curativos Ambulatoriais de Unidades Básicas de Saúde (UBS), com atendimento de urgência do Município de Goiânia. Os dados foram coletados no período de junho a julho de 2007 e obtidos por meio de entrevista com roteiro estruturado, contendo questões de caracterização dos pacientes e de um check-list, para a avaliação das feridas crônicas, por meio dos sinais e sintomas clínicos indicativos de infecção, e análise de amostras de feridas utilizando o swab, mediante técnica de Levine. Após aprovação pelo Comitê de Ética e Consentimento, foram avaliados 46 pacientes, e analisadas amostras de 60 feridas. Os programas computacionais utilizados para organizar e analisar estatisticamente os dados foram: o Excel e o SPSS (versão 15.0), respectivamente. A média de idade foi de 55 anos, 37 (80,4%) eram do sexo masculino, 20 (43.5%) pertenciam à classe social E, 23 (50%) eram aposentados e possuíam itens de saneamento básico, 28 (61%) apresentaram úlceras venosas, localizadas nos membros inferiores, 31 (67,4%) realizavam o curativo nas UBS ou em domicílios. Das 60 lesões, 45 (75%) estavam infectadas e 15 (25%) não infectadas. Mediante análise bivariada, verificaram-se associação com o status de infecção as seguintes características: profundidade da extensão do dano tissular, quantidade de tecido necrótico e exsudato. Dentre os sinais e sintomas, os clássicos ocorreram numa freqüência superior a 65%, tanto no grupo de infectadas quanto não infectadas, e nos adicionais verificou-se variação na ocorrência, em ambos os grupos de feridas. Houve predominância do Staphylococcus aureus em 65% dos casos e a maioria sensível aos antibióticos testados. Entre as bactérias Gram-negativas, as mais freqüentes foram: Pseudomonas aeruginosa (23,3%), resistentes à amoxicilina+ácido clavulânico, cefalexina e cefotaxima; Proteus mirabilis (16,6%) e Proteus vulgaris (15,0%) sensíveis a gentamicina, aztreonam, ciprofloxacino e amicacina. Estes resultados indicam a necessidade de se estruturar uma rede integrada, para o atendimento dos pacientes com feridas crônicas. Também evidenciam critérios adicionais que podem ser empregados na elaboração do protocolo de atendimento, buscando a melhoria da qualidade da assistência prestada nas unidades básicas de saúde.

Background: Eating disorders are serious conditions associated with an impaired health-related quality of life and increased healthcare utilization and costs. Despite the existence of evidence-based treatments, access to treatment is often delayed due to insufficient health care resources. Internet-based self-help interventions may have the potential to successfully bridge waiting time for face-to-face outpatient treatment and, thus, contribute to overcoming treatment gaps. However, little is known about the feasibility of implementing such interventions into routine healthcare. The aim of this study is to analyze the effects and feasibility of an Internet-based selfhelp intervention (everyBody Plus) specifically designed for patients with Bulimia Nervosa, Binge Eating Disorder and other specified feeding and eating disorders (OSFED) on a waiting list for outpatient face-to-face treatment. The aim of this paper is to describe the study protocol. Methods: A multi-country randomized controlled trial will be conducted in Germany and the UK. N=275 female patients awaiting outpatient treatment will be randomly allocated either to the guided online self-help intervention “everyBody Plus” or a waitlist control group condition without access to the intervention. everyBody Plus comprises eight weekly sessions that cover topics related to eating and exercise patterns, coping with negative emotions and stress as well as improving body image. Participants will receive weekly individualized feedback based on their self-monitoring and journal entries. Assessments will take place at baseline, post-intervention as well as at 6- and 12-months follow up. In addition, all participants will be asked to monitor core eating disorder symptoms weekly to provide data on the primary outcome. The primary outcome will be number of weeks after randomization until a patient achieves a clinically relevant improvement in core symptoms (BMI, binge eating, compensatory behaviors) for the first time. Secondary outcomes include frequency of core symptoms and eating disorder related attitudes and behaviors, as well as associated psychopathology. Additional secondary outcomes will be the participating therapists' confidence in treating eating disorders as well as perceived benefits of everyBody Plus for patients. Discussion: To the best of our knowledge, this is the first randomized controlled trial examining the effects of Internet-based self-help for outpatients with eating disorders awaiting face-to-face outpatient treatment. If proven to be effective and successfully implemented, Internet-based self-help programs might be used as a first step of treatment within a stepped-care approach, thus reducing burden and cost for both patients and health care providers.

The purpose and aims of this qualitative descriptive study were to describe how past experiences with research (including communication, information, values and support) may contribute to research fatigue among youth and parents of youth with HIV, CF, and T1D. Eighteen parents and youth were purposively recruited from outpatient subspecialty clinics at a major academic medical center. They took part in qualitative interviews, completed a demographics form, and the Decisional Conflict Scale. Youth participants also completed the Erikson Psychosocial Stage Inventory. Two major themes emerged: blurred lines and hope for the future. Research fatigue was not found in this sample. Results point to challenges with informed consent in settings where research and clinical care are integrated, and suggest that protective factors allow for continued participation without excess burden on youth and parents. Strategies to minimize research fatigue and support engagement in research are offered.