2026

In recent years, in psychiatric care, certified public psychologists have come to be clearly positioned as members of multidisciplinary collaboration and team-based care, against the backdrop of their establishment as a national qualification. However, it remains difficult to say that how the professional expertise and strengths of psychologists are recognized and exercised within multidisciplinary collaboration in psychiatric care has been sufficiently visualized. Furthermore, research on multidisciplinary collaboration in psychiatric care from the perspective of certified public psychologists remains limited. This study aimed to clarify the aspects in which certified public psychologists are able to exercise, as well as those in which they feel unable to exercise, their professional expertise and strengths within multidisciplinary collaboration, based on an understanding of the expertise and strengths as perceived by certified public psychologists working in psychiatric care. By doing so, the study sought to obtain insights that would contribute to the qualitative improvement of psychiatric care and to the more effective utilization of certified public psychologists within multidisciplinary teams. The participants were nine certified public psychologists employed at psychiatric medical institutions across Japan. Semi-structured interviews were conducted online. The verbatim interview data were analyzed using co-occurrence network analysis with the quantitative text analysis software KH Coder 3. The extracted subgraphs were then examined in context using KWIC concordance, followed by categorization and naming. The results of the analysis revealed that the professional expertise of certified public psychologists is not limited to individual, technique-based expertise such as psychological tests and psychotherapy. It was shown that certified public psychologists exercise their expertise through a “translation” role—understanding patients’ internal experiences and conveying them in an accessible manner to other professionals—as well as through a “lubricant” role that facilitates and coordinates relationships among different professions. In addition, certified public psychologists were found to function with both patients and the medical team in view, serving as a link between individuals and between professional groups, and this role was recognized as an important strength in psychiatric care. On the other hand, aspects were also shown in which professional expertise was felt to be unable to be fully exercised due to differences in treatment policies, organizational structures, differences in professional expertise, and a lack of opportunities for communication. In such circumstances, certified public psychologists were found to make ongoing efforts to present their expertise and strengths in ways that could be effectively communicated, through measures such as devising electronic medical record documentation, engaging in informal communication, and conducting study sessions and psychoeducation. In order for certified public psychologists to fully exercise their professional expertise and strengths within multidisciplinary collaboration, it is important to build an environment that facilitates collaboration, including not only individual efforts and devising but also the development of in-hospital systems and mechanisms for sharing professional expertise among multiple professions. In addition, such environmental development is considered to lead to improvements in the quality of patient support. The findings obtained in this study serve as guidance for certified public psychologists in clinical settings to recognize their own professional expertise and strengths and to further demonstrate them in their daily clinical practice. Based on these findings, it is expected that the professional expertise and strengths of certified public psychologists will be further clarified, thereby contributing to the enhancement of psychological support in psychiatric care and to the provision of comprehensive support tailored to each individual patient.

The present study aims to elucidate how medical social workers (MSWs) engage with patients, families, and multidisciplinary teams during discharge conferences and the surrounding practice processes, with particular attention to the formation, coordination, and continuity of supportive relationships. The objective of this study is to theoretically and empirically clarify the structural underpinnings of MSW practice in the context of discharge support. In recent years, amid healthcare system reforms and the promotion of community-based integrated care systems, discharge support has been increasingly institutionalized as a core function of medical institutions. Discharge conferences, in particular, have been positioned as key mechanisms for implementing multidisciplinary collaboration. However, while institutional compliance and procedural standardization have progressed, several practical challenges have been identified. Discharge support tends to become procedure-centered, making it difficult to adequately reflect patients’ and families’ values, preferences, and perspectives on daily life. Moreover, existing research has paid limited theoretical attention to the processes through which multidisciplinary collaboration is actually generated and sustained, as well as to the concrete roles played by MSWs within these collaborative practices. To address these gaps, this study conceptualizes discharge conferences not as isolated or event-based meetings, but as part of a continuous practice process extending from the early stages of hospitalization through the initial period of post-discharge support. Within this continuum, the study focuses on how MSWs position themselves relationally and how their practices contribute to the coordination of support and decision-making. A mixed-methods research design was employed, integrating qualitative and quantitative approaches. The qualitative component consisted of semi-structured interviews with MSWs working in acute-care hospitals. These interviews explored concrete experiences related to discharge conferences and associated practices, including interactions with patients and families, coordination with multidisciplinary professionals, facilitation of shared decision-making, and reflection on practice following discharge. Qualitative analysis revealed that MSW practice is structured around five interrelated factors. The first factor, mediation, involves bridging patients’ and families’ narratives with professional judgments, as well as connecting medical treatment perspectives with everyday life contexts to establish a foundation for mutual understanding. The second factor, coordination, refers to practices through which MSWs reconcile diverse professional expertise, roles, and values to support the formulation of coherent and shared care plans. The third factor, reflection, involves reviewing cognitive discrepancies, ethical tensions, and relational dynamics that emerge during practice in order to refine judgments and interventions. The fourth factor, relationship continuity support, focuses on rebuilding and maintaining relationships among patients, families, and professionals to ensure continuity of care following discharge. The fifth factor, deepening reflection, captures the process through which MSWs enhance their professional expertise and sustain ongoing practice improvement through accumulated experience. Based on the qualitative findings, a questionnaire was developed and administered to MSWs nationwide as part of the quantitative phase of the study. The collected data were analyzed using covariance structure analysis to examine the relationships among the identified factors. The results confirmed that the five factors are structurally interrelated and collectively constitute the practice structure of MSWs in discharge support. These findings provide quantitative support for the validity of the practice structure model generated through qualitative analysis. Overall, this study demonstrates that the role of MSWs during and around discharge conferences should not be understood as a fixed set of tasks or procedural functions. Rather, MSW practice represents a dynamic and relational process in which practitioners continuously reposition themselves within evolving relationships through mediation, coordination, and reflection. By articulating this practice structure, the study makes both theoretical and practical contributions to the field of medical social work. Furthermore, it offers a conceptual basis for reimagining discharge conferences as collaborative spaces that support the reconstruction of patients’ and families’ lives, rather than as formalized procedures driven primarily by institutional requirements.

School lunches during early childhood play an important role in supporting the development of physical functions, including chewing ability, and fostering healthy eating habits and social skills. Simultaneously, foods that are difficult to chew can increase the risk of asphyxiation and choking; therefore, when determining portion sizes, it is necessary to balance the varying demands of promoting development while ensuring safety. Furthermore, portion size is closely related to the factors involved in meal service management, such as staffing and time constraints in food preparation. Focusing on food size as a common element underlying these issues, this study examines the actual conditions of meal portion sizes and their relationships with factors related to growth and development, safety, and meal service operations. In Chapter 2, age-specific portion sizes provided in facilities were quantitatively assessed through menu analysis and direct measurement of food size, and their distributions and inter-facility differences were clarified. The results showed differences in size between meals for 2-year-olds and those for children aged ≥ 3 years, indicating that age- appropriate adjustments were made in some facilities. However, even within the same age category, the portion sizes differed across facilities. In particular, dishes for which the number of items per serving was predetermined showed large differences in size, whereas dishes containing multiple ingredients showed smaller differences. In Chapter 3, a questionnaire survey of childcare and educational facilities was conducted to identify portion weights and sizes by age group, and to examine the factors associated with their determination. Portion sizes varied across facilities, revealing that approaches to treating children of the same age differed depending on the facility Furthermore, menu planners’ experience, frequency of meal rounds, use of outsourced food service providers, and collaboration with childcare staff were associated with portion size. Particularly, collaboration with childcare staff appeared to help prevent meals from being served in excessively small portion sizes. These findings suggest that portion sizes may be determined in practice regarding the experience of menu planners, observation of children’s eating behaviors, and organizational arrangements. Chapter 4 integrates and discusses these findings from the perspectives of chewing development, safety, and meal service management. In particular, meal rounds provide valuable opportunities to confirm the ease of eating and safety in actual mealtime settings, and to feed this information back into menu planning and portion size adjustments. Facilities that conducted daily meal rounds provided slightly larger portion sizes, suggesting that the sizes were appropriately adjusted to promote the chewing function while maintaining safety. Therefore, the effective use of existing meal-round practices may contribute to the optimization of portion sizes. Overall, meal portion sizes were associated with multiple factors, and on-site decisions appeared to be made according to local circumstances. However, without sufficiently standardized guidelines or benchmarks, these differences in judgment may contribute to variations in portion sizes across facilities. The findings of this study are expected to contribute to improving meal provision practices that support children’s growth and development in childcare and educational facilities while enhancing safety considerations.

In depopulated rural areas, the provision of healthcare and long-term care services is severely constrained by shortages of medical and care resources as well as geographic barriers to access. As a result, there is an urgent need to reconstruct support systems that are grounded in patients’ everyday living environments. The purpose of this study was to clarify the current status and challenges of community-based rehabilitation in depopulated rural areas from physicians’ perspectives and to develop a locally appropriate, community-complete rehabilitation model. Semi-structured interviews were conducted with four physicians working in depopulated rural regions, and the interview transcripts were analyzed using qualitative content analysis. As a result, six categories relevant to the development of a community-complete rehabilitation system were generated. Category I, Structural Challenges and Innovation in the Regional Healthcare System, highlighted the need to reconceptualize the entire community as a healthcare space under conditions of limited human resources. Category II, Specialized Assessment and Service Delivery System, indicated the necessity of establishing evaluation and support systems to compensate for shortages of rehabilitation professionals. Category III, Home-Based Living Support and Rehabilitation Practice, emphasized the importance of home-based support including environmental assessment and preventive intervention. Category IV, Interprofessional Collaboration and Communication, demonstrated the need for effective mechanisms of information sharing and collaborative practice. Category V, Patient-Centered Support Philosophy, underscored the importance of respecting patients’ choices and sharing and documenting their preferences. Category VI, Professional Competence and Regional Culture, suggested that adaptation to local culture and cooperative attitudes among professionals are essential conditions for sustainable support. By integrating these six categories, this study proposed a community-based rehabilitation model designed to operationalize patient-centered decision-making support in depopulated rural areas. The model places patient-centered decision- making at its core and identifies spatial continuity, which conceptualizes the entire community as a support space, and temporal flexibility, which enables continuous support regardless of disease stage, as essential conditions. Furthermore, the model demonstrates a structure in which professional development, practical interprofessional collaboration, and preventive and comprehensive care function as key elements supporting patient decision-making. In particular, ICT-enabled collaborative frameworks such as the D/N with P model facilitate effective interprofessional practice, enhance the quality of comprehensive support, and expand patients’ available options, thereby increasing autonomy in decision-making. This model provides a systematic framework that enables individuals to continue living in their familiar communities until the end of life, even in depopulated rural areas, and offers important implications for future regional healthcare policy and the development of community-based rehabilitation systems.