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Horwitz AG, McCarthy K, Sen S. A review of the peak-end rule in mental health contexts. Curr Opin Psychol 2024; 58:101845. [PMID: 39018885 DOI: 10.1016/j.copsyc.2024.101845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
The peak-end rule, a memory heuristic in which the most emotionally salient part of an experience (i.e., peak) and conclusion of an experience (i.e., end) are weighted more heavily in summary evaluations, has been understudied in mental health contexts. The recent growth of intensive longitudinal methods has provided new opportunities for examining the peak-end rule in the retrospective recall of mental health symptoms, including measures often used in measurement-based care initiatives. Additionally, principles of the peak-end rule have significant potential to be applied to exposure-based therapy procedures. Additional research is needed to better understand the contexts in which, and persons for whom, the peak-end rule presents a greater risk of bias, to ultimately improve assessment strategies and clinical care.
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Affiliation(s)
- Adam G Horwitz
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48109, USA.
| | - Kaitlyn McCarthy
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48109, USA
| | - Srijan Sen
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd., Ann Arbor, MI, 48109, USA
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He Y, Wang X, Wang Z, Zhang P, Huang X, Yu M, Murphy JK, Michalak EE, Liu J, Yang T, Yang X, Fang Y, Lam RW, Chen J. Comparison of the Efficacy Between Standard Measurement-Base Care (MBC) and Enhanced MBC for Major Depressive Disorder: A Pilot Study. Neuropsychiatr Dis Treat 2024; 20:1465-1473. [PMID: 39100573 PMCID: PMC11296504 DOI: 10.2147/ndt.s468332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/15/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose To validate the efficacy of enhanced measurement-based care against standard measurement-based care in patients with major depressive disorder. Patients and Methods In this pilot study of an ongoing multicenter cluster randomized controlled trails, 160 patients diagnosed with major depressive disorder were enrolled from 2 mental health centers, with a plan to include 12 centers in total. One hundred patients engaged in a six-month evaluation using a technology-enhanced measurement-based care tool, including assessments of clinical symptoms, side effects, and functionality at baseline, two months, four months and six months. Simultaneously, the remaining 60 patients underwent standard paper-based measurement-based care, utilizing the same set of scales over the same six-month period, with assessments at the same time points. Results Patients utilizing the enhanced measurement-based care tool demonstrated a significantly higher reduction rate in PHQ-9 scores compared to those using standard paper-based measurement-based care during the two-month follow-up. Additionally, a notable positive correlation was observed between the frequency of enhanced measurement-based care tool usage and the quality of life during the two-month follow-up. Conclusion Enhanced measurement-based care has the effect of reducing depressive symptoms. Our study emphasized that using enhanced measurement-based care via smartphones is a feasible tool for patients with major depressive disorder. Our future study, including results from additional research centers, may further validate the effectiveness of enhanced measurement-based care.
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Affiliation(s)
- Yuru He
- Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - Xing Wang
- Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - Zuowei Wang
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, People’s Republic of China
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, People’s Republic of China
| | - Ping Zhang
- Fengxian District Mental Health Center, Shanghai, People’s Republic of China
| | - Xiaojia Huang
- Division of Mood Disorders, Shanghai Hongkou Mental Health Center, Shanghai, People’s Republic of China
- Clinical Research Center for Mental Health, School of Medicine, Shanghai University, Shanghai, People’s Republic of China
| | - Meihong Yu
- Fengxian District Mental Health Center, Shanghai, People’s Republic of China
| | - Jill K Murphy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Erin E Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jing Liu
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Tao Yang
- Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
| | - Xiaorui Yang
- Department of Psychology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
| | - Yiru Fang
- Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, People’s Republic of China
| | - Raymond W Lam
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jun Chen
- Clinical Research Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, People’s Republic of China
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Kramer J, Wilens TE, Rao V, Villa R, Yule AM. Feasibility of a 2-Part Substance Use Screener Self-Administered by Patients on Paper: Observational Study. JMIR Form Res 2024; 8:e52801. [PMID: 38916950 PMCID: PMC11234052 DOI: 10.2196/52801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 03/26/2024] [Accepted: 05/08/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Measurement-based care in behavioral health uses patient-reported outcome measures (PROMs) to screen for mental health symptoms and substance use and to assess symptom change over time. While PROMs are increasingly being integrated into electronic health record systems and administered electronically, paper-based PROMs continue to be used. It is unclear if it is feasible to administer a PROM on paper when the PROM was initially developed for electronic administration. OBJECTIVE This study aimed to examine the feasibility of patient self-administration of a 2-part substance use screener-the Tobacco, Alcohol, Prescription medications, and other Substances (TAPS)-on paper. This screener was originally developed for electronic administration. It begins with a limited number of questions and branches to either skip or reflex to additional questions based on an individual's responses. In this study, the TAPS was adapted for paper use due to barriers to electronic administration within an urgent care behavioral health clinic at an urban health safety net hospital. METHODS From August 2021 to March 2022, research staff collected deidentified paper TAPS responses and tracked TAPS completion rates and adherence to questionnaire instructions. A retrospective chart review was subsequently conducted to obtain demographic information for the patients who presented to the clinic between August 2021 and March 2022. Since the initial information collected from TAPS responses was deidentified, demographic information was not linked to the individual TAPS screeners that were tracked by research staff. RESULTS A total of 507 new patients were seen in the clinic with a mean age of 38.7 (SD 16.6) years. In all, 258 (50.9%) patients were male. They were predominantly Black (n=212, 41.8%), White (n=152, 30%), and non-Hispanic or non-Latino (n=403, 79.5%). Most of the patients were publicly insured (n=411, 81.1%). Among these 507 patients, 313 (61.7%) completed the TAPS screener. Of these 313 patients, 76 (24.3%) adhered to the instructions and 237 (75.7%) did not follow the instructions correctly. Of the 237 respondents who did not follow the instructions correctly, 166 (70%) answered more questions and 71 (30%) answered fewer questions than required in TAPS part 2. Among the 237 patients who did not adhere to questionnaire instructions, 44 (18.6%) responded in a way that contradicted their response in part 1 of the screener and ultimately affected their overall TAPS score. CONCLUSIONS It was challenging for patients to adhere to questionnaire instructions when completing a substance use screener on paper that was originally developed for electronic use. When selecting PROMs for measurement-based care, it is important to consider the structure of the questionnaire and how the PROM will be administered to determine if additional support for PROM self-administration needs to be implemented.
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Affiliation(s)
- Joanna Kramer
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Timothy E Wilens
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Vinod Rao
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Richard Villa
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
| | - Amy M Yule
- Department of Psychiatry, Boston Medical Center, Boston, MA, United States
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O'Brien VC, Kablinger AS, Ko H, Jones SB, McNamara RS, Phenes AR, Hankey MS, Gatto AJ, Tenzer MM, Sharp HD, Cooper LD. Use of Patient-Reported Outcome Measures to Assess the Effectiveness of Hybrid Psychiatric Visits. Psychiatr Serv 2024:appips20230355. [PMID: 38863328 DOI: 10.1176/appi.ps.20230355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Little empirical evidence exists to support the effectiveness of hybrid psychiatric care, defined as care delivered through a combination of telephone, videoconferencing, and in-person visits. The authors aimed to investigate the effectiveness of hybrid psychiatric care compared with outpatient waitlist groups, assessed with patient-reported outcome measures (PROMs). METHOD Participants were recruited from an adult psychiatry clinic waitlist on which the most common primary diagnoses were unipolar depression, generalized anxiety disorder, and bipolar disorder. Patients (N=148) were randomly assigned to one of two waitlist groups that completed PROMs once or monthly before treatment initiation. PROMs were used to assess symptoms of depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (Generalized Anxiety Disorder-7 [GAD-7]), and daily psychological functioning (Brief Adjustment Scale-6 [BASE-6]). Patient measures were summarized descriptively with means, medians, and SDs and then compared by using the Kruskal-Wallis test; associated effect sizes were calculated. PROM scores for patients who received hybrid psychiatric treatment during a different period (N=272) were compared with scores of the waitlist groups. RESULTS PROM assessments of patients who engaged in hybrid care indicated significant improvements in symptom severity compared with the waitlist groups, regardless of the number of PROMs completed while patients were on the waitlist. Between the hybrid care and waitlist groups, the effect size for the PHQ-9 score was moderate (d=0.66); effect sizes were small for the GAD-7 (d=0.46) and BASE-6 (d=0.45) scores. CONCLUSIONS The findings indicate the clinical effectiveness of hybrid care and that PROMs can be used to assess this effectiveness.
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Affiliation(s)
- Virginia C O'Brien
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Hayoung Ko
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Sydney B Jones
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Robert S McNamara
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Ashlie R Phenes
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Maria Stack Hankey
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Alyssa J Gatto
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Martha M Tenzer
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Hunter D Sharp
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
| | - Lee D Cooper
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke (O'Brien, Kablinger, McNamara, Phenes); Department of Psychology, Virginia Tech, Blacksburg (Ko, Jones, Cooper); Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia (Stack Hankey, Tenzer, Sharp); Department of Psychology, Brown University, Providence, Rhode Island (Gatto)
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Varidel M, Hickie IB, Prodan A, Skinner A, Marchant R, Cripps S, Oliveria R, Chong MK, Scott E, Scott J, Iorfino F. Dynamic learning of individual-level suicidal ideation trajectories to enhance mental health care. NPJ MENTAL HEALTH RESEARCH 2024; 3:26. [PMID: 38849429 PMCID: PMC11161660 DOI: 10.1038/s44184-024-00071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/25/2024] [Indexed: 06/09/2024]
Abstract
There has recently been an increase in ongoing patient-report routine outcome monitoring for individuals within clinical care, which has corresponded to increased longitudinal information about an individual. However, many models that are aimed at clinical practice have difficulty fully incorporating this information. This is in part due to the difficulty in dealing with the irregularly time-spaced observations that are common in clinical data. Consequently, we built individual-level continuous-time trajectory models of suicidal ideation for a clinical population (N = 585) with data collected via a digital platform. We demonstrate how such models predict an individual's level and variability of future suicide ideation, with implications for the frequency that individuals may need to be observed. These individual-level predictions provide a more personalised understanding than other predictive methods and have implications for enhanced measurement-based care.
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Affiliation(s)
- Mathew Varidel
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Ante Prodan
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
- School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Adam Skinner
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Roman Marchant
- Human Technology Institute, University of Technology, Sydney, NSW, Australia
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | - Sally Cripps
- Human Technology Institute, University of Technology, Sydney, NSW, Australia
- School of Mathematical and Physical Sciences, University of Technology Sydney, Sydney, NSW, Australia
| | | | - Min K Chong
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elizabeth Scott
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jan Scott
- Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
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Rong P, Heidrick L, Pattee GL. A multimodal approach to automated hierarchical assessment of bulbar involvement in amyotrophic lateral sclerosis. Front Neurol 2024; 15:1396002. [PMID: 38836001 PMCID: PMC11148322 DOI: 10.3389/fneur.2024.1396002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/01/2024] [Indexed: 06/06/2024] Open
Abstract
Introduction As a hallmark feature of amyotrophic lateral sclerosis (ALS), bulbar involvement leads to progressive declines of speech and swallowing functions, significantly impacting social, emotional, and physical health, and quality of life. Standard clinical tools for bulbar assessment focus primarily on clinical symptoms and functional outcomes. However, ALS is known to have a long, clinically silent prodromal stage characterized by complex subclinical changes at various levels of the bulbar motor system. These changes accumulate over time and eventually culminate in clinical symptoms and functional declines. Detection of these subclinical changes is critical, both for mechanistic understanding of bulbar neuromuscular pathology and for optimal clinical management of bulbar dysfunction in ALS. To this end, we developed a novel multimodal measurement tool based on two clinically readily available, noninvasive instruments-facial surface electromyography (sEMG) and acoustic techniques-to hierarchically assess seven constructs of bulbar/speech motor control at the neuromuscular and acoustic levels. These constructs, including prosody, pause, functional connectivity, amplitude, rhythm, complexity, and regularity, are both mechanically and clinically relevant to bulbar involvement. Methods Using a custom-developed, fully automated data analytic algorithm, a variety of features were extracted from the sEMG and acoustic recordings of a speech task performed by 13 individuals with ALS and 10 neurologically healthy controls. These features were then factorized into 10 composite outcome measures using confirmatory factor analysis. Statistical and machine learning techniques were applied to these composite outcome measures to evaluate their reliability (internal consistency), validity (concurrent and construct), and efficacy for early detection and progress monitoring of bulbar involvement in ALS. Results The composite outcome measures were demonstrated to (1) be internally consistent and structurally valid in measuring the targeted constructs; (2) hold concurrent validity with the existing clinical and functional criteria for bulbar assessment; and (3) outperform the outcome measures obtained from each constituent modality in differentiating individuals with ALS from healthy controls. Moreover, the composite outcome measures combined demonstrated high efficacy for detecting subclinical changes in the targeted constructs, both during the prodromal stage and during the transition from prodromal to symptomatic stages. Discussion The findings provided compelling initial evidence for the utility of the multimodal measurement tool for improving early detection and progress monitoring of bulbar involvement in ALS, which have important implications in facilitating timely access to and delivery of optimal clinical care of bulbar dysfunction.
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Affiliation(s)
- Panying Rong
- Department of Speech-Language-Hearing: Sciences and Disorders, University of Kansas, Lawrence, KS, United States
| | - Lindsey Heidrick
- Department of Hearing and Speech, University of Kansas Medical Center, Kansas City, KS, United States
| | - Gary L Pattee
- Neurology Associate P.C., Lincoln, NE, United States
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de Jong K, Douglas S, Wolpert M, Delgadillo J, Aas B, Bovendeerd B, Carlier I, Compare A, Edbrooke-Childs J, Janse P, Lutz W, Moltu C, Nordberg S, Poulsen S, Rubel JA, Schiepek G, Schilling VNLS, van Sonsbeek M, Barkham M. Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01381-3. [PMID: 38733413 DOI: 10.1007/s10488-024-01381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/13/2024]
Abstract
We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.
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Affiliation(s)
- Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands.
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
| | - Miranda Wolpert
- Division of Psychology and Language Sciences, Department of Clinical, Education and Health Psychology, University College London, United Kingdom, UK
| | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Benjamin Aas
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Faculty of Psychology and Educational Sciences, LMU Munich, Munich, Germany
| | - Bram Bovendeerd
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Dimence, Center for mental health care, Deventer, The Netherlands
| | - Ingrid Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, UK
| | | | - Wolfgang Lutz
- Department of Psychology, University of Trier, Trier, Germany
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Samuel Nordberg
- Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Julian A Rubel
- Institute of Psychology, University of Osnabrück, Salzburg, Austria
| | - Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
| | | | | | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Higashi RT, Etingen B, Richardson E, Palmer J, Zocchi MS, Bixler FR, Smith B, McMahon N, Frisbee KL, Fortney JC, Turvey C, Evans J, Hogan TP. Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation. JMIR Ment Health 2024; 11:e54007. [PMID: 38728684 PMCID: PMC11127133 DOI: 10.2196/54007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. OBJECTIVE This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. METHODS Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ2 tests. We analyzed interview data using thematic analysis. RESULTS We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). CONCLUSIONS Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA's Collect-Share-Act model of MBC.
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Affiliation(s)
- Robin T Higashi
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Bella Etingen
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Research and Development Service, Dallas Veterans Affairs Medical Center, Dallas, TX, United States
| | - Eric Richardson
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jennifer Palmer
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Boston Healthcare System, Boston, MA, United States
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Mark S Zocchi
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Felicia R Bixler
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Veterans Affairs Hospital, Hines, IL, United States
| | - Bridget Smith
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Hines Veterans Affairs Hospital, Hines, IL, United States
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nicholas McMahon
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
| | - Kathleen L Frisbee
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, United States
| | - John C Fortney
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Division of Population Health, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Carolyn Turvey
- Center for Access & Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States
- Office of Rural Health, Veterans Rural Health Resource Center - Iowa City, Iowa City Veterans Affairs Health Care System, Iowa City, IA, United States
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Jennifer Evans
- Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, Washington, DC, United States
| | - Timothy P Hogan
- Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
- eHealth Partnered Evaluation Initiative, Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research (CHOIR), Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
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Kuo PB, Tanana MJ, Goldberg SB, Caperton DD, Narayanan S, Atkins DC, Imel ZE. Machine-Learning-Based Prediction of Client Distress From Session Recordings. Clin Psychol Sci 2024; 12:435-446. [PMID: 39104662 PMCID: PMC11299859 DOI: 10.1177/21677026231172694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Natural language processing (NLP) is a subfield of machine learning that may facilitate the evaluation of therapist-client interactions and provide feedback to therapists on client outcomes on a large scale. However, there have been limited studies applying NLP models to client outcome prediction that have (a) used transcripts of therapist-client interactions as direct predictors of client symptom improvement, (b) accounted for contextual linguistic complexities, and (c) used best practices in classical training and test splits in model development. Using 2,630 session recordings from 795 clients and 56 therapists, we developed NLP models that directly predicted client symptoms of a given session based on session recordings of the previous session (Spearman's rho =0.32, p<.001). Our results highlight the potential for NLP models to be implemented in outcome monitoring systems to improve quality of care. We discuss implications for future research and applications.
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Nair N, Xavier S, Rabouin D, Mohan G, Rangaswamy T, Ramachandran P, Joober R, Schmitz N, Malla A, Iyer SN. Patient-reported outcome measures in early psychosis: A cross-cultural, longitudinal examination of the self-reported health and self-reported mental health measures in Chennai, India and Montreal, Canada. Schizophr Res 2024; 267:75-83. [PMID: 38520813 DOI: 10.1016/j.schres.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVE Despite their acknowledged value, patient-reported outcome measures (PROMs) are infrequently used in psychosis, particularly in low-and middle-income countries. We compared ratings on two single-item PROMs, Self-Rated Health (SRH) and Self-Rated Mental Health (SRMH), of persons receiving similar early psychosis services in Chennai, India and Montreal, Canada. We hypothesized greater improvements in SRH and SRMH in the Chennai (compared to the Montreal) sample. METHODS Participants (Chennai N = 159/168 who participated in the larger study; Montreal N = 74/165 who participated in the larger study) completed the SRH and SRMH during at least two out of three timepoints (entry, months 12 and 24). Repeated measures proportional odds logistic regressions examined the effects of time (baseline to month 24), site, and relevant baseline (e.g., gender) and time-varying covariates (i.e., symptoms) on SRH and SRMH scores. RESULTS SRH (but not SRMH) scores significantly differed between the sites at baseline, with Chennai patients reporting poorer health (OR: 0.33; CI: 0.18, 0.63). While Chennai patients reported similar significant improvements in their SRH (OR: 7.03; CI: 3.13; 15.78) and SRMH (OR: 2.29, CI: 1.03, 5.11) over time, Montreal patients only reported significant improvements in their SRMH. Women in Chennai (but not Montreal) reported lower mental health than men. Higher anxiety and longer durations of untreated psychosis were associated with poorer SRH and SRMH, while negative symptoms were associated with SRH. CONCLUSIONS As hypothesized, Chennai patients reported greater improvements in health and mental health. The marked differences between health and mental health in Montreal, in contrast to the overlap between the two in Chennai, aligns with previous findings of clearer distinctions between mind and body in Western societies. Cross-context (e.g., anxiety) and context-specific (e.g., gender) factors influence patients' health perceptions. Our results highlight the value of integrating simple PROMs in early psychosis.
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Affiliation(s)
- Neha Nair
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | - Salomé Xavier
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | - Daniel Rabouin
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | | | | | | | - Ridha Joober
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | - Norbert Schmitz
- Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada; Department of Population-Based Medicine, University Hospital Tübingen, Tübingen, Germany.
| | - Ashok Malla
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
| | - Srividya N Iyer
- Department of Psychiatry, McGill University, Montreal, Canada; Prevention and Early Intervention Program for Psychosis (PEPP), Douglas Mental Health University Institute, Montreal, Canada.
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Douglas S, Page AC, Moltu C, Kyron M, Satterthwaite T. The Connections Matter: Bi-Directional Learning in Program Evaluation and Practice-Oriented Research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:318-335. [PMID: 37768486 DOI: 10.1007/s10488-023-01304-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
Intended for researchers and clinical leaders, this article suggests that embedded program evaluation is a good fit with the desired features of practice-oriented research. The systematic nature of evaluation that is built into the operational workflow of a practice setting may increase the diversity of methods available to explore processes and outcomes of interest. We propose a novel conceptual framework that uses a human-centered systems lens to foster such embedded evaluation in clinical routine. This approach emphasizes the evaluator-practitioner partnership to build confidence in the bi-directional learning of practice-based evidence with evidence-based practice. The iterative cycles inherent to design thinking are aimed at developing better evaluation questions. The attention to structure and context inherent to systems thinking is intended to support meaningful perspectives in the naturally complex world of health care. Importantly, the combined human-centered systems lens can create greater awareness of the influence of individual and systemic biases that exist in any endeavor or institution that involves people. Recommended tools and strategies include systems mapping, program theory development, and visual facilitation using a logic model to represent the complexity of mental health treatment for communication, shared understanding, and connection to the broader evidence base. To illustrate elements of the proposed conceptual framework, two case examples are drawn from routine outcome monitoring (ROM) and progress feedback. We conclude with questions for future collaboration and research that may strengthen the partnership of evaluators and practitioners as a community of learners in service of local and system-level improvement.
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Affiliation(s)
- Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA.
| | - Andrew C Page
- School of Psychological Science and WA Mental Health Research Centre, University of Western Australia, Perth, Australia
| | - Christian Moltu
- District General Hospital of Førde, Førde, Norway
- Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
| | - Michael Kyron
- School of Psychological Science and WA Mental Health Research Centre, University of Western Australia, Perth, Australia
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12
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Samokhvalov AV, Levitt E, MacKillop J. Using Measurement-Based Care as a Precision Medicine Strategy for Substance Use Disorders. Curr Psychiatry Rep 2024; 26:215-221. [PMID: 38489141 DOI: 10.1007/s11920-024-01495-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE OF REVIEW Precision medicine prioritizes characterization of individual patient parameters to optimize care and this review evaluates measurement-based care (MBC) as a strategy for doing so in the treatment of substance use disorders (SUD). Measurement-based care refers to the systematic use of validated assessments to inform diagnosis and treatment planning, with varying frequency of assessments. Despite the seemingly obvious grounds for the use of MBC in treating SUD, systematic implementation to date has been limited. Thus, the goal of this review is to evaluate efforts to date and to stimulate greater consideration of MBC models in addictions programs. RECENT FINDINGS Data from two published randomized controlled trials and findings from pragmatic clinical research highlight the potential utility of MBC in the SUD treatment settings. Despite these findings, the existing literature indicates the high need for larger-scale clinical trials and quality improvement programs. Potential barriers to the implementation of MBC for SUD are outlined at the patient, provider, organization, and system levels, as well as the challenges associated with the use of MBC programs for clinical research. Critical thinking considerations and risk mitigation strategies are offered toward advancing MBC for SUD beyond the current nascent state. Collectively, the existing data confirm that MBC is a suitable and promising strategy for applying a precision medicine approach in SUD treatment, warranting further implementation efforts and scientific inquiry.
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Affiliation(s)
- Andriy V Samokhvalov
- Homewood Research Institute, Guelph, ON, Canada.
- Homewood Health Centre, Guelph, ON, Canada.
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Emily Levitt
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, ON, Canada
| | - James MacKillop
- Homewood Research Institute, Guelph, ON, Canada
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton/McMaster University, Hamilton, ON, Canada
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Frontini R, Costa C, Baptista S, Garcia CDC, Vian-Lains A. Measurement-Based Care in Youth: An Opportunity for Better Clinical Outcomes? Healthcare (Basel) 2024; 12:910. [PMID: 38727467 PMCID: PMC11083159 DOI: 10.3390/healthcare12090910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
Measurement-based care (MBC) is a procedure in which systematic and routine assessments are performed. Through this practice, clinicians can verify the progress of the symptomatology of the patient and adapt the appointments and the intervention to the current symptoms. Studies have reflected on the importance and the benefits of this type of procedure in the adult population, and have shown positive results. However, there is a lack of evidence concerning the remaining populations. Regarding youth, for instance, few articles have evaluated the benefits of using this procedure in clinical practice. However, research focused on this topic has revealed positive results, especially when clinicians were loyal to the MBC procedures. Still, further research is needed. This letter aims to share the methodology used by our multidisciplinary team, composed of psychologists and psychiatrists, in a clinical context at the Hospital Cruz Vermelha, Lisboa, applied to the adult population; the objective is to share and discuss some alterations that could be made to our evaluation protocol to enable the same to be used with the youth population. We believe that implementing MBC for youth is crucial for several reasons, including enhanced treatment efficacy, more personalized treatment, a reduced reliance on subjectivity, and empowerment not only of patients but also families.
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Affiliation(s)
- Roberta Frontini
- Clínica de Neurociências e Saúde Mental, Hospital Cruz Vermelha, 1500-048 Lisboa, Portugal; (C.C.); (S.B.); (A.V.-L.)
- Faculdade de Ciências Humanas, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal;
| | - Catarina Costa
- Clínica de Neurociências e Saúde Mental, Hospital Cruz Vermelha, 1500-048 Lisboa, Portugal; (C.C.); (S.B.); (A.V.-L.)
| | - Sílvia Baptista
- Clínica de Neurociências e Saúde Mental, Hospital Cruz Vermelha, 1500-048 Lisboa, Portugal; (C.C.); (S.B.); (A.V.-L.)
| | | | - António Vian-Lains
- Clínica de Neurociências e Saúde Mental, Hospital Cruz Vermelha, 1500-048 Lisboa, Portugal; (C.C.); (S.B.); (A.V.-L.)
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Connors EH, Childs AW, Douglas S, Jensen-Doss A. Data-Informed Communication: How Measurement-Based Care Can Optimize Child Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01372-4. [PMID: 38662178 DOI: 10.1007/s10488-024-01372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/26/2024]
Abstract
Measurement-based care (MBC) research and practice, including clinical workflows and systems to support MBC, are grounded in adult-serving mental health systems. MBC research evidence is building in child and adolescent services, but MBC practice is inherently more complex due to identified client age, the family system and the need to involve multiple reporters. This paper seeks to address a gap in the literature by providing practical guidance for youth-serving clinicians implementing MBC with children and their families. We focus on MBC as a data-informed, client-centered communication process, and present three key strategies to enhance usual care child and adolescent psychotherapy via developmentally-appropriate MBC. These strategies include (1) go beyond standardized measures; (2) lean into discrepancies; and (3) get curious together. Case-based examples drawn from various child-serving settings illustrate these key strategies of MBC in child psychotherapy.
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Affiliation(s)
| | - Amber W Childs
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Susan Douglas
- Department of Leadership, Policy, and Organizations, Vanderbilt University, Peabody College, Nashville, TN, USA
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Feria-Raposo I, García-León MÁ, Rodríguez-Cano E, Blanco-Blanco J, Moreno-Casbas MT, Gonzalez-Castro AI, Gómez-Lozano MJ, Guerrero-Pedraza A, Sarri C, Portillo F, Sarró S, McKenna PJ, Salvador R, Pomarol-Clotet E. Psychometric properties of the Spanish version of the Health of Nation Outcome Scales for schizophrenia patients. J Psychiatr Ment Health Nurs 2024. [PMID: 38501552 DOI: 10.1111/jpm.13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/04/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024]
Abstract
Accessible Summary What is known on the subject? Functioning is one of the most affected areas in schizophrenia. Social, occupational and personal domains are affected, and these deficits are responsible for a major part of the disability associated with the disorder. There are several instruments to measure functioning, but the HoNOS provides a wide assessment of impairment in 12 areas of functioning. What does the paper add to existing knowledge? The Spanish version of the HoNOS shows good properties in terms of reliability and validity for use in schizophrenia patients. Although some authors divide the scale according to proposed underlying dimensions, in schizophrenia this division may not be appropriate. What are the implications for practice? A reliable and easy-to-use measure of impairment in different areas of functioning is useful for optimizing the treatment and rehabilitation of patients with schizophrenia. ABSTRACT INTRODUCTION: The HoNOS scale was designed for the assessment of psychosocial impairment in various domains. While it is widely used in psychiatric settings, it has not been validated in Spanish for use in patients with schizophrenia. AIM To examine the psychometric properties of the Spanish version of the HoNOS scale in a sample of schizophrenia patients. METHOD A total of 194 individuals aged 18 to 65 with schizophrenia spectrum diagnoses were evaluated using the HoNOS. Illness severity and level of functioning were also assessed. RESULTS The HoNOS showed moderate internal consistency, good inter-observer reliability and good test-retest reliability. Factor analysis revealed an internal structure consisting of four factors, with item distribution differing from the theoretical dimensions proposed for the original scale. DISCUSSION The Spanish version of the HoNOS scale is a reliable and valid instrument for assessing psychosocial impairment in individuals diagnosed with schizophrenia spectrum disorders. However, further research is needed to determine its internal structure more accurately. IMPLICATIONS FOR PRACTICE The HoNOS scale provides researchers and clinicians with a valid measure of impairment in twelve different domains, which can facilitate and guide the treatment of schizophrenia patients.
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Affiliation(s)
- Isabel Feria-Raposo
- Benito Menni CASM, Sant Boi de Llobregat, Barcelona, Spain
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- CIBERSAM, ISCIII, Madrid, Spain
- Unidad de Investigación en Cuidados y Servicios de Salud del Instituto de Salud Carlos III (Investén-ISCIII), Madrid, Spain
| | | | - Elena Rodríguez-Cano
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- CIBERSAM, ISCIII, Madrid, Spain
| | - Joan Blanco-Blanco
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS) and Society, Health, Education and Culture Research Group (GESEC), Lleida, Spain
| | - María Teresa Moreno-Casbas
- Unidad de Investigación en Cuidados y Servicios de Salud del Instituto de Salud Carlos III (Investén-ISCIII), Madrid, Spain
- CIBERFES, ISCIII, València, Spain
| | | | | | | | - Carmen Sarri
- Benito Menni CASM, Sant Boi de Llobregat, Barcelona, Spain
| | | | - Salvador Sarró
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- CIBERSAM, ISCIII, Madrid, Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- CIBERSAM, ISCIII, Madrid, Spain
| | - Raymond Salvador
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- CIBERSAM, ISCIII, Madrid, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalaries Research Foundation, Barcelona, Spain
- CIBERSAM, ISCIII, Madrid, Spain
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Barber J, Childs AW, Resnick S, Connors EH. Leveraging Measurement-Based Care to Reduce Mental Health Treatment Disparities for Populations of Color. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01364-4. [PMID: 38489017 DOI: 10.1007/s10488-024-01364-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Abstract
Disparities in mental health treatment have consistently been documented for clients of color as compared to White clients. Most mental health care disparities literature focuses on access to care at the point of initial engagement to treatment, resulting in a dearth of viable solutions being explored to retain clients in care once they begin. Measurement-based care (MBC) is a person-centered practice that has been shown to improve the therapeutic relationship, make treatment more personalized, and empower the client to have an active role in their care. Problems with therapeutic alliance and treatment relevance are associated with early termination for communities of color in mental health services. However, MBC has not been explored as a clinical practice to address therapeutic alliance and continual engagement for people of color seeking mental health care. This Point of View describes several MBC features that may be able to impact current sources of disparity in mental health treatment quality and provides a rationale for each. Our hope is that the field of MBC and progress feedback will more explicitly consider the potential of MBC practices to promote equity and parity in mental health services of color and will start to explore these associations empirically. We also discuss whether MBC should be culturally adapted to optimize its relevance and effectiveness for communities of color and other groups experiencing marginalization. We propose that MBC has promise to promote equitable mental health service quality and outcomes for communities of color.
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Affiliation(s)
- Jessica Barber
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
- Department of Veterans Affairs, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT, USA.
| | - Amber W Childs
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sandra Resnick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, West Haven, CT, USA
| | - Elizabeth H Connors
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Poudyal A, Lewis DM, Taha S, Martinez AJ, Magoun L, Ho YX, Carmio N, Naslund JA, Sanchez K, Lesh N, Patel V. Designing an App to Support Measurement-Based Peer Supervision of Frontline Health Workers Delivering Brief Psychosocial Interventions in Texas: Multimethod Study. JMIR Form Res 2024; 8:e55205. [PMID: 38466971 DOI: 10.2196/55205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. OBJECTIVE We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. METHODS We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app's overall usability. We also calculated the participants' likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. RESULTS A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants' likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs' workloads. CONCLUSIONS We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app's use and efficacy in real-world settings to support task-shared mental health programs across the United States.
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Affiliation(s)
- Anubhuti Poudyal
- Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, NY, United States
| | | | - Sarah Taha
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Alyssa J Martinez
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Y Xian Ho
- Dimagi, Inc, Cambridge, MA, United States
| | - Natali Carmio
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Katherine Sanchez
- Patient and Community Engaged Research Center, Baylor Scott and White Research Institute, Dallas, TX, United States
| | - Neal Lesh
- Dimagi, Inc, Cambridge, MA, United States
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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Higa-McMillan CK, Park AL, Daleiden EL, Becker KD, Bernstein A, Chorpita BF. Getting More Out of Clinical Documentation: Can Clinical Dashboards Yield Clinically Useful Information? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:268-285. [PMID: 38261119 DOI: 10.1007/s10488-023-01329-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/24/2024]
Abstract
This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (M age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., Caregiver Psychoeducation: Anxiety would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.
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Yule AM, Youn SJ, Dean K, Woodward DW, Firmin ES, Kramer J, Stone M, Marques L, Wilens TE. Different factors identified by stakeholder group for barriers and facilitators to measurement-based care implementation in behavioral health clinics. J Clin Psychol 2024; 80:576-590. [PMID: 38230918 PMCID: PMC10923014 DOI: 10.1002/jclp.23639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/16/2023] [Accepted: 12/23/2023] [Indexed: 01/18/2024]
Abstract
INTRODUCTION Despite the benefits of measurement-based care (MBC) in the behavioral health setting, there have been difficulties in implementation and low saturation. Although barriers and facilitators to MBC implementation have been identified, research has generally only included the perspective of one stakeholder group. The current study aims to examine the similarities and differences-by stakeholder group-in the identified barriers to and facilitators of implementing MBC in the behavioral health setting. METHOD A purposeful sampling approach was used to recruit and conduct interviews and focus groups with stakeholders (clinicians, clinic leaders, and administrative staff) from four behavioral health clinics at an academic medical center that is part of a larger healthcare system. The data coding process included a directed content analytic approach whereby the coding team used an iterative process to analyze deidentified transcripts starting with a codebook based on the Consolidated Framework for Implementation Research (CFIR) constructs. RESULTS A total of 31 clinicians, 11 clinic leaders, and 8 administrative staff participated in the interviews and focus groups. There was convergence among all stakeholder regarding which CFIR constructs were identified as barriers and facilitators, but there were differences in the specific thematic factors identified by stakeholders as barriers and facilitators within each of these implementation constructs. The barriers and facilitators that stakeholders identified within each CFIR construct were often connected to their specific role in implementing MBC. CONCLUSION Collecting information on barriers and facilitators to MBC implementation from the multiple stakeholders involved in the process may enhance successful implementation of MBC given the variation between groups in identified thematic factors. Administrative staff perspectives, which have not been reported in the literature, may be of particular importance in planning for successful MBC implementation.
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Affiliation(s)
- Amy M. Yule
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118
| | - Soo Jeong Youn
- Department of Behavioral Health, Reliant Medical Group, OptumCare, Worcester, Massachusetts, United States
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Kimberlye Dean
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Diana W. Woodward
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Elizabeth S. Firmin
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Joanna Kramer
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, 801 Massachusetts Ave, Boston, MA 02118
| | - Mira Stone
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
| | - Luana Marques
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114
| | - Timothy E. Wilens
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
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Rush AJ, Gore-Langton RE, Bart G, Bradley KA, Campbell CI, McKay J, Oslin DW, Saxon AJ, Winhusen TJ, Wu LT, Moran LM, Tai B. Tools to implement measurement-based care (MBC) in the treatment of opioid use disorder (OUD): toward a consensus. Addict Sci Clin Pract 2024; 19:14. [PMID: 38419116 PMCID: PMC10902994 DOI: 10.1186/s13722-024-00446-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/13/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The prevalence and associated overdose death rates from opioid use disorder (OUD) have dramatically increased in the last decade. Despite more available treatments than 20 years ago, treatment access and high discontinuation rates are challenges, as are personalized medication dosing and making timely treatment changes when treatments fail. In other fields such as depression, brief measures to address these tasks combined with an action plan-so-called measurement-based care (MBC)-have been associated with better outcomes. This workgroup aimed to determine whether brief measures can be identified for using MBC for optimizing dosing or informing treatment decisions in OUD. METHODS The National Institute on Drug Abuse Center for the Clinical Trials Network (NIDA CCTN) in 2022 convened a small workgroup to develop consensus about clinically usable measures to improve the quality of treatment delivery with MBC methods for OUD. Two clinical tasks were addressed: (1) to identify the optimal dose of medications for OUD for each patient and (2) to estimate the effectiveness of a treatment for a particular patient once implemented, in a more granular fashion than the binary categories of early or sustained remission or no remission found in The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). DISCUSSION Five parameters were recommended to personalize medication dose adjustment: withdrawal symptoms, opioid use, magnitude (severity and duration) of the subjective effects when opioids are used, craving, and side effects. A brief rating of each OUD-specific parameter to adjust dosing and a global assessment or verbal question for side-effects was viewed as sufficient. Whether these ratings produce better outcomes (e.g., treatment engagement and retention) in practice deserves study. There was consensus that core signs and symptoms of OUD based on some of the 5 DSM-5 domains (e.g., craving, withdrawal) should be the basis for assessing treatment outcome. No existing brief measure was found to meet all the consensus recommendations. Next steps would be to select, adapt or develop de novo items/brief scales to inform clinical decision-making about dose and treatment effectiveness. Psychometric testing, assessment of acceptability and whether the use of such scales produces better symptom control, quality of life (QoL), daily function or better prognosis as compared to treatment as usual deserves investigation.
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Affiliation(s)
- A John Rush
- Duke-NUS Medical School, The National University of Singapore, Duke University School of Medicine, Singapore, Singapore
| | | | - Gavin Bart
- School of Medicine & Division of Medicine at Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | | | - Cynthia I Campbell
- Kaiser Permanente Northern California Division of Research, Oakland, CA, USA
| | - James McKay
- Penn Center on the Continuum of Care in the Addictions, Philadelphia VA Center of Excellence in Substance Addiction Treatment and Education, University of Pennsylvania, Philadelphia, PA, USA
| | - David W Oslin
- University of Psychiatry, VISN 4 Mental Illness, Research, Education and Clinical Center Crescenz VA Medical Center, Stephen A. Cohen Military Family Clinic at the Perelman School of Medicine, Philadelphia, PA, USA
| | - Andrew J Saxon
- University of Washington and Center of Excellence in Substance Addiction Treatment and Education at the VA Puget Sound Health Care System, Seattle, WA, USA
| | - T John Winhusen
- Addiction Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Li-Tzy Wu
- Duke University School of Medicine, Durham, NC, USA
| | - Landhing M Moran
- Center for Clinical Trials Network, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Betty Tai
- Center for Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, 11601 Landsdown Street (3WF), Bethesda, MD, 20892, USA.
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Barber J, Resnick SG. Can Measurement-Based Care Reduce Burnout in Mental Health Clinicians? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01349-3. [PMID: 38379054 DOI: 10.1007/s10488-024-01349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/22/2024]
Abstract
Burnout is a syndrome characterized by mental and emotional fatigue or exhaustion, depersonalization, and a lessened sense of personal accomplishment and efficacy. Burnout leads to negative consequences for mental health clinicians and for mental health care organizations. Measurement-based care (MBC) is a clinical process in which clinicians and clients use patient-generated data, also called treatment feedback, to collaboratively monitor mental health care and to inform goal-setting and treatment planning. We propose that MBC may improve the experience of care for both clients and clinicians, and ultimately protect against each of the three components of burnout. When combined with other organizational changes, adoption of MBC may support organizational level efforts to reduce burnout in mental health services.
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Affiliation(s)
- Jessica Barber
- Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, West Haven, CT, USA.
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA.
| | - Sandra G Resnick
- Office of Mental Health and Suicide Prevention, US Department of Veterans Affairs, West Haven, CT, USA
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA
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22
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Patel-Syed Z, Becker S, Olson M, Rinella H, Scott K. What do you think it means? Using cognitive interviewing to improve measurement in implementation science: description and case example. Implement Sci Commun 2024; 5:14. [PMID: 38355677 PMCID: PMC10865651 DOI: 10.1186/s43058-024-00549-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Pragmatic measures are essential to evaluate the implementation of evidence-based interventions. Cognitive interviewing, a qualitative method that collects partner feedback throughout measure development, is particularly useful for developing pragmatic implementation measures. Measure developers can use cognitive interviewing to increase a measure's fit within a particular implementation context. However, cognitive interviewing is underused in implementation research, where most measures remain "homegrown" and used for single studies. We provide a rationale for using cognitive interviewing in implementation science studies and illustrate its use through a case example employing cognitive interviewing to inform development of a measurement-based care protocol for implementation in opioid treatment programs. Applications of cognitive interviewing, including developing a common language with partners and collecting multi-level feedback on assessment procedures, to improve measurement in implementation science are discussed.
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Affiliation(s)
- Zabin Patel-Syed
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA.
| | - Sara Becker
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Miranda Olson
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Hailey Rinella
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
| | - Kelli Scott
- Northwestern University Feinberg School of Medicine, Institute for Public Health and Medicine, Center for Dissemination and Implementation Science, Chicago, USA
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23
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Meyer-Kalos P, Owens G, Fisher M, Wininger L, Williams-Wengerd A, Breen K, Abate J, Currie A, Olinger N, Vinogradov S. Putting measurement-based care into action: A mixed methods study of the benefits of integrating routine client feedback in coordinated specialty care programs for early psychosis. RESEARCH SQUARE 2024:rs.3.rs-3918063. [PMID: 38405727 PMCID: PMC10889084 DOI: 10.21203/rs.3.rs-3918063/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Measurement-based care (MBC) is an effective tool in the delivery of evidence-based practices (EBPs). MBC utilizes feedback loops to share information and drive changes throughout a learning healthcare system. Few studies have demonstrated this practice in team-based care for people with early psychosis. This paper describes the development of a personalized feedback report derived from routine assessments that is shared with clients and clinicians as part of a MBC process. Methods We used a quasi pre-post comparison design with mixed methods to evaluate the implementation of a personalized feedback report at 5 early psychosis coordinated specialty care programs (CSC). We compared clients enrolled in CSC who did and did not receive a feedback report over the first 6 months of treatment. The sample included 204 clients: 146 who did not receive the feedback report and were enrolled over 2 years, and 58 who received the feedback report. A subset of 67 clients completed measures at both intake and 6-month follow-up, including 42 who received the report and 25 who did not. We compared the two groups with regard to self-reported symptoms, likelihood of completing treatment, and perception of shared decision making. We conducted qualitative interviews with 5 clients and 5 clinicians to identify the benefits and challenges associated with the personalized feedback report. Results People who received a personalized feedback report reported significant improvements in shared decision-making and had greater improvements over time in their intent to attend future treatment sessions. They engaged in more sessions for Supported Employment and Education (SEE), case management, and peer support, and fewer medication visits over the first 6 months of treatment. Both groups showed significant improvement in symptoms and functioning. Results from the qualitative analysis indicated that the experience of receiving the reports was valuable and validating for both patients and clinicians. Conclusions A personalized feedback report was integrated into standard of care for early psychosis programs. This process may improve shared decision-making, strengthen the likelihood to stay in treatment, and increase engagement in psychosocial interventions. We posit that this process facilitates strengths-focused discussions, enhances intrinsic motivation, and strengthens the therapeutic alliance.
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24
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Martinez RG, McNeil GD, Cornacchio D, Schneider BN, Peris TS. A Pilot Project to Integrate Individualized Measurement Into Measurement-Based Care in a Child Partial Hospitalization Program. Behav Ther 2024; 55:191-200. [PMID: 38216232 DOI: 10.1016/j.beth.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 01/14/2024]
Abstract
Measurement-based care (MBC), or the regular use of progress measures to inform clinical decision-making, improves quality of care and clinical outcomes. MBC typically focuses on standardized rather than individualized outcome measurement. In this pilot study, we examined the clinical utility of integrating individualized measurement with existing standardized outcome monitoring in a children's partial hospitalization program. Participants were 48 youth (M age 10.13 ± 1.39; 54.2% male, 41.7% female, 4.2% transgender or nonbinary). Comorbidity was common; 83.4% of youth had more than one diagnosis at intake. Using the Youth Top Problems for individualized outcome measurement, we examined Top Problem content and clinical improvement over time. Finally, we examined completion rates and describe implementation issues. Top Problems were heterogeneous and sensitive to change. Of the 144 problems, 107 (74%) had a focus consistent with measures used in program, while 37 (26%) were not captured by standardized measures used in program. Effect sizes from admission to final measurement ranged from Cohen's d = .75 - 1.00. Initial adoption of the MBC was strong, but sustained use of the system over the treatment course was challenging. Individualized outcome measurement in children's partial hospitalization programs is feasible to administer and sensitive to clinical change that is unique from change captured in standardized measures. Parents were able to self-identify clinically meaningful, highly individualized Top Problems. Challenges of implementation and clinical assessment in acute settings and potential strategies for improving implementation are discussed.
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Affiliation(s)
- Ruben G Martinez
- Kaiser Permanente Washington Health Research Institute; UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior
| | - Galen D McNeil
- UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior
| | | | | | - Tara S Peris
- UCLA Jane & Terry Semel Institute for Neuroscience & Human Behavior.
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25
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Bassi E, Bright K, Norman L, Pintson K, Daniel S, Sidhu S, Gondziola J, Bradley J, Fersovitch M, Stamp L, Moskovic K, LaMonica H, Iorfino F, Gaskell T, Tomlinson S, Johnson D, Dimitropoulos G. Perceptions of mental health providers of the barriers and facilitators of using and engaging youth in digital mental-health-enabled measurement based care. Digit Health 2024; 10:20552076241253093. [PMID: 38726214 PMCID: PMC11080807 DOI: 10.1177/20552076241253093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 05/12/2024] Open
Abstract
Objectives Increased rates of mental health disorders and substance use among youth and young adults have increased globally, furthering the strain on an already burdened mental health system. Digital solutions have been proposed as a potential option for the provision of timely mental health services for youth, with little research exploring mental health professional views about using such innovative tools. In Alberta, Canada, we are evaluating the implementation and integration of a digital mental health (dMH) platform into existing service pathways. Within this paper we seek to explore mental health professionals' perceptions of the barriers and facilitators that may influence their utilization of digital MH-enabled measurement-based care (MBC) with the youth who access their services. Methods A qualitative, descriptive methodology was used to inductively generate themes from focus groups conducted with mental health professionals from specialized mental health services and primary care networks in Alberta. Results As mental health professionals considered the barriers and facilitators of using dMH with youth, they referenced individual and family barriers and facilitators to consider. Providers highlighted perceived barriers, including: first, cultural stigma, family apprehension about mental health care, and parental access to dMH and MBC as deterrents to providers adopting digital platforms in routine care; second, perceptions of increased responsibility and liability for youth in crisis; third, perception that some psychiatric and neurodevelopmental disorders in youth are not amenable to dMH; fourth, professionals contemplated youth readiness to engage with dMH-enabled MBC. Participants also highlighted pertinent facilitators to dMH use, noting: first, the suitability of dMH for youth with mild mental health concerns; second, youth motivated to report their changes in mental health symptoms; and lastly, youth proficiency and preference for dMH options. Conclusions By identifying professionals' perceptions of barriers and facilitators for youth users, we may better understand how to address misconceptions about who is eligible and appropriate for dMH through training and education.
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Affiliation(s)
- E.M. Bassi
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K.S. Bright
- School of Nursing and Midwifery, Faculty of Health, Community, and Education, Mount Royal University, Calgary, Alberta, Canada
- Heroes in Mind, Advocacy, and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, College of Health Science, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L.G. Norman
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - K. Pintson
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Daniel
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - S. Sidhu
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - J. Gondziola
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - J. Bradley
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - M. Fersovitch
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - L. Stamp
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - K. Moskovic
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - H.M. LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - F. Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, Australia
| | - T. Gaskell
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - S. Tomlinson
- Provincial Addiction and Mental Health, Alberta Health Services, Calgary, Alberta, Canada
| | - D.W. Johnson
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - G. Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Calgary Eating Disorders Program, Alberta Health Services, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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26
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McDaniel BT, Cornet V, Carroll J, Chrones L, Chudzik J, Cochran J, Guha S, Lawrence DF, McCue M, Sarkey S, Lorenz B, Fawver J. Real-world clinical outcomes and treatment patterns in patients with MDD treated with vortioxetine: a retrospective study. BMC Psychiatry 2023; 23:938. [PMID: 38093196 PMCID: PMC10720213 DOI: 10.1186/s12888-023-05439-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND This study included evaluation of the effectiveness of vortioxetine, a treatment for adults with major depressive disorder (MDD), using patient-reported outcome measures (PROMs) in a real-world setting. METHODS This retrospective chart review analyzed the care experiences of adult patients with a diagnosis of MDD from Parkview Physicians Group - Mind-Body Medicine, Midwestern United States. Patients with a prescription for vortioxetine, an initial baseline visit, and ≥ 2 follow-up visits within 16 weeks from September 2014 to December 2018 were included. The primary outcome measure was effectiveness of vortioxetine on depression severity as assessed by change in Patient Health Questionnaire-9 (PHQ-9) scores ~ 12 weeks after initiation of vortioxetine. Secondary outcomes included changes in depression-related symptoms (i.e., sexual dysfunction, sleep disturbance, cognitive function, work/social function), clinical characteristics, response, remission, and medication persistence. Clinical narrative notes were also analyzed to examine sleep disturbance, sexual dysfunction, appetite, absenteeism, and presenteeism. All outcomes were examined at index (start of vortioxetine) and at ~ 12 weeks, and mean differences were analyzed using pairwise t tests. RESULTS A total of 1242 patients with MDD met inclusion criteria, and 63.9% of these patients had ≥ 3 psychiatric diagnoses and 65.9% were taking ≥ 3 medications. PHQ-9 mean scores decreased significantly from baseline to week 12 (14.15 ± 5.8 to 9.62 ± 6.03, respectively; p < 0.001). At week 12, the response and remission rates in all patients were 31.0% and 23.1%, respectively, and 67% continued vortioxetine treatment. Overall, results also showed significant improvements by week 12 in anxiety (p < 0.001), sexual dysfunction (p < 0.01), sleep disturbance (p < 0.01), cognitive function (p < 0.001), work/social functioning (p = 0.021), and appetite (p < 0.001). A significant decrease in presenteeism was observed at week 12 (p < 0.001); however, no significant change was observed in absenteeism (p = 0.466). CONCLUSIONS Using PROMs, our study results suggest that adults with MDD prescribed vortioxetine showed improvement in depressive symptoms in the context of a real-world clinical practice setting. These patients had multiple comorbid psychiatric and physical diagnoses and multiple previous antidepressant treatments had failed.
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Affiliation(s)
- Brandon T McDaniel
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Victor Cornet
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Jeanne Carroll
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | | | - Joseph Chudzik
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
| | - Jeanette Cochran
- Parkview Physicians Group - Mind-Body Medicine, Fort Wayne, IN, US
| | - Shion Guha
- Parkview Mirro Center for Research and Innovation, 10622 Parkview Plaza Drive, Fort Wayne, IN, 46845, US
- Faculty of Information, Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | | | - Maggie McCue
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Sara Sarkey
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Betty Lorenz
- Takeda Pharmaceuticals U.S.A., Inc, Lexington, MA, US
| | - Jay Fawver
- Parkview Physicians Group - Mind-Body Medicine, Fort Wayne, IN, US.
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Lee KC, Duarte KL, Lasswell E, Clark AL, Bhakta SG, Harlé KM. Comparison of Delivery of Care Before and During COVID-19 Within an Academic Outpatient Psychiatry Practice. Telemed J E Health 2023; 29:1801-1809. [PMID: 37074079 DOI: 10.1089/tmj.2023.0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Introduction: The COVID-19 pandemic has challenged outpatient mental health clinics. This article compares care delivery and patient characteristics before and during the COVID-19 pandemic in outpatient mental health clinics within an academic health system. Methods: A retrospective cohort study was conducted in patients who received outpatient psychiatric services at two clinics (A and B). The investigators compared care delivery with patients with mental health conditions prepandemic (January 1-December 31, 2019) and midpandemic (January 1-December 31, 2020) periods. Care delivery was defined as the number and type of new and return visits (telehealth and face-to-face visits), patients with recorded measurement-based care (MBC) outcomes, and communication capability between patients and providers. Results: During the prepandemic period, 6,984 patients were seen in Clinics A and B, resulting in 57,629 visits. In the midpandemic period, 7,110 patients were served, resulting in 61,766 total visits. Medication management visits increased from 2019 to 2020; number of visits with documented outcome measures increased by 90% in Clinic A and 15% in Clinic B. The number of MyChart messages per patient increased more than twofold during the midpandemic period. The number of new visits with primary diagnosis of anxiety disorders increased in CY2020 and the number of visits with primary diagnosis of major depressive/mood disorders decreased in CY2020. Payor mix did not vary between the two periods although there was variability between payor mix at the two primary clinic locations. Discussion: The study suggests that there was no detrimental impact on access to care between the prepandemic and midpandemic periods within the health system. Mental health visits while pivoting to telehealth increased during the midpandemic period. Transition to telepsychiatry improved the ability to administer and document MBC.
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Affiliation(s)
- Kelly C Lee
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, California, USA
| | - Kristen L Duarte
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Eve Lasswell
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Ashley L Clark
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Savita G Bhakta
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Katia M Harlé
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- VA San Diego Healthcare System, San Diego, California, USA
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Weisz JR, Fitzpatrick OM, Venturo-Conerly KE, Sternberg A, Steinberg JS, Ng MY. Research Review: The internalizing paradox - youth anxiety and depression symptoms, psychotherapy outcomes, and implications for research and practice. J Child Psychol Psychiatry 2023; 64:1720-1734. [PMID: 37222162 PMCID: PMC10667566 DOI: 10.1111/jcpp.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Youth anxiety and depression have long been combined within the empirically derived internalizing syndrome. The two conditions show substantial comorbidity, symptom co-occurrence, and overlap in treatment procedures, but paradoxically diverge in psychotherapy outcomes: strong, positive effects for anxiety and weak effects for depression. METHODS Drawing on recent research, we examine candidate explanations for this paradox to help identify strategies for addressing it by improving outcomes for youth depression. RESULTS Candidate explanations include that youth depression, compared with youth anxiety, has more varied comorbidities and more heterogeneous symptom combinations, has greater uncertainty regarding mediators and mechanisms of change, is treated with more complex and potentially confusing protocols, and has characteristics that may impede client engagement. Candidate strategies for shrinking the psychotherapy effectiveness gap include personalizing through transdiagnostic modular treatment, simplifying therapy by focusing on empirically supported principles of change, developing effective strategies for engaging family members as intervention allies, using shared decision-making to inform clinical decisions and boost client engagement, capitalizing on youth-friendly technological advances, and shortening and digitizing treatments to enhance their accessibility and appeal. CONCLUSIONS Recent advances suggest explanations for the internalizing paradox, which in turn suggest strategies for shrinking the youth anxiety-depression psychotherapy outcome gap; these form an agenda for a promising new era of research.
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Affiliation(s)
- John R. Weisz
- Department of Psychology, Harvard University, Cambridge, MA 02138 USA
| | | | | | - Ariel Sternberg
- Department of Psychology, Harvard University, Cambridge, MA 02138 USA
| | | | - Mei Yi Ng
- Department of Psychology, Florida International University, Miami, FL 33199 USA
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Martinez RG, Weiner BJ, Meza RD, Dorsey S, Palazzo LG, Matson A, Bain C, Mettert KD, Pullmann MD, Lewis CC. Study protocol: Novel Methods for Implementing Measurement-Based Care with youth in Low-Resource Environments (NIMBLE). Implement Sci Commun 2023; 4:152. [PMID: 38017522 PMCID: PMC10683142 DOI: 10.1186/s43058-023-00526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND For youth receiving care in community mental health centers, comorbidities are the rule rather than the exception. Using measurement-based care (MBC), or the routine evaluation of symptoms to inform care decisions, as the foundation of treatment for youth with comorbid problems significantly improves the impact of psychotherapy by focusing care and building engagement and alliance. MBC increases the rate of symptom improvement, detects clients who would otherwise deteriorate, and alerts clinicians to non-responders. Despite its demonstrated utility, MBC is rarely implemented with fidelity; less than 15% of providers report using MBC per recommendations. Previous efforts to support MBC implementation have yielded suboptimal outcomes, in part, due to organizations' challenges with identifying and prioritizing barriers and selecting and developing strategies to overcome them. New methods are needed for identifying and prioritizing barriers, and matching strategies to barriers to optimize MBC implementation and treatment quality to improve youth mental health outcomes in community settings. METHODS Pragmatic implementation methods will be piloted in four diverse community mental health centers. Methods include (a) rapid evidence synthesis; (b) rapid ethnography; (c) design kits (e.g., kits with disposable cameras, journals, maps); (d) barrier prioritization, and (e) causal pathway diagramming. These activities will generate actionable barriers; subsequently, we will use facilitated group processes to prioritize barriers and develop causal pathway diagrams to match strategies to barriers to create implementation plans that optimize MBC fidelity (Aim 1). We will track strategy deployment for 6 months, then compare MBC fidelity for another 6 months post-implementation with data from 2 years of historical controls (Aim 2). Finally, we will co-design a toolkit for design kit methods with youth and the practice and scientific communities (Aim 3). DISCUSSION Optimizing MBC implementation in community mental health centers could transform youth mental health care by ensuring the most pressing symptoms are targeted early in treatment. The discussion section highlights expected challenges and limits to using the five methods, including recruitment and engagement given the high pressure on community mental health settings. TRIAL REGISTRATION Clinicaltrials.gov. NCT05644756 . Registered on 18 November 2022. This trial was retrospectively registered.
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Affiliation(s)
- Ruben G Martinez
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rosemary D Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Lorella G Palazzo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Abigail Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Carolyn Bain
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kayne D Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Gerczuk M, Triantafyllopoulos A, Amiriparian S, Kathan A, Bauer J, Berking M, Schuller BW. Zero-shot personalization of speech foundation models for depressed mood monitoring. PATTERNS (NEW YORK, N.Y.) 2023; 4:100873. [PMID: 38035199 PMCID: PMC10682756 DOI: 10.1016/j.patter.2023.100873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/01/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023]
Abstract
The monitoring of depressed mood plays an important role as a diagnostic tool in psychotherapy. An automated analysis of speech can provide a non-invasive measurement of a patient's affective state. While speech has been shown to be a useful biomarker for depression, existing approaches mostly build population-level models that aim to predict each individual's diagnosis as a (mostly) static property. Because of inter-individual differences in symptomatology and mood regulation behaviors, these approaches are ill-suited to detect smaller temporal variations in depressed mood. We address this issue by introducing a zero-shot personalization of large speech foundation models. Compared with other personalization strategies, our work does not require labeled speech samples for enrollment. Instead, the approach makes use of adapters conditioned on subject-specific metadata. On a longitudinal dataset, we show that the method improves performance compared with a set of suitable baselines. Finally, applying our personalization strategy improves individual-level fairness.
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Affiliation(s)
- Maurice Gerczuk
- Chair of Embedded Intelligence for Healthcare and Wellbeing, University of Augsburg, Augsburg, Germany
| | | | - Shahin Amiriparian
- Chair of Embedded Intelligence for Healthcare and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Alexander Kathan
- Chair of Embedded Intelligence for Healthcare and Wellbeing, University of Augsburg, Augsburg, Germany
| | - Jonathan Bauer
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Erlangen, Germany
| | - Björn W. Schuller
- Chair of Embedded Intelligence for Healthcare and Wellbeing, University of Augsburg, Augsburg, Germany
- GLAM, Imperial College, London, UK
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Liebmann EP, Resnick SG, Austin KL, Jedele JM. Patient and Treatment Characteristics Associated With Receipt of Core Patient-Reported Outcome Measures in VA Mental Health. Mil Med 2023; 188:3613-3620. [PMID: 35849075 DOI: 10.1093/milmed/usac218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/04/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Measurement-based care (MBC) has been implemented in Veterans Affairs since 2016 and is increasingly used in other mental health care organizations. Little quantitative research exists that assesses patient-level barriers and facilitators of MBC. This study examines correlates of receiving patient-reported outcome measures (PROMs) among veterans receiving both psychotherapy and pharmacotherapy (Both), psychotherapy only (Psychotherapy), and pharmacotherapy only (Pharmacotherapy). METHODS Data on PROM administration were obtained for a 12-month period for 1,726,578 veterans who initiated outpatient mental health care during fiscal year 2019. Clinical, treatment, and PROM data were extracted from the electronic health record. Logistic regression was used to model the association between veteran and treatment characteristics and PROM administration. RESULTS Thirty-two percent of veterans in Both, 26.0% in Psychotherapy, and 8.8% in Pharmacotherapy received at least one PROM. The probability of PROM administration was positively associated with the number of treatment encounters during the fiscal year 2019. Major depressive, generalized anxiety, and other depressive disorders were associated with an increased probability of PROM administration. Psychotic disorders, personality disorders, older age, dementia, and electronic health record suicide risk flag were associated with decreased odds of PROM administration across treatment types. CONCLUSIONS Rates of PROM administration differ depending on the type of treatment received. The probability of PROM administration is influenced by the frequency of encounters and, to a lesser extent, having a diagnosis congruent with symptoms assessed in the set of PROMs considered. Consistent with hypotheses from the MBC implementation literature, potential indicators of clinical severity and cognitive impairment decrease the likelihood of PROM utilization.
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Affiliation(s)
- Edward P Liebmann
- VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sandra G Resnick
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
- U.S. Department of Veterans Affairs, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Affairs Central Office, West Haven, CT 06516, USA
| | - Karen L Austin
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48105, USA
| | - Jenefer M Jedele
- VA Serious Mental Illness Treatment Resource and Evaluation Center, Ann Arbor, MI 48105, USA
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Cho E, Cook JR, Hawley KM. A Structural Model of Organization and Clinician Factors Associated with Standardized Measure Use in a National Survey of Youth Mental Health Providers. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:876-887. [PMID: 37458956 PMCID: PMC11056910 DOI: 10.1007/s10488-023-01286-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 10/01/2023]
Abstract
Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making.
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Affiliation(s)
- Evelyn Cho
- University of Missouri, Columbia, USA
- Harvard University, Cambridge, USA
| | - Jonathan R Cook
- University of Missouri, Columbia, USA
- Pacific Anxiety Group, Belmont, USA
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Rosansky JA, Okst K, Tepper MC, Baumgart Schreck A, Fulwiler C, Wang PS, Schuman-Olivier Z. Participants' Engagement With and Results From a Web-Based Integrative Population Mental Wellness Program (CHAMindWell) During the COVID-19 Pandemic: Program Evaluation Study. JMIR Ment Health 2023; 10:e48112. [PMID: 37883149 PMCID: PMC10636615 DOI: 10.2196/48112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/31/2023] [Accepted: 09/03/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a public health care system's patient population. OBJECTIVE This program evaluation was conducted to explore participants' engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation. METHODS We examined participants' symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up. RESULTS The program enrolled 903 participants (664/903, 73.5% female; 556/903, 61.6% White; 113/903, 12.5% Black; 84/903, 9.3% Asian; 7/903, 0.8% Native; 36/903, 4% other; and 227/903, 25.1% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95% CI 1.14-2.84; P=.01). Participants' odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time. CONCLUSIONS CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects.
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Affiliation(s)
- Joseph A Rosansky
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kayley Okst
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
- Department of Psychology, New York University, New York, NY, United States
| | - Miriam C Tepper
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
- New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Ana Baumgart Schreck
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
| | - Carl Fulwiler
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Philip S Wang
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, United States
| | - Zev Schuman-Olivier
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Hickie IB, Iorfino F, Rohleder C, Song YJC, Nichles A, Zmicerevska N, Capon W, Guastella AJ, Leweke FM, Scott J, McGorry P, Mihalopoulos C, Killackey E, Chong MK, McKenna S, Aji M, Gorban C, Crouse JJ, Koethe D, Battisti R, Hamilton B, Lo A, Hackett ML, Hermens DF, Scott EM. EMPOWERED trial: protocol for a randomised control trial of digitally supported, highly personalised and measurement-based care to improve functional outcomes in young people with mood disorders. BMJ Open 2023; 13:e072082. [PMID: 37821139 PMCID: PMC10583041 DOI: 10.1136/bmjopen-2023-072082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/08/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVES Many adolescents and young adults with emerging mood disorders do not achieve substantial improvements in education, employment, or social function after receiving standard youth mental health care. We have developed a new model of care referred to as 'highly personalised and measurement-based care' (HP&MBC). HP&MBC involves repeated assessment of multidimensional domains of morbidity to enable continuous and personalised clinical decision-making. Although measurement-based care is common in medical disease management, it is not a standard practice in mental health. This clinical effectiveness trial tests whether HP&MBC, supported by continuous digital feedback, delivers better functional improvements than standard care and digital support. METHOD AND ANALYSIS This controlled implementation trial is a PROBE study (Prospective, Randomised, Open, Blinded End-point) that comprises a multisite 24-month, assessor-blinded, follow-up study of 1500 individuals aged 15-25 years who present for mental health treatment. Eligible participants will be individually randomised (1:1) to 12 months of HP&MBC or standardised clinical care. The primary outcome measure is social and occupational functioning 12 months after trial entry, assessed by the Social and Occupational Functioning Assessment Scale. Clinical and social outcomes for all participants will be monitored for a further 12 months after cessation of active care. ETHICS AND DISSEMINATION This clinical trial has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (HREC Approval Number: X22-0042 & 2022/ETH00725, Protocol ID: BMC-YMH-003-2018, protocol version: V.3, 03/08/2022). Research findings will be disseminated through peer-reviewed journals, presentations at scientific conferences, and to user and advocacy groups. Participant data will be deidentified. TRIAL REGISTRATION NUMBER ACTRN12622000882729.
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Affiliation(s)
- Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Cathrin Rohleder
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - William Capon
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - F Markus Leweke
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Medicine Mannheim, Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Jan Scott
- Newcastle University, Newcastle upon Tyne, UK
| | - Patrick McGorry
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne Australia, Parkville, Victoria, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia
| | - Min K Chong
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah McKenna
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Melissa Aji
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Carla Gorban
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dagmar Koethe
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | | | - Blake Hamilton
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- headspace Camperdown, Camperdown, New South Wales, Australia
| | - Alice Lo
- Mind Plasticity, Sydney, New South Wales, Australia
| | - Maree L Hackett
- George Institute for Global Health, Newtown, New South Wales, Australia
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Saunders EFH, Brady M, Mukherjee D, Baweja R, Forrest LN, Gomaa H, Babinski D, He F, Pearl AM, Liao D, Waschbusch DA. Gender differences in transdiagnostic domains and function of adults measured by DSM-5 assessment scales at the first clinical visit: a cohort study. BMC Psychiatry 2023; 23:709. [PMID: 37784092 PMCID: PMC10544467 DOI: 10.1186/s12888-023-05207-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 09/20/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Measurement-based care has been called for as best practice in psychiatric care and learning health systems and use of transdiagnostic measures was suggested as part of the DSM-5. Our objective is to examine gender differences in first visit socioeconomic, transdiagnostic, and functional characteristics of a dynamic, real-world measurement-based care cohort. METHODS Transdiagnostic, functional, and clinical measures were collected from 3,556 patients at first visit in an ambulatory psychiatric clinic. All patients were evaluated at the first visit by board-certified psychiatrists or licensed clinical psychologists. Demographic variables and clinical diagnoses were collected from the Electronic Medical Record. Self-report measures were collected that assessed transdiagnostic symptoms (DSM-5 Level 1 Cross-cutting Measure and Level 2 symptom scales), disability, alcohol use, attention deficit hyperactivity disorder (ADHD) symptoms, depression, anxiety, mania, suicidal thoughts and behaviors, and trauma exposure. RESULTS Men and women did not differ in age, BMI, household income, high school graduation rate, race, or ethnicity, but women were more likely to be formerly married and less likely to have commercial insurance. Compared to men, women reported significantly higher overall psychopathology on the transdiagnostic Level 1 Cross-cutting measure and had higher depression, anxiety, sleep, anger, ADHD combined presentation, and suicidality severity. Women also had higher disability scores than men. However, men reported higher alcohol, tobacco and substance use, and more risky behavior than women. Trauma exposure differed significantly by gender; men reported more exposure to accidents, war-related trauma, serious accidents, and major disasters and women reported more unwanted sexual contact. CONCLUSIONS This cross-sectional study of a transdiagnostic, ecologically-valid real-word measurement-based care cohort demonstrates gender differences in socioeconomic factors, trauma exposure, transdiagnostic symptoms, and functioning.
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Affiliation(s)
- Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA.
| | - Megan Brady
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dahlia Mukherjee
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Ritika Baweja
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Lauren N Forrest
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Hassaan Gomaa
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Dara Babinski
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Fan He
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Amanda M Pearl
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
| | - Duanping Liao
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine and Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA
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Harry ML, Sanchez K, Ahmedani BK, Beck AL, Coleman KJ, Coley RY, Daida YG, Lynch FL, Rossom RC, Waring SC, Simon GE. Assessing the differential item functioning of PHQ-9 items for diverse racial and ethnic adults with mental health and/or substance use disorder diagnoses: A retrospective cohort study. J Affect Disord 2023; 338:402-413. [PMID: 37127116 PMCID: PMC10524453 DOI: 10.1016/j.jad.2023.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Improving health equity in depression care and suicide screening requires that measures like the Patient Health Questionnaire 9 (PHQ-9) function similarly for diverse racial and ethnic groups. We evaluated PHQ-9 differential item functioning (DIF) between racial/ethnic groups in a retrospective cohort study of secondary electronic health record (EHR) data from eight healthcare systems. METHODS The population (n = 755,156) included patients aged 18-64 with mental health and/or substance use disorder (SUD) diagnoses who had a PHQ-9 with no missing item data in the EHR for primary care or mental health visits between 1/1/2009-9/30/2017. We drew two random samples of 1000 from the following racial/ethnic groups originally recorded in EHRs (n = 14,000): Hispanic, and non-Hispanic White, Black, Asian, American Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, multiracial. We assessed DIF using iterative hybrid ordinal logistic regression and item response theory with p < 0.01 and 1000 Monte Carlo simulations, where change in model R2 > 0.01 represented non-negligible (e.g., clinically meaningful) DIF. RESULTS All PHQ-9 items displayed statistically significant, but negligible (e.g., clinically unmeaningful) DIF between compared groups. The negligible DIF varied between random samples, although six items showed negligible DIF between the same comparison groups in both random samples. LIMITATIONS Our findings may not generalize to disaggregated racial/ethnic groups or persons without mental health and/or SUD diagnoses. CONCLUSIONS We found the PHQ-9 had clinically unmeaningful cross-cultural DIF for adult patients with mental health and/or SUD diagnoses. Future research could disaggregate race/ethnicity to discern if within-group identification impacts PHQ-9 DIF.
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Affiliation(s)
- Melissa L Harry
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA.
| | - Katherine Sanchez
- Baylor Scott and White, Center for Applied Health Research, Temple, TX, USA
| | - Brian K Ahmedani
- Henry Ford Health, Center for Health Policy & Health Services Research, Detroit, MI, USA
| | - Arne L Beck
- The Kaiser Permanente Colorado Institute for Health Research, Aurora, CO, USA
| | - Karen J Coleman
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA, USA
| | - R Yates Coley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Yihe G Daida
- Kaiser Permanente Hawaii, Center for Integrated Health Care Research, Honolulu, HI, USA
| | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Stephen C Waring
- Essentia Health, Essentia Institute of Rural Health, Duluth, MN, USA
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Matson TE, Williams EC, Lapham GT, Oliver M, Hallgren KA, Bradley KA. Association between cannabis use disorder symptom severity and probability of clinically-documented diagnosis and treatment in a primary care sample. Drug Alcohol Depend 2023; 251:110946. [PMID: 37688980 PMCID: PMC10655701 DOI: 10.1016/j.drugalcdep.2023.110946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/01/2023] [Accepted: 08/13/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Brief cannabis screening followed by standardized assessment of symptoms may support diagnosis and treatment of cannabis use disorder (CUD). This study tested whether the probability of a medical provider diagnosing and treating CUD increased with the number of substance use disorder (SUD) symptoms documented in patients' EHRs. METHODS This observational study used EHR and claims data from an integrated healthcare system. Adult patients were included who reported daily cannabis use and completed the Substance Use Symptom Checklist, a scaled measure of DSM-5 SUD symptoms (0-11), during routine care 3/1/2015-3/1/2021. Logistic regression estimated associations between SUD symptom counts and: 1) CUD diagnosis; 2) CUD treatment initiation; and 3) CUD treatment engagement, defined based on Healthcare Effectiveness Data and Information Set (HEDIS) ICD-codes and timelines. We tested moderation across age, gender, race, and ethnicity. RESULTS Patients (N=13,947) were predominantly middle-age, male, White, and non-Hispanic. Among patients reporting daily cannabis use without other drug use (N=12,568), the probability of CUD diagnosis, treatment initiation, and engagement increased with each 1-unit increase in Symptom Checklist score (p's<0.001). However, probabilities of diagnosis, treatment, and engagement were low, even among those reporting ≥2 symptoms consistent with SUD: 14.0% diagnosed (95% CI: 11.7-21.6), 16.6% initiated treatment among diagnosed (11.7-21.6), and 24.3% engaged in treatment among initiated (15.8-32.7). Only gender moderated associations between Symptom Checklist and diagnosis (p=0.047) and treatment initiation (p=0.012). Findings were similar for patients reporting daily cannabis use with other drug use (N=1379). CONCLUSION Despite documented symptoms, CUD was underdiagnosed and undertreated in medical settings.
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Affiliation(s)
- Theresa E Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98101, USA.
| | - Emily C Williams
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Health Services Research & Development (HSR&D) Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98101, USA
| | - Gwen T Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA
| | - Kevin A Hallgren
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
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Bailey K, Lo LA, Chauhan B, Formuli F, Peck JR, Burra TA. Using a Quality Improvement Approach to Implement Measurement-Based Care (MBC) in Outpatient General Psychiatry. Jt Comm J Qual Patient Saf 2023; 49:563-571. [PMID: 37455195 DOI: 10.1016/j.jcjq.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/11/2023] [Accepted: 06/14/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Measurement-based care (MBC) is the clinical practice of using patient-reported symptom measurement to inform treatment decisions. MBC has been shown to improve patient outcomes and quality of care in outpatient psychiatry. Despite these benefits, MBC is not routinely used in most psychiatric outpatient settings. This quality improvement (QI) project aimed to achieve 75% completion of symptom scales using an online MBC platform in a general psychiatry clinic in Toronto, Canada, by June 2022. METHODS The QI team used the Model for Improvement methodology. The main outcome measure was completion of symptom scales using an online MBC platform. Process measures included counts of invitations to join the MBC platform, counts of online MBC account creation, and counts of symptom scale assignment by clinicians. Balancing measures included administrative task completion and physician workload assessment. Stakeholder interviews explored barriers and facilitators to MBC utilization. RESULTS Completion of symptom scales increased from 7/65 (10.8%) preintervention to 40/70 (57.1%) during the 26-week intervention. Clinician reminders and coaching clinicians about how to incorporate MBC into the care process facilitated uptake of MBC. Stakeholders identified several barriers to implementation, particularly physician attitudes toward MBC and perceived administrative burden. CONCLUSION Completion of symptom scales increased over the course of this QI initiative. Successful implementation of MBC in general psychiatry outpatient settings requires the availability of a broad range of measurement scales given the diversity of mental health diagnoses. Implementation must also consider health equity, including access to technology and availability of symptom scales in multiple languages.
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Wang Y, Ye JL, Chen T, Zhang L. Assessment of psychometric properties of the Huaxi Emotional-distress Index questionnaire (HEI)in a large sample of general hospital inpatients. Gen Hosp Psychiatry 2023; 84:188-193. [PMID: 37572466 DOI: 10.1016/j.genhosppsych.2023.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/11/2023] [Accepted: 07/28/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVES Huaxi Emotional-distress Index questionnaire (HEI) is a 9-item questionnaire designed to measure psychological distress. The present study aimed to validate the factor structure of the HEI and its reliability and validity using a large sample from inpatients of West China Hospital. METHODS HEI data were collected from inpatients of various departments at West China Hospital in 2019 through the hospital's data management platform (total sample, N = 55,396). The internal consistency reliability of the HEI was examined. Exploratory factor analysis (N = 27,696) and confirmatory factor analysis(N = 27,700) were conducted to validate the construct validity. RESULTS Three factors, namely depression (DEP), anxiety (ANX), and suicidal risk (SR), were extracted through exploratory factor analysis, which accounted for 79.55% of the total variance.The results of confirmatory factor analysis supported the fit for the three-component model oblique model as the best-fitting model compared with one-component model and two-component model. The internal consistency of the HEI was α =0.918. The internal consistencyα of ANX, DEP and SR is 0.87,0.814,0.843 respectively. CONCLUSIONS HEI is a validated and concise tool that serves a dual purpose of screening for mood disorders and assessing depressive and anxiety symptoms as well as suicidal risk among inpatients in Chinese general hospitals.
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Affiliation(s)
- Ye Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jia-Lu Ye
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Ting Chen
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China
| | - Lan Zhang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, China.
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Snider MDH, Boyd MR, Walker MR, Powell BJ, Lewis CC. Using audit and feedback to guide tailored implementations of measurement-based care in community mental health: a multiple case study. Implement Sci Commun 2023; 4:94. [PMID: 37580815 PMCID: PMC10424451 DOI: 10.1186/s43058-023-00474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Audit and feedback (A&F) is an implementation strategy that can facilitate implementation tailoring by identifying gaps between desired and actual clinical care. While there are several theory-based propositions on which A&F components lead to better implementation outcomes, many have not been empirically investigated, and there is limited guidance for stakeholders when applying A&F in practice. The current study aims to illustrate A&F procedures in six community mental health clinics, with an emphasis on reporting A&F components that are relevant to theories of how feedback elicits behavior change. METHODS Six clinics from a larger trial using a tailored approach to implement measurement-based care (MBC) were analyzed for feedback content, delivery mechanisms, barriers to feedback, and outcomes of feedback using archival data. Pattern analysis was conducted to examine relations between A&F components and changes in MBC use. RESULTS Several sites utilized both aggregate and individualized data summaries, and data accuracy concerns were common. Feedback cycles featuring individual-level clinician data, data relevant to MBC barriers, and information requested by data recipients were related to patterns of increased MBC use. CONCLUSIONS These findings support extant theory, such as Feedback Intervention Theory. Mental health professionals wishing to apply A&F should consider establishing reciprocal feedback mechanisms on the quality and amount of data being received and adopting specific roles communicating and addressing data quality concerns. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02266134.
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Affiliation(s)
- Mira D H Snider
- Department of Psychology, West Virginia University, 53 Campus Drive Morgantown, Morgantown, WV, 26505, USA.
| | - Meredith R Boyd
- Department of Psychology, University of California Los Angeles, Los Angeles, USA
| | - Madison R Walker
- Center for Health Equity Research, University of North Carolina, Chapel Hill, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School, Washington University in St. Louis, St. Louis, USA
- Division of Infectious Diseases, John T. Milliken Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, USA
- Center for Dissemination and Implementation, Institute for Public Health, Washington University in St. Louis, St. Louis, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
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Norris LA, Rabner JC, Crane ME, Cervin M, Ney JS, Benito KG, Kendall PC, Frank HE. What caregivers like the most (and least) about cognitive behavioral therapy for youth anxiety: A mixed methods approach. J Anxiety Disord 2023; 98:102742. [PMID: 37343420 DOI: 10.1016/j.janxdis.2023.102742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/29/2023] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
Cognitive behavioral therapy (CBT) is an efficacious therapy for youth anxiety disorders. Caregivers are key stakeholders in youth therapy, and their feedback on treatment can help to inform intervention personalization. This mixed-methods study applied a systematic inductive thematic analysis to identify themes among most- and least-liked CBT features reported by caregivers using open-ended responses on the Client Satisfaction Questionnaire (CSQ-8). The sample included 139 caregivers of youth ages 7-17 (M = 12.21, SD = 3.05; 59% female; 79.1% Caucasian, 5.8% Black, 2.9% Asian, 2.2% Hispanic, 7.9% Multiracial, 2.2% Other) with principal anxiety diagnoses who completed 16-sessions of CBT. CSQ-8 quantitative satisfaction scores (M = 29.18, SD = 3.30; range: 16-32) and survey-based treatment response rates (responders n = 93, 67%) were high. Most-liked treatment features included: coping skills (i.e., exposure, understanding/identifying anxiety, rewards, homework), therapist factors (interpersonal style/skill, relationship, accessibility), caregiver involvement, one-on-one time with a therapist, structure, consistency, and personally tailored treatment. Least-liked treatment features included: questionnaires, logistical barriers, telehealth, need for more sessions, non-anxiety concerns not addressed, insufficient caregiver involvement, and aspects of exposure tasks. Proportional frequencies of most- and least-liked themes differed by treatment responder status (e.g., responders cited exposure and homework as most-liked more frequently).
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Affiliation(s)
- Lesley A Norris
- Department of Psychology, Temple University, Philadelphia, PA, USA; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | | | - Margaret E Crane
- Department of Psychology, Temple University, Philadelphia, PA, USA; Department of Psychiatry, Weill Cornell Medicine, New York City, NY, USA
| | - Matti Cervin
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Julia S Ney
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Kristen G Benito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Hannah E Frank
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Shepardson RL, Funderburk JS, Weisberg RB, Maisto SA. Brief, modular, transdiagnostic, cognitive-behavioral intervention for anxiety in veteran primary care: Development, provider feedback, and open trial. Psychol Serv 2023; 20:622-635. [PMID: 35099230 PMCID: PMC10166236 DOI: 10.1037/ser0000622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Anxiety is undertreated in primary care, and most treatment provided is pharmacological rather than behavioral. Integrating behavioral health providers (BHPs) using the Primary Care Behavioral Health (PCBH) model can help address this treatment gap, but brief interventions suitable for use in PCBH practice are needed. We developed a modular, cognitive-behavioral anxiety intervention, Modular Anxiety Skills Training (MAST), that is evidence-based, transdiagnostic, feasible for PCBH, and patient-centered. MAST comprises up to six 30-min sessions emphasizing skills training. This article describes the rationale for and development of MAST as well as pilot work in the Veterans Health Administration (VA) to tailor and refine MAST for delivery to Veterans in VA primary care (MAST-V) to improve feasibility for VA BHPs and acceptability to Veterans. We used a convergent mixed-methods design with concurrent data collection. In phase one, we interviewed five BHPs to obtain feedback on the treatment manual. BHPs assessed MAST-V to be highly compatible with PCBH and provided suggestions to enhance feasibility. In phase two, we conducted an open trial in which six Veterans experiencing clinically significant anxiety received and provided feedback on all nine possible modules; we also assessed changes in mental health symptoms and functioning as well as treatment satisfaction and credibility. Veterans found MAST-V to be highly acceptable, and pre-post clinical outcomes were very promising with large effect sizes. Findings from this initial pilot provide preliminary support for the feasibility, acceptability, and efficacy of MAST-V and suggest further research with a randomized clinical trial is warranted. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Robyn L. Shepardson
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
| | - Jennifer S. Funderburk
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
- Department of Psychiatry, University of Rochester
| | - Risa B. Weisberg
- VA Boston Healthcare System
- Department of Psychiatry, Boston University School of Medicine
- Department of Family Medicine, Alpert Medical School, Brown University
| | - Stephen A. Maisto
- Center for Integrated Healthcare, Syracuse VA Medical Center
- Department of Psychology, Syracuse University
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Knights J, Bangieva V, Passoni M, Donegan ML, Shen J, Klein A, Baker J, DuBois H. A framework for precision "dosing" of mental healthcare services: algorithm development and clinical pilot. Int J Ment Health Syst 2023; 17:21. [PMID: 37408006 DOI: 10.1186/s13033-023-00581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/18/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND One in five adults in the US experience mental illness and over half of these adults do not receive treatment. In addition to the access gap, few innovations have been reported for ensuring the right level of mental healthcare service is available at the right time for individual patients. METHODS Historical observational clinical data was leveraged from a virtual healthcare system. We conceptualize mental healthcare services themselves as therapeutic interventions and develop a prototype computational framework to estimate their potential longitudinal impacts on depressive symptom severity, which is then used to assess new treatment schedules and delivered to clinicians via a dashboard. We operationally define this process as "session dosing": 497 patients who started treatment with severe symptoms of depression between November 2020 and October 2021 were used for modeling. Subsequently, 22 mental health providers participated in a 5-week clinical quality improvement (QI) pilot, where they utilized the prototype dashboard in treatment planning with 126 patients. RESULTS The developed framework was able to resolve patient symptom fluctuations from their treatment schedules: 77% of the modeling dataset fit criteria for using the individual fits for subsequent clinical planning where five anecdotal profile types were identified that presented different clinical opportunities. Based on initial quality thresholds for model fits, 88% of those individuals were identified as adequate for session optimization planning using the developed dashboard, while 12% supported more thorough treatment planning (e.g. different treatment modalities). In the clinical pilot, 90% of clinicians reported using the dashboard a few times or more per member. Although most clinicians (67.5%) either rarely or never used the dashboard to change session types, numerous other discussions were enabled, and opportunities for automating session recommendations were identified. CONCLUSIONS It is possible to model and identify the extent to which mental healthcare services can resolve depressive symptom severity fluctuations. Implementation of one such prototype framework in a real-world clinic represents an advancement in mental healthcare treatment planning; however, investigations to assess which clinical endpoints are impacted by this technology, and the best way to incorporate such frameworks into clinical workflows, are needed and are actively being pursued.
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Affiliation(s)
- Jonathan Knights
- Mindstrong, Inc., 101 Jefferson Drive, Suite 228, Menlo Park, CA, 94025, USA.
| | - Victoria Bangieva
- Mindstrong, Inc., 101 Jefferson Drive, Suite 228, Menlo Park, CA, 94025, USA
| | - Michela Passoni
- Mindstrong, Inc., 101 Jefferson Drive, Suite 228, Menlo Park, CA, 94025, USA
| | - Macayla L Donegan
- Mindstrong, Inc., 101 Jefferson Drive, Suite 228, Menlo Park, CA, 94025, USA
| | - Jacob Shen
- Mindstrong, Inc., 101 Jefferson Drive, Suite 228, Menlo Park, CA, 94025, USA
| | - Audrey Klein
- Mindstrong, Inc., 101 Jefferson Drive, Suite 228, Menlo Park, CA, 94025, USA
| | - Justin Baker
- Mindstrong, Inc., 101 Jefferson Drive, Suite 228, Menlo Park, CA, 94025, USA
| | - Holly DuBois
- Mindstrong, Inc., 101 Jefferson Drive, Suite 228, Menlo Park, CA, 94025, USA
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Turi E, McMenamin A, Kueakomoldej S, Kurtzman E, Poghosyan L. The effectiveness of nurse practitioner care for patients with mental health conditions in primary care settings: A systematic review. Nurs Outlook 2023; 71:101995. [PMID: 37343483 PMCID: PMC10592550 DOI: 10.1016/j.outlook.2023.101995] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND The nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings. PURPOSE The purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders. METHODS Studies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included. FINDINGS Seventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms. DISCUSSION More high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings.
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Affiliation(s)
- Eleanor Turi
- School of Nursing, Columbia University, New York, NY.
| | - Amy McMenamin
- School of Nursing, Columbia University, New York, NY.
| | | | - Ellen Kurtzman
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ.
| | - Lusine Poghosyan
- School of Nursing, Columbia University, New York, NY; Mailman School of Public Health, Columbia University, New York, NY.
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Cascalheira CJ, Flinn RE, Zhao Y, Klooster D, Laprade D, Hamdi SM, Scheer JR, Gonzalez A, Lund EM, Gomez IN, Saha K, De Choudhury M. Models of Gender Dysphoria Using Social Media Data for Use in Technology-Delivered Interventions: Machine Learning and Natural Language Processing Validation Study. JMIR Form Res 2023; 7:e47256. [PMID: 37327053 DOI: 10.2196/47256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/28/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The optimal treatment for gender dysphoria is medical intervention, but many transgender and nonbinary people face significant treatment barriers when seeking help for gender dysphoria. When untreated, gender dysphoria is associated with depression, anxiety, suicidality, and substance misuse. Technology-delivered interventions for transgender and nonbinary people can be used discretely, safely, and flexibly, thereby reducing treatment barriers and increasing access to psychological interventions to manage distress that accompanies gender dysphoria. Technology-delivered interventions are beginning to incorporate machine learning (ML) and natural language processing (NLP) to automate intervention components and tailor intervention content. A critical step in using ML and NLP in technology-delivered interventions is demonstrating how accurately these methods model clinical constructs. OBJECTIVE This study aimed to determine the preliminary effectiveness of modeling gender dysphoria with ML and NLP, using transgender and nonbinary people's social media data. METHODS Overall, 6 ML models and 949 NLP-generated independent variables were used to model gender dysphoria from the text data of 1573 Reddit (Reddit Inc) posts created on transgender- and nonbinary-specific web-based forums. After developing a codebook grounded in clinical science, a research team of clinicians and students experienced in working with transgender and nonbinary clients used qualitative content analysis to determine whether gender dysphoria was present in each Reddit post (ie, the dependent variable). NLP (eg, n-grams, Linguistic Inquiry and Word Count, word embedding, sentiment, and transfer learning) was used to transform the linguistic content of each post into predictors for ML algorithms. A k-fold cross-validation was performed. Hyperparameters were tuned with random search. Feature selection was performed to demonstrate the relative importance of each NLP-generated independent variable in predicting gender dysphoria. Misclassified posts were analyzed to improve future modeling of gender dysphoria. RESULTS Results indicated that a supervised ML algorithm (ie, optimized extreme gradient boosting [XGBoost]) modeled gender dysphoria with a high degree of accuracy (0.84), precision (0.83), and speed (1.23 seconds). Of the NLP-generated independent variables, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) clinical keywords (eg, dysphoria and disorder) were most predictive of gender dysphoria. Misclassifications of gender dysphoria were common in posts that expressed uncertainty, featured a stressful experience unrelated to gender dysphoria, were incorrectly coded, expressed insufficient linguistic markers of gender dysphoria, described past experiences of gender dysphoria, showed evidence of identity exploration, expressed aspects of human sexuality unrelated to gender dysphoria, described socially based gender dysphoria, expressed strong affective or cognitive reactions unrelated to gender dysphoria, or discussed body image. CONCLUSIONS Findings suggest that ML- and NLP-based models of gender dysphoria have significant potential to be integrated into technology-delivered interventions. The results contribute to the growing evidence on the importance of incorporating ML and NLP designs in clinical science, especially when studying marginalized populations.
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Affiliation(s)
- Cory J Cascalheira
- Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, United States
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Ryan E Flinn
- Augusta University, Augusta, GA, United States
- University of North Dakota, Grand Forks, ND, United States
| | - Yuxuan Zhao
- Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, United States
| | | | - Danica Laprade
- Northern Arizona University, Flagstaff, AZ, United States
| | - Shah Muhammad Hamdi
- Department of Computer Science, Utah State University, Logan, UT, United States
| | - Jillian R Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | | | - Emily M Lund
- University of Alabama, Tuscaloosa, AL, United States
- Ewha Women's University, Seoul, Republic of Korea
| | - Ivan N Gomez
- Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, United States
| | - Koustuv Saha
- University of Illinois at Urbana-Champaign, Champaign, IL, United States
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Riblet NB, Matsunaga S, Shiner B, Schnurr PP, Watts BV. Are suicide risk scales sensitive to change? A scoping review. J Psychiatr Res 2023; 161:170-178. [PMID: 36931135 PMCID: PMC10149613 DOI: 10.1016/j.jpsychires.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION Clinician- or self-administered scales are frequently used to assist in detecting risk of death by suicide and to determine the effectiveness of interventions. No recent review studies have examined whether these scales are sensitive to change. We conducted a scoping review to identify suicide risk scales that are sensitive to change. MATERIAL AND METHODS We searched Medline and Excerpta Medica Database from inception through March 17, 2022, to identify randomized trials, pooled analysis, quasi-experimental studies, and cohort studies reporting on sensitivity to change of suicide risk scales. We assessed sensitivity to change by examining internal and external responsiveness. Internal responsiveness evaluates whether the scale measures changes in suicide-related symptoms in response to an intervention while external responsiveness assess whether changes in the scale correspond to changes in risk of suicide. We summarized findings across studies using descriptive analysis. RESULTS Among 38 eligible scales, we identified 27 scales that included items that were modifiable to change. However, only 7 scales had been studied to determine their sensitivity to change based on internal or external responsiveness. While the results of studies suggested that 6 scales have internal responsiveness, none of the included studies confirmed that scales have external responsiveness. DISCUSSION A few suicide risk scales are internally responsive and may be useful in a clinical or research setting. It is unclear, however, whether changes in scores correspond to an actual change in suicide risk. Future research should confirm the external responsiveness of scales using robust metrics including suicide mortality.
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Affiliation(s)
- Natalie B Riblet
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA.
| | - Sarah Matsunaga
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA
| | - Brian Shiner
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA; National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, USA
| | - Paula P Schnurr
- Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA; National Center for PTSD, 215 North Main Street, White River Junction, VT, 05009, USA
| | - Bradley V Watts
- Veterans Affairs Medical Center, Mental Health Service, 215 North Main Street, White River Junction, VT, 05009, USA; Geisel School of Medicine at Dartmouth College, 1 Rope Ferry Road, Hanover NH, 03755, USA; Veterans Rural Health Resource Center, White River Junction VA Medical Center, White River Junction, VT, 05009, USA
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Urmanche AA, Solomonov N, Sankin LS, Subramanyam A, Pedreza-Cumba M, Scaduto L, Garcia J, Jockers K, Wolf R, Sirey JA. Research-Practice Partnership to Develop and Implement Routine Mental Health Symptom Tracking Tool Among Older Adults During COVID-19. Am J Geriatr Psychiatry 2023; 31:326-337. [PMID: 36641298 PMCID: PMC9788852 DOI: 10.1016/j.jagp.2022.12.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Older adults are disproportionally impacted by the COVID-19 pandemic, causing a mental health crisis in late life, due to physical restrictions (e.g., quarantine), limited access to services, and lower literacy and access to technology. Despite established benefits, systematic screening of mental health needs of older adults in community and routine care settings is limited and presents multiple challenges. Cross-disciplinary collaborations are essential for identification and evaluation of mental health needs and service delivery. METHODS Using a research-practice partnership model, we developed and implemented a routine mental health needs identification and tracking tool at a community-based social services organization. Repeated screenings were conducted remotely over 5 months and included depression, anxiety, perceived loneliness, social support, and related domains such as sleep quality, resilience, and trauma symptoms linked to COVID-19. We examined symptomatic distress levels and associations between different domains of functioning. RESULTS Our project describes the process of establishing a research-practice partnership during the COVID-19 pandemic. We collected 292 screenings from 124 individuals; clients were mildly to moderately depressed and anxious, reporting large amounts of time alone and moderate levels of loneliness. Those reporting higher depressive symptoms reported higher anxiety symptoms, poorer sleep quality, lower quality of life, lower capacity to adapt to challenging situations, and greater trauma symptoms due to COVID-19. CONCLUSION Our routine screening tool can serve as a blueprint for case management agencies and senior centers nationwide, beyond the pressing mental health crisis due to COVID-19, to continue identifying needs as they emerge in the community.
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Affiliation(s)
- Adelya A Urmanche
- Weill Cornell Institute of Geriatric Psychiatry (AAU, NS, LSS, JAS), Weill Cornell Medical College, New York, NY; Mount Sinai Beth Israel (AAU), New York, NY
| | - Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry (AAU, NS, LSS, JAS), Weill Cornell Medical College, New York, NY
| | - Lindsey S Sankin
- Weill Cornell Institute of Geriatric Psychiatry (AAU, NS, LSS, JAS), Weill Cornell Medical College, New York, NY
| | | | | | | | | | - Ken Jockers
- Hudson Guild (AS, MPC, LS, JG, KJ, RW), New York, NY
| | - Robert Wolf
- Hudson Guild (AS, MPC, LS, JG, KJ, RW), New York, NY
| | - Jo Anne Sirey
- Weill Cornell Institute of Geriatric Psychiatry (AAU, NS, LSS, JAS), Weill Cornell Medical College, New York, NY.
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Marriott BR, Walker MR, Howard J, Puspitasari A, Scott K, Albright K, Lewis CC. Taking a Magnifying Glass to Measurement-Based Care Consultation Sessions: with What Issues Do Mental Health Clinicians Struggle? ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:366-378. [PMID: 36542316 PMCID: PMC10201798 DOI: 10.1007/s10488-022-01244-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Ongoing consultation following initial training is one of the most commonly deployed implementation strategies to facilitate uptake of evidence-based practices, such as measurement-based care (MBC). Group consultation provides an interactive experience with an expert and colleagues to get feedback on actual issues faced, yet there is little research that unpacks the questions raised in consultation and what types of issues are important to address. METHODS The current study characterized the questions and concerns raised by community mental health clinicians (N = 38 across six clinics) during group consultation sessions completed as part of an MBC implementation trial. We conducted a qualitative content analysis of consultation forms completed by clinicians before each MBC consultation session. RESULTS Clinicians sought MBC consultation for clients across a range of ages and levels of depression severity. Qualitative results revealed five main questions and concerns in consultation sessions: (1) how to administer the PHQ-9, (2) how to review PHQ-9 scores, (3) how to respond to PHQ-9 score, (4) the types of clients for whom MBC would be appropriate, and (5) how MBC could impact a clinician's usual care. CONCLUSION Findings highlight the need for ongoing consultation and limitations of workshop training alone. Practical recommendations for addressing the common questions and concerns identified are presented to support MBC use.
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Affiliation(s)
- Brigid R Marriott
- Department of Psychiatry, Indiana University School of Medicine, 410 W. 10th St, 46202, Indianapolis, IN, USA.
| | - Madison R Walker
- University of North Carolina, 135 Dauer Dr, 27599, Chapel Hill, NC, USA
| | | | - Ajeng Puspitasari
- Rogers Behavioral Health, 576 Bielenberg Dr Ste 180, 55125, Woodbury, MN, USA
| | - Kelli Scott
- Brown University, 121 S. Main Street, 02903, Providence, RI, USA
| | - Karen Albright
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Ave, 80045, Aurora, CO, USA
| | - Cara C Lewis
- MacColl Center for Healthcare Innovation, Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, 98101, Seattle, WA, USA
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Matson TE, Hallgren KA, Lapham GT, Oliver M, Wang X, Williams EC, Bradley KA. Psychometric Performance of a Substance Use Symptom Checklist to Help Clinicians Assess Substance Use Disorder in Primary Care. JAMA Netw Open 2023; 6:e2316283. [PMID: 37234003 PMCID: PMC10220521 DOI: 10.1001/jamanetworkopen.2023.16283] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
Importance Substance use disorders (SUDs) are underrecognized in primary care, where structured clinical interviews are often infeasible. A brief, standardized substance use symptom checklist could help clinicians assess SUD. Objective To evaluate the psychometric properties of the Substance Use Symptom Checklist (hereafter symptom checklist) used in primary care among patients reporting daily cannabis use and/or other drug use as part of population-based screening and assessment. Design, Setting, and Participants This cross-sectional study was conducted among adult primary care patients who completed the symptom checklist during routine care between March 1, 2015, and March 1, 2020, at an integrated health care system. Data analysis was conducted from June 1, 2021, to May 1, 2022. Main Outcomes and Measures The symptom checklist included 11 items corresponding to SUD criteria in the Diagnostic and Statistical Manual for Mental Disorders (Fifth Edition) (DSM-5). Item response theory (IRT) analyses tested whether the symptom checklist was unidimensional and reflected a continuum of SUD severity and evaluated item characteristics (discrimination and severity). Differential item functioning analyses examined whether the symptom checklist performed similarly across age, sex, race, and ethnicity. Analyses were stratified by cannabis and/or other drug use. Results A total of 23 304 screens were included (mean [SD] age, 38.2 [5.6] years; 12 554 [53.9%] male patients; 17 439 [78.8%] White patients; 20 393 [87.5%] non-Hispanic patients). Overall, 16 140 patients reported daily cannabis use only, 4791 patients reported other drug use only, and 2373 patients reported both daily cannabis and other drug use. Among patients with daily cannabis use only, other drug use only, or both daily cannabis and other drug use, 4242 (26.3%), 1446 (30.2%), and 1229 (51.8%), respectively, endorsed 2 or more items on the symptom checklist, consistent with DSM-5 SUD. For all cannabis and drug subsamples, IRT models supported the unidimensionality of the symptom checklist, and all items discriminated between higher and lower levels of SUD severity. Differential item functioning was observed for some items across sociodemographic subgroups but did not result in meaningful change (<1 point difference) in the overall score (0-11). Conclusions and Relevance In this cross-sectional study, a symptom checklist, administered to primary care patients who reported daily cannabis and/or other drug use during routine screening, discriminated SUD severity as expected and performed well across subgroups. Findings support the clinical utility of the symptom checklist for standardized and more complete SUD symptom assessment to help clinicians make diagnostic and treatment decisions in primary care.
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Affiliation(s)
- Theresa E. Matson
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research & Development Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Kevin A. Hallgren
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Gwen T. Lapham
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Xiaoming Wang
- Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
| | - Emily C. Williams
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Health Services Research & Development Center for Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Katharine A. Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Department of Medicine, University of Washington School of Medicine, Seattle
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50
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Ko H, Gatto AJ, Jones SB, O'Brien VC, McNamara RS, Tenzer MM, Sharp HD, Kablinger AS, Cooper LD. Improving measurement-based care implementation in adult ambulatory psychiatry: a virtual focus group interview with multidisciplinary healthcare professionals. BMC Health Serv Res 2023; 23:408. [PMID: 37101134 PMCID: PMC10132409 DOI: 10.1186/s12913-023-09202-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 02/20/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Measurement-Based Care (MBC) is an evidence-based practice shown to enhance patient care. Despite being efficacious, MBC is not commonly used in practice. While barriers and facilitators of MBC implementation have been described in the literature, the type of clinicians and populations studied vary widely, even within the same practice setting. The current study aims to improve MBC implementation in adult ambulatory psychiatry by conducting focus group interviews while utilizing a novel virtual brainwriting premortem method. METHODS Semi-structured focus group interviews were conducted with clinicians (n = 18) and staff (n = 7) to identify their current attitudes, facilitators, and barriers of MBC implementation in their healthcare setting. Virtual video-conferencing software was used to conduct focus groups, and based on transcribed verbatin, emergent barriers/facilitators and four themes were identified. Mixed methods approach was utilized for this study. Specifically, qualitative data was aggregated and re-coded separately by three doctoral-level coders. Quantitative analyses were conducted from a follow-up questionnaire surveying clinician attitudes and satisfaction with MBC. RESULTS The clinician and staff focus groups resulted in 291 and 91 unique codes, respectively. While clinicians identified a similar number of barriers (40.9%) and facilitators (44.3%), staff identified more barriers (67%) than facilitators (24.7%) for MBC. Four themes emerged from the analysis; (1) a description of current status/neutral opinion on MBC; (2) positive themes that include benefits of MBC, facilitators, enablers, or reasons on why they conduct MBC in their practice, (3) negative themes that include barriers or issues that hinder them from incorporating MBC into their practice, and (4) requests and suggestions for future MBC implementation. Both participant groups raised more negative themes highlighting critical challenges to MBC implementation than positive themes. The follow-up questionnaire regarding MBC attitudes showed the areas that clinicians emphasized the most and the least in their clinical practice. CONCLUSION The virtual brainwriting premortem focus groups provided critical information on the shortcomings and strengths of MBC in adult ambulatory psychiatry. Our findings underscore implementation challenges in healthcare settings and provide insight for both research and clinical practice in mental health fields. The barriers and facilitators identified in this study can inform future training to increase sustainability and better integrate MBC with positive downstream outcomes in patient care.
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Affiliation(s)
- Hayoung Ko
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA.
| | - Alyssa J Gatto
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Sydney B Jones
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Virginia C O'Brien
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Robert S McNamara
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Martha M Tenzer
- Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia, USA
| | - Hunter D Sharp
- Health Analytics Research Team, Carilion Clinic, Roanoke, Virginia, USA
| | - Anita S Kablinger
- Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Lee D Cooper
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
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