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Abstract
PURPOSE OF REVIEW Assertive Community Treatment is an established evidenced based practice that provides intensive community treatment for individuals with severe mental illness with recurrent hospitalizations and/or homelessness. Emerging evidence indicates limitations in its implementation in terms of to the original ACT model and its current relevance. RECENT FINDINGS Findings from recent studies (2018-2020) reveals challenges with implementation centered around basic implementation activities, such as changes in the psychosocial context of individuals with SMI, clinicians' abilities to demonstrate competencies with new practices, and ongoing evolution of mental health systems of care worldwide. Intermediary and purveyor organizations (IPO) can provide the infrastructure to support the spread of EBPs while addressing challenges and opportunities. Thus, implementation of ACT can be accomplished when employing a rigorous framework and infrastructure that can synthesize and translate science relevant for practice. SUMMARY The relevance of ACT depends on its implementation that is responsive to change. An implementation science-informed approach is key to providing ACT to individuals in the critical space between the hospital and community. With this approach, we can optimize ACT as a service delivery vehicle by careful analysis of how best to furnish and evaluate the latest, most effective and efficient treatments, rehabilitation and support services.
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Perspectives of Treatment Providers and Clients with Serious Mental Illness Regarding Effective Therapeutic Relationships. J Behav Health Serv Res 2018; 43:341-53. [PMID: 26658917 DOI: 10.1007/s11414-015-9492-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study explores the nature of clinical therapeutic relationships between mental health treatment providers and high-need clients with serious mental illness who had recently discontinued treatment. Semi-structured qualitative interviews of 56 clients with serious mental illness who had recently discontinued care and 25 mental health treatment providers were completed. Both clients with serious mental illness and treatment providers emphasized the importance of client-focused goal setting, time and availability of treatment providers, a caring approach, and trust and honesty in the relationship. However, clients with serious mental illness placed greater emphasis on goals involving tangible services, a notable area of discord between the two groups. Individuals with serious mental illness and treatment providers agreed regarding several key elements to a positive clinical relationship. Further attention to client goals related to tangible services may serve to improve relationships between treatment providers and high-need clients with serious mental illness.
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Hoagwood KE, Essock S, Morrissey J, Libby A, Donahue S, Druss B, Finnerty M, Frisman L, Narasimhan M, Stein BD, Wisdom J, Zerzan J. Use of Pooled State Administrative Data for Mental Health Services Research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:67-78. [PMID: 25578511 PMCID: PMC4500680 DOI: 10.1007/s10488-014-0620-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
State systems are a rich, albeit challenging, laboratory for policy-relevant services research studies. State mental health authorities routinely devote resources to collect data for state planning and reporting purposes. However, these data are rarely used in cross-state comparisons to inform state or federal policy development. In 2008, in response to key recommendations from the National Institute of Mental Health (NIMH) Advisory Council's "The Road Ahead: Research Partnership to Transform Services," (http://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/reports/road-ahead.pdf), NIMH issued a request for applications (RFA) to support studies on the impact of state policy changes on access, cost, quality and outcomes of care for individuals with mental disorders. The purpose of the RFA was to bridge the divide between research and policy by encouraging research that used state administrative data across states, and to address significant state-defined health policy initiatives. Five projects involving eight states were selected through peer review for funding. Projects began in 2009 and were funded for 3 years. This report provides a brief description of the five projects, followed by an analysis of the impact, challenges, and lessons learned from these policy-partnered studies. We conclude by offering suggestions on ways to use state administrative data for informing state health policies, which is especially timely given national and state changes in the structure and financing of healthcare.
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Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York, USA.
| | - Susan Essock
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Joseph Morrissey
- Cecil G. Sheps Center for Health Services Research, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Anne Libby
- School of Medicine, University of Colorado Health Sciences Center, Denver, USA
| | - Sheila Donahue
- New York State Office of Mental Health (OMH), Albany, USA
| | - Benjamin Druss
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - Molly Finnerty
- New York State Office of Mental Health (OMH), Albany, USA.,Bureau of Evidence Based Services & Implementation Science, NYS Psychiatric Institute, New York, USA
| | - Linda Frisman
- School of Social Work, University of Connecticut, Storrs, USA
| | - Meera Narasimhan
- Department of Neuropsychiatry and Behavioral Sciences, School of Medicine, University of South Carolina, Columbia, USA
| | - Bradley D Stein
- RAND Corporation, School of Medicine, Pittsburgh, USA.,School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Jennifer Wisdom
- Office of the Vice President for Research, George Washington University, Washington, USA
| | - Judy Zerzan
- Colorado Department of Health Care Policy and Financing, Denver, USA
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Essock SM, Olfson M, Hogan MF. Current practices for measuring mental health outcomes in the USA: International overview of routine outcome measures in mental health. Int Rev Psychiatry 2016; 27:296-305. [PMID: 25800077 DOI: 10.3109/09540261.2015.1014314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The prevalence and impact of mental health conditions calls for measuring the adequacy of care, but progress in measuring mental health outcomes in the USA has been uneven, with some important domains (such as employment and other measures of everyday functioning) rarely captured. Bright spots include progress in adopting uniform measures of the quality of inpatient mental healthcare and early progress in measuring adequacy of medication and psychotherapy treatment. To some extent, progress in measurement has been limited by separate governing structures and payment rules in mental health and overall health settings. This is becoming a critical problem as awareness of the scope and impact of mental health co-morbidities emerges at the same time as pressures for healthcare cost controls intensify. A search for better measures may be accelerated as problems linked to co-morbid mental health problems (e.g. readmission to hospitals) come into sharper focus due to changes in healthcare financing related to the US Patient Protection and Affordable Care Act, 2010.
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Affiliation(s)
- Susan M Essock
- New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York
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Stein BD, Pangilinan M, Sorbero MJ, Marcus SM, Donahue SA, Xu Y, Smith TE, Essock SM. Using claims data to generate clinical flags predicting short-term risk of continued psychiatric hospitalizations. Psychiatr Serv 2014; 65:1341-6. [PMID: 25022360 PMCID: PMC4315754 DOI: 10.1176/appi.ps.201300306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE As health information technology advances, efforts to use administrative data to inform real-time treatment planning for individuals are increasing, despite few empirical studies demonstrating that such administrative data predict subsequent clinical events. Medicaid claims for individuals with frequent psychiatric hospitalizations were examined to test how well patterns of service use predict subsequent high short-term risk of continued psychiatric hospitalizations. METHODS Medicaid claims files from New York and Pennsylvania were used to identify Medicaid recipients ages 18-64 with two or more inpatient psychiatric admissions during a target year ending March 31, 2009. Definitions from a quality-improvement initiative were used to identify patterns of inpatient and outpatient service use and prescription fills suggestive of clinical concerns. Generalized estimating equations and Markov models were applied to examine claims through March 2011, to see what patterns of service use were sufficiently predictive of additional hospitalizations to be clinically useful. RESULTS A total of 11,801 individuals in New York and 1,859 in Pennsylvania identified met the cohort definition. In both Pennsylvania and New York, multiple recent hospitalizations, but not failure to use outpatient services or failure to fill medication prescriptions, were significant predictors of high risk of continued frequent hospitalizations, with odds ratios greater than 4.0. CONCLUSIONS Administrative data can be used to identify individuals at high risk of continued frequent hospitalizations. Payers and system administrators could use such information to authorize special services (such as mobile outreach) for such individuals to promote service engagement and prevent rapid rehospitalizations.
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Affiliation(s)
- Bradley D Stein
- Dr. Stein and Mr. Sorbero are with RAND Corporation, Pittsburgh (e-mail: ). Dr. Stein is also with the Department of Psychiatry, University of Pittsburgh. Dr. Pangilinan, Ms. Donahue, and Ms. Xu are with the Office of Performance Measurement and Evaluation, New York State Office of Mental Health, Albany. Dr. Marcus, Dr. Smith, and Dr. Essock are with the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Marcus is also with the Department of Biostatistics, Columbia University Mailman School of Public Health. Dr. Smith and Dr. Essock are also with Mental Health Services and Policy Research, New York State Psychiatric Institute, New York City
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Smith TE, Stein BD, Donahue SA, Sorbero MJ, Karpati A, Marsik T, Myers RW, Thomann-Howe D, Appel A, Essock SM. Reengagement of high-need individuals with serious mental illness after discontinuation of services. Psychiatr Serv 2014; 65:1378-80. [PMID: 25124372 PMCID: PMC4610129 DOI: 10.1176/appi.ps.201300549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study determined rates of reengagement in services for individuals with serious mental illness who had discontinued services. METHODS As part of a quality assurance program in New York City involving continuous review of Medicaid claims and other administrative data, clinician care monitors identified 2,834 individuals with serious mental illness who were apparently in need of care but disengaged from services. The care monitors reviewed monthly updates of Medicaid claims, encouraged outreach from providers who had previously worked with identified individuals, and determined whether individuals had reengaged in services. RESULTS Reengagement rates over a 12-month follow-up period were low, particularly for individuals who had been incarcerated or for whom no service provider was available to provide outreach. CONCLUSIONS Subgroups of disengaged individuals with serious mental illness have different rates of reengagement. Active outreach by providers might benefit some, but such targeting is inefficient when the individual cannot be located.
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Affiliation(s)
- Thomas E Smith
- Dr. Smith and Dr. Essock are with the Department of Psychiatry, College of Physicians and Surgeons, Columbia University, and with the New York State Psychiatric Institute, New York City (e-mail: ). Dr. Stein is with the Department of Psychiatry, University of Pittsburgh, and with RAND Corporation, Pittsburgh. Ms. Donahue is with the New York State Office of Mental Health, Albany. Mr. Sorbero is with Community Care Behavioral Health Organization, Pittsburgh. Dr. Karpati is with the International Union Against Tuberculosis and Lung Disease, New York City. Ms. Marsik is with the New York City Department of Health and Mental Hygiene. Dr. Myers and Ms. Appel are with the New York State Office of Mental Health, Albany and New York City. Ms. Thomann-Howe is with Harlem United, New York City
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