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Li S, Gulley J, Booty M, Firchow B, McGladrey ML. Using Photovoice to Improve Engagement in Community Health Assessments Addressing Behavioral Health. J Behav Health Serv Res 2024:10.1007/s11414-024-09885-4. [PMID: 38710979 DOI: 10.1007/s11414-024-09885-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 05/08/2024]
Abstract
Behavioral health disorders are well-known to have close links with the social determinants of health, yet little is known about how impacted communities perceive these links. Qualitative participatory methods can not only provide insight into how communities conceptualize these relationships but also empower those with lived experience to contextualize their perspectives and formulate calls to action. This study used Photovoice as a participatory method to supplement the Clark County Health Department Community Health Assessment and determine priority facilitators and barriers contributing to the behavioral health of Clark County, KY, residents. A secondary aim was to gain a greater understanding of how the Photovoice methodology impacts community engagement efforts in Community Health Assessments. Twenty-three Clark County residents participated in four Photovoice groups involving five weekly sessions, which included photograph "show and tell," critical group dialogue, participatory analysis, and planning for dissemination. Secondary analysis of Photovoice focus group discussions revealed behavioral health facilitators and barriers were most influenced by (1) public sector unresponsiveness, (2) strong partnerships formed between community and grassroots organizations, and (3) the siloed division of responsibility between agencies and across sectors. The authors also found the Photovoice method successfully enhanced engagement and empowered those with lived experience to frame their perspectives of the behavioral health landscape. This project has implications for enhancing community engagement and empowerment in behavioral health-focused public health assessments and shaping policy to promote multi-sector collaboration.
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Affiliation(s)
- Stacey Li
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, 70118, USA.
| | | | - Marisa Booty
- University of Kentucky College of Arts and Sciences, Lexington, KY, 40506, USA
| | - Bradley Firchow
- University of Kentucky College of Medicine, Lexington, KY, 40506, USA
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Mark TL, Henretty K, Gibbons BJ, Zarkin GA. Association of Arizona's Implementation of a Behavioral Health Crisis Response System With Suicide Hospitalizations. Psychiatr Serv 2024; 75:148-154. [PMID: 37554005 DOI: 10.1176/appi.ps.20220628] [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] [Indexed: 08/10/2023]
Abstract
OBJECTIVE In July 2022, the 988 Suicide and Crisis Lifeline went live. The Lifeline is part of larger federal and state efforts to build comprehensive behavioral health crisis response systems that include mobile crisis units and crisis diversion and stabilization centers. Comprehensive response systems are anticipated to reduce hospitalizations for suicide and other behavioral health crises; however, research testing this assumption has been limited. The authors used Arizona-a state known for its comprehensive crisis system-to determine the association between state implementation of a comprehensive behavioral health crisis response system and suicide-related hospitalizations. METHODS A comparative interrupted time-series (CITS) design was used to compare changes in suicide-related hospitalizations after the 2015 implementation of Arizona's crisis response system (N=215,063). Data were from the 2010-2019 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID). Nevada (N=84,091 hospitalizations) was used as a comparison state because it is a western state that had not yet implemented a comprehensive crisis system and had available HCUP SID data. The CITS model included controls for time-varying differences in state demographic composition. RESULTS From 2010 to 2014 to 2019, annual suicide-related hospitalizations in Arizona increased from 122.0 to 324.2 to 584.5, respectively, per 100,000 people, and in Nevada, hospitalizations increased from 94.7 to 263.2 to 595.5, respectively, per 100,000 people. Arizona's crisis response system was associated with a significant relative decrease in the quarterly trend of 2.57 suicide-related hospitalizations per 100,000 people (p=0.033). CONCLUSIONS More research is needed to understand how the implementation of a comprehensive crisis response system may affect suicide-related hospitalizations.
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Drake RE, Bond GR, Mascayano F. Modification of the Individual Placement and Support Model of Supported Employment. Psychiatr Serv 2023:appips20220484. [PMID: 36718603 DOI: 10.1176/appi.ps.20220484] [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: 02/01/2023]
Abstract
Individual placement and support (IPS) is a robust evidence-based model of supported employment for people with mental health conditions that has been implemented in high-income countries. The model is now being extended to new populations and settings, often with modifications. Current evidence indicates that minor modifications may increase fit, major alterations of core principles generally reduce effectiveness, and augmentations have mixed success. The authors recommend that those who implement IPS adhere to its core principles whenever possible, use standardized methods to document and assess modifications, and follow basic scientific procedures to develop, measure, and evaluate modifications before recommending policy changes.
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Affiliation(s)
- Robert E Drake
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Drake); Westat, Lebanon, New Hampshire (Drake, Bond); New York State Psychiatric Institute and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano)
| | - Gary R Bond
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Drake); Westat, Lebanon, New Hampshire (Drake, Bond); New York State Psychiatric Institute and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano)
| | - Franco Mascayano
- Columbia University Vagelos College of Physicians and Surgeons, New York City (Drake); Westat, Lebanon, New Hampshire (Drake, Bond); New York State Psychiatric Institute and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City (Mascayano)
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Smith TE, Bury D, Hendrick D, Morse G, Drake RE. Barriers to Client Engagement and Strategies to Improve Participation in Mental Health and Supported Employment Services. Psychiatr Serv 2023; 74:38-43. [PMID: 36065584 DOI: 10.1176/appi.ps.202200023] [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: 01/04/2023]
Abstract
OBJECTIVE A few clients in every mental health center present challenging behaviors, have difficulty engaging in services, and create stress within the treatment team. The authors provided consultations on clients with these characteristics over 4 years in the Social Security Administration's Supported Employment Demonstration (SED). METHODS Four experienced community mental health leaders provided consultations on 105 of nearly 2,000 clients receiving team-based behavioral health and employment services in the SED. Using document analysis, consultants coded their notes and identified themes that described barriers to client engagement and strategies teams used to overcome them. RESULTS Clients who were difficult to engage experienced complex and interacting behavioral health, medical, and social conditions, which made it hard for therapists to develop therapeutic relationships and help clients find employment. Faced with engagement barriers, staff were often discouraged and felt hopeless about achieving success. To address these barriers, consultants and teams developed several strategies: using supervisors and teammates for support, providing persistent outreach, pursuing referrals and consultations to help with complex conditions, and developing realistic goals. CONCLUSIONS Supervisors, team leaders, and consultants in community mental health settings should help staff develop realistic strategies to manage the small number of clients whose behaviors present the greatest challenges. Effective strategies involve providing team-based outreach and support, fostering staff morale, obtaining specialist consultations regarding complex conditions, and calibrating realistic goals.
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Affiliation(s)
- Thomas E Smith
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Debra Bury
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Delia Hendrick
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Gary Morse
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
| | - Robert E Drake
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York City (Smith); Westat, Lebanon, New Hampshire (Bury, Drake); WestBridge Recovery Center, Manchester, New Hampshire (Hendrick); Places for People, St. Louis (Morse)
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Johnson S, Dalton‐Locke C, Baker J, Hanlon C, Salisbury TT, Fossey M, Newbigging K, Carr SE, Hensel J, Carrà G, Hepp U, Caneo C, Needle JJ, Lloyd‐Evans B. Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care. World Psychiatry 2022; 21:220-236. [PMID: 35524608 PMCID: PMC9077627 DOI: 10.1002/wps.20962] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best ap-proaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision-making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low- and middle-income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low-resource settings may lead to wider learning from locally embedded strategies.
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Affiliation(s)
- Sonia Johnson
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | | | - John Baker
- School of Healthcare, University of LeedsLeedsUK
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK,Department of PsychiatrySchool of Medicine, and Centre for Innovative Drug Development and Therapeutic Trials for Africa, College of Health Sciences, Addis Ababa UniversityAddis AbabaEthiopia
| | - Tatiana Taylor Salisbury
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Matt Fossey
- Faculty of Health, Education, Medicine and Social CareAnglia Ruskin UniversityChelmsfordUK
| | - Karen Newbigging
- Department of PsychiatryUniversity of OxfordOxfordUK,Institute for Mental Health, University of BirminghamBirminghamUK
| | - Sarah E. Carr
- Health Service and Population Research DepartmentInstitute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondonUK
| | - Jennifer Hensel
- Department of PsychiatryUniversity of ManitobaWinnipegMBCanada
| | - Giuseppe Carrà
- Department of Medicine and SurgeryUniversity of Milano BicoccaMilanItaly
| | - Urs Hepp
- Integrated Psychiatric Services Winterthur, Zürcher UnterlandWinterthurSwitzerland
| | - Constanza Caneo
- Departamento de Psiquiatría, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
| | - Justin J. Needle
- Centre for Health Services Research, School of Health Sciences, City, University of LondonLondonUK
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Whitley K, Tastenhoye C, Downey A, Rozel JS. Mental Health Care of Detained Youth Within Juvenile Detention Facilities. Child Adolesc Psychiatr Clin N Am 2022; 31:31-44. [PMID: 34801154 DOI: 10.1016/j.chc.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Mental health treatment of juvenile offenders and undocumented immigrant youth in detention provides a unique opportunity for treatment providers. Although the work may be challenging, the clinical needs and opportunities for early and meaningful interventions are significant. One of the best clinical experiences a psychiatrist can have is working with extremely high-risk youth to help them find safer and better developmental pathways. Few settings can offer such an opportunity to leverage clinical skills to improve the lives and futures of children and adolescents as are afforded to those professionals lucky enough to work in juvenile justice settings.
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Affiliation(s)
- Kevin Whitley
- Southwood Psychiatric Hospital, 2575 Boyce Plaza Road, Pittsburgh, PA 15241, USA
| | - Camille Tastenhoye
- Department of Psychiatry, University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Amanda Downey
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA 94118, USA
| | - John S Rozel
- University of Pittsburgh, resolve Crisis Services of UPMC Western Psychiatric Hospital, 333 N Braddock Avenue, Pittsburgh, PA 15208, USA.
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