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Oluwoye O, Puzia M, Amram O, Weeks DL. The Role of Proximity to Coordinated Specialty Care For Early Psychosis And Program Engagement in Washington State: The Interaction of Travel Time, Race, and Ethnicity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01397-9. [PMID: 39046688 DOI: 10.1007/s10488-024-01397-9] [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: 06/30/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE Proximity to mental health services is a predictor of timely access to services. The present study sought to investigate whether travel time was associated with engagement in coordinated specialty care (CSC) for early psychosis, with specific attention to whether the interaction of travel time by race and ethnicity had differential impact. DATA SOURCE/STUDY SETTING Data collected between 2019 and 2022 as part of the New Journeys evaluation, the CSC model in Washington State. STUDY DESIGN This cross-sectional study included a sample of 225 service users with first episode psychosis (FEP) who had received services from New Journeys. DATA COLLECTION Service users' addresses, and the physical location of CSC were geocoded. Spatial proximity was calculated as travel time in minutes. Scheduled appointments, attendance and program status were captured monthly by clinicians as part of the New Journeys measurement battery. PRINCIPAL FINDINGS Proximity was significantly associated with the number of appointments scheduled and attended, and program status (graduation/completion and disengagement). Among Hispanic service users with spatial proximity further away from CSC (longer commutes) was associated with a lower likelihood of graduating/completing CSC compared to non-Hispanic service users (p = .04). Non-white services users had a higher risk of disengagement from CSC compared to white service users (p = .03); additionally, the effects of spatial proximity on disengagement were amplified for non-White service users (p = .03). CONCLUSIONS Findings suggest that proximity is associated with program engagement and partially explains potential differences in program status among ethnoracial group.
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Affiliation(s)
- Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
- Elson S. Floyd College of Medicine, Washington State University, 412 E. Spokane Falls Blvd, Spokane, WA, 99202-1495, USA.
| | - Megan Puzia
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Douglas L Weeks
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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Kim B, Guyer M, Keshavan M. Using implementation science to operate as a learning health system to improve outcomes in early psychosis. Early Interv Psychiatry 2024; 18:374-380. [PMID: 38527863 DOI: 10.1111/eip.13496] [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: 09/26/2022] [Revised: 09/23/2023] [Accepted: 01/24/2024] [Indexed: 03/27/2024]
Abstract
AIM Early interventions are well understood to improve psychosis outcomes, but their successful implementation remains limited. This article introduces a three-step roadmap for advancing the implementation of evidence-based practices to operate as a learning health system, which can be applied to early interventions for psychosis and is intended for an audience that is relatively new to systematic approaches to implementation. METHODS The roadmap is grounded in implementation science, which specializes in methods to promote routine use of evidence-based innovations. The roadmap draws on learning health system principles that call for commitment of leadership, application of evidence, examination of care experiences, and study of health outcomes. Examples are discussed for each roadmap step, emphasizing both data- and stakeholder-related considerations applicable throughout the roadmap. CONCLUSIONS Early psychosis care is a promising topic through which to discuss the critical need to move evidence into practice. Despite remarkable advances in early psychosis interventions, population-level impact of those interventions is yet to be realized. By providing an introduction to how implementation science principles can be operationalized in a learning health system and sharing examples from early psychosis care, this article prompts inclusion of a wider audience in essential discourse on the role that implementation science can play for moving evidence into practice for other realms of psychiatric care as well. To this end, the proposed roadmap can serve as a conceptual guiding template and framework through which various psychiatric services can methodically pursue timely implementation of evidence-based interventions for higher quality care and improved outcomes.
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Affiliation(s)
- Bo Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Margaret Guyer
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Department of Mental Health, Boston, Massachusetts, USA
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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3
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DeLisi LE. A lifetime of mental health treatments for people with schizophrenia: update and narrative review. Curr Opin Psychiatry 2024; 37:140-146. [PMID: 38512852 DOI: 10.1097/yco.0000000000000926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW To provide a summary of the most up-to-date thoughts about treatment for schizophrenia at different stages of illness. RECENT FINDINGS The use of Coordinated Specialty Care clinics has arisen as the standard for early on in the treatment of psychosis, providing the notion that recovery is possible. New medications that do not depend on postsynaptic dopamine receptor blockade are soon becoming available. SUMMARY A focus should be made by clinicians to personalize treatment plans for each patient who has the possibility of being diagnosed with a primary psychosis and the plan should be to predict outcomes based on biological markers that include genetic vulnerability, early psychosocial combined with pharmacological treatments as needed and then a plan to determine or maintain treatments going forward into the future. It is important to individualize treatment by stage of illness, as well as characteristics of the individual patient. Research is ongoing to advance knowledge for interventions at each stage from the premorbid period through to chronicity.
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Affiliation(s)
- Lynn E DeLisi
- Department of Psychiatry, Cambridge Health Alliance, Department of Psychiatry, Harvard Medical School, Cambridge, Massachusetts, USA
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Hirschtritt ME, Staglin B, Buttlaire S, Ahearn K, Oglesby S, Dixon LB, Shern D, Ewing T, Niendam TA. Reimbursement for a Broader Array of Services in Coordinated Specialty Care for Early Psychosis. Psychiatr Serv 2024:appips20230551. [PMID: 38532691 DOI: 10.1176/appi.ps.20230551] [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: 03/28/2024]
Abstract
Despite the growing evidence supporting the benefits of coordinated specialty care (CSC) for early psychosis, access to this multimodal, evidence-based program in the United States has been hindered by a lack of funding for core CSC services and activities. The recent approval of team-based reimbursement codes by the Centers for Medicare and Medicaid Services has the potential to fund substantially more CSC services for clients with insurance coverage that accepts the new team-based billing codes. This streamlined and more inclusive billing strategy may reduce administrative burden and support the financial viability of CSC programs.
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Affiliation(s)
- Matthew E Hirschtritt
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Brandon Staglin
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Stuart Buttlaire
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Kerry Ahearn
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Sarada Oglesby
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Lisa B Dixon
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - David Shern
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Toby Ewing
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
| | - Tara A Niendam
- Division of Research, Kaiser Permanente Northern California, Oakland, and Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco (Hirschtritt); One Mind, Rutherford, California (Staglin); Permanente Medical Group, Oakland, California (Buttlaire); Aldea Children & Family Services, Napa, California (Ahearn, Oglesby); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon); National Association of State Mental Health Program Directors, Alexandria, Virginia (Shern); California Mental Health Services Oversight and Accountability Commission, Sacramento (Ewing); Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento (Niendam)
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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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Hazan H, Ferrara M, Riley S, Li F, Zhou B, Kline E, Gibbs-Dean T, Karmani S, Tayfur SN, Tek C, Keshavan M, Srihari V. The impact of early detection (ED) campaigns on care presentations: Beyond DUP reduction. Schizophr Res 2024; 264:457-461. [PMID: 38266513 PMCID: PMC10923115 DOI: 10.1016/j.schres.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/13/2023] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
We examined the effects of an early detection (ED) campaign (Mindmap), that successfully shortened the duration of untreated psychosis (DUP), on patient presentation profiles at two receiving coordinated specialty care (CSC) services. Data were collected between 2015 and 2019 during a test of ED delivered at one CSC (STEP, n = 147) compared to usual detection at another CSC (PREP, n = 63). Regression models were used to test the effects of ED and DUP on presentation. Before the launch of ED, there were no differences in presentation between STEP and PREP. However, the ED changed the profile of presentations to STEP such that patients were admitted with better negative and total symptoms scores, but worse GAF current and GAF social and with a greater decline in function over the prior year (GAF-Δ). Site-by-time interaction effects were not significant. During the campaign years, STEP vs. PREP recruited patients with better negative and total symptoms, GAF role, and pre-morbid adjustment scores but with worse positive symptoms, GAF current, and GAF-Δ. Nonetheless, mediation analysis revealed that DUP reduction accounted for very little (<8 %) of these differences in presentation. Early detection campaigns while successfully reducing access delays, can have salutary effects on presentation independent of DUP reduction.
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Affiliation(s)
- Hadar Hazan
- Yale Medical School, United States of America.
| | | | - Sarah Riley
- Yale Medical School, United States of America
| | - Fangyong Li
- Yale Center for Analytical Sciences, United States of America
| | - Bin Zhou
- Yale Center for Analytical Sciences, United States of America
| | | | | | | | | | - Cenk Tek
- Yale Medical School, United States of America
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7
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Ghose SS, George P, Goldman HH, Ren W, Zhu X, Dixon LB, Rosenblatt A. Community- and Program-Level Predictors of Funding Streams Used by Coordinated Specialty Care Programs. Psychiatr Serv 2024; 75:155-160. [PMID: 37528699 DOI: 10.1176/appi.ps.20220112] [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: 08/03/2023]
Abstract
OBJECTIVE Although coordinated specialty care (CSC) is an effective service model to address first-episode psychosis, CSC is not widely accessible in the United States, and funding for this service model often remains challenging. The authors examined whether community- or program-level factors predict the use of public and private funding streams in a national sample of 34 CSC programs in 22 U.S. states and territories. METHODS As part of a larger mixed-methods study, CSC program leaders completed a brief questionnaire regarding funding sources. Statistical modeling was used to examine program- and community-level predictors of the use of funding sources. RESULTS Most CSC programs (20 of 34, 59%) reported that Mental Health Block Grant (MHBG) set-aside funds accounted for more than half of their total funding, and 11 of these programs reported that these funds contributed to >75% of their funding. Programs ≤5 years old were more likely to rely on MHBG set-aside funds. Programs in Medicaid expansion states were more likely to rely on Medicaid funding than programs in nonexpansion states. Programs in higher-income service catchment areas used more state funds than did those in lower-income areas, and among programs in lower-income service catchment areas, those that were >4 years old were more likely than those ≤4 years old to rely on state funds other than Medicaid. CONCLUSIONS CSC programs remain largely dependent on MHBG set-aside funding. Some programs have diversified their funding streams, most notably by including more Medicaid and other state funding. A more comprehensive funding approach is needed to reduce reliance on the MHBG set-aside funds.
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Affiliation(s)
- Sushmita Shoma Ghose
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Preethy George
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Howard H Goldman
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Weijia Ren
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Xiaoshu Zhu
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Lisa B Dixon
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
| | - Abram Rosenblatt
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); University of Maryland School of Medicine, Baltimore (Goldman); Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, and New York State Psychiatric Institute, New York City (Dixon). Dr. Dixon is Editor of the journal; Marvin Swartz was decision editor on the manuscript
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Moon KJ, Stephenson S, Hasenstab KA, Sridhar S, Seiber EE, Breitborde NJK, Nawaz S. Policy Complexities in Financing First Episode Psychosis Services: Implementation Realities from a Home Rule State. J Behav Health Serv Res 2024; 51:132-145. [PMID: 38017296 DOI: 10.1007/s11414-023-09865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/30/2023]
Abstract
Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.
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Affiliation(s)
- Kyle J Moon
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Kathryn A Hasenstab
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
| | - Eric E Seiber
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA
| | - Nicholas J K Breitborde
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus, OH, USA
- Department of Psychology, Ohio State University, Columbus, OH, USA
| | - Saira Nawaz
- Center for Health Outcomes and Policy Evaluation Studies, Ohio State University College of Public Health, Columbus, OH, USA.
- Division of Health Services Management and Policy, Ohio State University College of Public Health, Columbus, OH, USA.
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Roy A. Reconceptualizing the Role of the Expert: The Unspoken Hierarchy in Mental Healthcare. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:616-617. [PMID: 37880549 DOI: 10.1007/s40596-023-01891-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Ananya Roy
- Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
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Patel V, Saxena S, Lund C, Kohrt B, Kieling C, Sunkel C, Kola L, Chang O, Charlson F, O'Neill K, Herrman H. Transforming mental health systems globally: principles and policy recommendations. Lancet 2023; 402:656-666. [PMID: 37597892 DOI: 10.1016/s0140-6736(23)00918-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/18/2023] [Accepted: 05/02/2023] [Indexed: 08/21/2023]
Abstract
A burgeoning mental health crisis is emerging globally, regardless of each country's human resources or spending. We argue that effectively responding to this crisis is impeded by the dominant framing of mental ill health through the prism of diagnostic categories, leading to an excessive reliance on interventions that are delivered by specialists; a scarcity of widespread promotive, preventive, and recovery-oriented strategies; and failure to leverage diverse resources within communities. Drawing upon a series of syntheses, we identify five principles to transform current practices; namely, address harmful social environments across the life course, particularly in the early years; ensure that care is not contingent on a categorical diagnosis but aligned with the staging model of mental illness; empower diverse front-line providers to deliver psychosocial interventions; embrace a rights-based approach that seeks to provide alternatives to violence and coercion in care; and centre people with lived experience in all aspects of care. We recommend four policy actions which can transform these principles into reality: a whole of society approach to prevention and care; a redesign of the architecture of care delivery to provide a seamless continuum of care, tailored to the severity of the mental health condition; investing more in what works to enhance the impact and value of the investments; and ensuring accountability through monitoring and acting upon a set of mental health indicators. All these actions are achievable, relying-for the most part-on resources already available to every community and country. What they do require is the acceptance that business as usual will fail and the solutions to transforming mental health-care systems are already present within existing resources.
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Affiliation(s)
- Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Shekhar Saxena
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Crick Lund
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Brandon Kohrt
- Center for Global Mental Health Equity, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Christian Kieling
- School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charlene Sunkel
- Global Mental Health Peer Network, Paarl, Cape Town, South Africa
| | - Lola Kola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Odille Chang
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Fiona Charlson
- School of Public Health, University of Queensland, Herston, QLD, Australia
| | - Kathryn O'Neill
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Helen Herrman
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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11
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Al-Abdulmunem M, Bond GR, Ressler DR, Becker DR, Swanson SJ, Marbacher J. Individual placement and support programmes for young adults: Where are they and whom do they serve? Early Interv Psychiatry 2023; 17:824-836. [PMID: 37211370 PMCID: PMC10524614 DOI: 10.1111/eip.13440] [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: 09/26/2022] [Revised: 02/08/2023] [Accepted: 05/05/2023] [Indexed: 05/23/2023]
Abstract
AIM Individual Placement and Support (IPS), an evidence-based supported employment model developed for adults with serious mental illness, has been recently targeted to young adults with mental health conditions, but little is known about its adoption in this age group in the United States. METHODS We recruited a volunteer sample of nine IPS programmes in five states serving young adults with mental health conditions aged 16 to 24. IPS team leaders reported programme and participant characteristics and rated barriers to employment and education. RESULTS Most IPS programmes were located in community mental health centres, served a small number of young adults, and received most referrals from external sources. The study sample of 111 participants included 53% female, 47% under 21 years old, 60% diagnosed with a depressive disorder; 92% had an employment goal, and 40% had an education goal. IPS specialists reported that managing mental health symptoms was the most common barrier to achieving employment and education goals. CONCLUSION Future research should examine how IPS programmes could best provide services to young adults.
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Affiliation(s)
- Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire, USA
| | - Gary R. Bond
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire, USA
| | - Daniel R. Ressler
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, Lebanon, New Hampshire, USA
| | - Deborah R. Becker
- The IPS Employment Center, Research Foundation for Mental Hygiene, New York, New York, USA
| | - Sarah J. Swanson
- The IPS Employment Center, Research Foundation for Mental Hygiene, New York, New York, USA
| | - Jessica Marbacher
- The IPS Employment Center, Research Foundation for Mental Hygiene, New York, New York, USA
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12
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Ghose SS, George P, Goldman HH, Daley TC, Dixon LB, Ren W, Zhu X, Rosenblatt A. State Mental Health Authority Level of Involvement in Coordinated Specialty Care Clinics and Client Outcomes. Psychiatr Serv 2023; 74:250-256. [PMID: 36128698 DOI: 10.1176/appi.ps.202100676] [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: 11/30/2022]
Abstract
OBJECTIVE State mental health authorities (SMHAs) in all U.S. states and territories administer the Mental Health Block Grant (MHBG) set-aside funding for first-episode psychosis. Funds support implementation of coordinated specialty care (CSC) programs. The authors investigated the relationship between the level of SMHA involvement with CSC programs and clinical outcomes of clients in these programs. METHODS As part of a mixed-methods study of 34 CSC programs, SMHAs from 21 states and one U.S. territory associated with the 34 CSC programs participated in a 1-hour interview (between November 2018 and May 2019) focused on SMHA involvement in administration of MHBG set-aside funds and the SMHA's ongoing relationship with funded CSC programs. SMHA involvement was rated on a scale of 1 to 5, with 5 indicating the highest involvement. Client outcome data were collected at the 34 study sites over an 18-month period. Multilevel random-effect modeling was used, controlling for response propensity (propensity score), client demographic variables, and program-level covariates (i.e., fidelity score, staff turnover rates, service area urbanicity, and number of clients enrolled). RESULTS Clients in CSC programs with SMHAs that were the most involved (level 5) had significantly improved symptoms, social functioning, and role functioning, compared with clients in programs with which SMHAs were least involved (level 1). CONCLUSIONS The findings suggest that increased SMHA involvement in CSC programs is relevant for positive client outcomes. Levels of first-episode psychosis funding doubled in 2021 and 2022, and it is important to identify how SMHAs affect the success of CSC programs and the individuals served.
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Affiliation(s)
- Sushmita Shoma Ghose
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Preethy George
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Howard H Goldman
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Tamara Cohen Daley
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Lisa B Dixon
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Weijia Ren
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Xiaoshu Zhu
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
| | - Abram Rosenblatt
- Westat, Rockville, Maryland (Ghose, George, Ren, Zhu, Rosenblatt); Department of Psychiatry, School of Medicine, University of Maryland, Baltimore (Goldman); Abt Associates, Durham, North Carolina (Daley); New York State Psychiatric Institute and Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York City (Dixon)
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13
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Stefancic A, Rogers RT, Styke S, Xu X, Buchsbaum R, Nossel I, Cabassa LJ, Stroup TS, Kimhy D. Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians. JMIR Ment Health 2022; 9:e41482. [PMID: 36331539 PMCID: PMC9675009 DOI: 10.2196/41482] [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: 08/25/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. OBJECTIVE This qualitative study sought clinicians' input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. METHODS Following the app's initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app's design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. RESULTS The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers' clinical judgment (eg, need for clinically relevant information), and organizations' mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention's scope, concerns regarding dilution of the intervention's core components, and concerns about increasing patient burden while using the app. CONCLUSIONS FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients-the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. TRIAL REGISTRATION ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6.
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Affiliation(s)
- Ana Stefancic
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - R Tyler Rogers
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Sarah Styke
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Xiaoyan Xu
- Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Ilana Nossel
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St Louis, St Louis, MO, United States
| | - T Scott Stroup
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, United States.,Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, New York, NY, United States
| | - David Kimhy
- Department of Psychiatry, Icahn School of Medicine, New York, NY, United States.,New York Mental Illness Research Education and Clinical Center, The James J Peters Veteran's Affairs Medical Center, Bronx, NY, United States
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14
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Dixon L, Goldman H. Getting a Complete Picture of Coordinated Specialty Care for Individuals Experiencing a First-Episode of Psychosis. Community Ment Health J 2022; 58:848-849. [PMID: 35299257 DOI: 10.1007/s10597-022-00960-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Lisa Dixon
- New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, Room 2702, Box 100, New York, NY, 10032, USA.
| | - Howard Goldman
- University of Maryland School of Medicine, Baltimore, USA
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15
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Gur RE. Considering alternatives to the schizophrenia construct. Schizophr Res 2022; 242:49-51. [PMID: 35033392 DOI: 10.1016/j.schres.2021.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, United States of America.
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